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Protection of Conscience Project

Service, not Servitude
Periodicals & Papers


Barousse AP.[Conscience objection]Medicina (B Aires) 2000;60(6):983-4 (Editorial) [Article in Spanish] PMID: 11436714


Bellandi D, Thompson E. Matters of principle. AMA favors reproductive rights access but says providers can't be forced to violate conscience. Mod Healthc. 2000 Jun 19;30(25):6, 14. PubMed PMID: 11183512.

Deanna Bellandi, Elizabeth Thompson

  • After Roman Catholic leaders issued strong criticism about its trampling of religious freedom, the American Medical Association approved a watered-down measure supporting continued community access to a full range of reproductive services following hospital consolidations. . .

Bowman KW, Hui EC. Bioethics for clinicians: 20. Chinese bioethics.CMAJ  Nov. 28, 2000; 163 (11): 1481

Kerry W. Bowman, Edwin C. Hui

  • Abstract:  Chines Canadians form one of the largest groups in the Canadian cultural mosaic. Many of the assumptions implicit in a Western autonomy-based approach to bioethical deliberation may not be shared by Chinese Canadians. In traditional Chinese culture, greater social and moral meaning rests in the interdependence of family and community, which overrides self-determination. Consequently, many Chinese may vest in family members the right to receive and disclose information, to make decisions and to organize patient care. Furthermore, interactions between Chinese patients and health care workers may be affected by important differences in values and goals and in the perception of the nature and meaning of illness. Acknowledging and negotiating these differences can lead to considerable improvement in communication and in the quality of care.

Curtin LL. The first ten principles for the ethical administration of nursing services. Nurs Adm Q. 2000 Fall;25(1):7-13. PubMed PMID: 18188901.

Leah Curtin

  • At the dawn of the 20th century, postmodern academics stressed the cultural differences among human beings. Philosophers predicated differing value systems based on these cultural differences, and conflicts have arisen among those who hold distinctly different religious traditions. Many people believe there can be no universal system to explain reality and thus form the basis for norms in human behavior. However, at the close of the 20th century scientists and philosophers had come full circle: physics quite literally became metaphysics, and ethical systems made sense. Rush Kidder interviewed two dozen "men and women of good conscience" from around the world and asked them if there is a single set of values that wise people use to make decisions. They answered with a resounding YES! Thus, in addition to the customary principles of beneficence, nonmalfeasance, honesty, and so forth, the author proposes a set of ethical principles based on those universal values, adapted to fit nursing administrators' dual responsibilities. Ethical decision making and behavior, the author contends, help to reconcile perspectives and interests and to keep values and mission uppermost in one's mind. In the process, ethical behavior establishes long-term relations of trust and cooperation, which in turn promote consistency and stability in an unstable world.

Dickens BM, Cook RJ. The scope and limits of conscientious objection. Int J Gynaecol Obstet. 2000 Oct;71(1):71-7. Review. PubMed PMID: 11044548.

Bernard M. Dickens, Rebecca J. Cook

  • Abstract:  Principles of religious freedom protect physicians, nurses and others who refuse participation in medical procedures to which they hold conscientious objections. However, they cannot decline participation in procedures to save life or continuing health. Physicians who refuse to perform procedures on religious grounds must refer their patients to non-objecting practitioners. When physicians refuse to accept applicants as patients for procedures to which they object, governmental healthcare administrators must ensure that non-objecting providers are reasonably accessible. Nurses' conscientious objections to participate directly in procedures they find religiously offensive should be accommodated, but nurses cannot object to giving patients indirect aid. Medical and nursing students cannot object to be educated about procedures in which they would not participate, but may object to having to perform them under supervision. Hospitals cannot usually claim an institutional conscientious objection, nor discriminate against potential staff applicants who would not object to participation in particular procedures

Elder L. Why some Jehovah's Witnesses accept blood and conscientiously reject official Watchtower Society blood policy. J Med Ethics. 2000 Oct;26(5):375-80. PubMed PMID: 11055042; PubMed Central PMCID: PMC1733296.

Lee Elder

  • In their responses to Dr Osamu Muramoto (hereafter Muramoto) Watchtower Society (hereafter WTS) spokesmen David Malyon and Donald Ridley (hereafter Malyon and Ridley), deny many of the criticisms levelled against the WTS by Muramoto. In this paper I argue as a Jehovah 's Witness (hereafter JW) and on behalf of the members ofAJWRB that there is no biblical basis for the WTS's partial ban on blood and that this dissenting theological view should be made clear to all JW patients who reject blood on religious grounds. Such patients should be guaranteed confidentiality should they accept whole blood or components that are banned by the WTS. I argue against Malyon's and Ridley's claim that WTS policy allows freedom of conscience to individual JWs and that it is non-coercive and non-punitive in dealing with conscientious dissent and I challenge the notion that there is monolithic support of the WTS blood policy among those who identify themselves as JWs and carry the WTS "advance directive."

Gendel J. Pharmacists' right to conscientious objection: the debate over Preven. J Gend Specif Med. 2000 May-Jun;3(4):43-6. PubMed PMID: 11253229.


Groenewoud JH, van der Heide A, Onwuteaka-Philipsen BD, Willems DL, van der Maas PJ, van der Wal G.  Clinical Problems with the Performance of Euthanasia and Physician-Assisted Suicide in the Netherlands.  N Engl J Med 2000; 342:551-556 February 24, 2000 DOI:10.1056/NEJM200002243420805

  • Conclusions: There may be clinical problems with the performance of euthanasia and physician-assisted suicide. In the Netherlands, physicians who intend to provide assistance with suicide sometimes end up administering a lethal medication themselves because of the patient’s inability to take the medication or because of problems with the completion of physician-assisted suicide.

Hanlon TR, Weiss MC, Rees J. British community pharmacists' views of physician-assisted suicide (PAS). J Med Ethics. 2000 Oct;26(5):363-9. PubMed PMID: 11055040; PubMed Central PMCID: PMC1733280.

Timothy R. G. Hanlon, Marjorie C. Weiss, Judith Rees

  • Objectives - To explore British community pharmacists' views on PAS , including professional responsibility, personal beliefs, changes in law and ethical guidance.

Design - Postal questionnaire

Setting - Great Britain

Subjects - A random sample of 320 registered full-time community pharmacists

Results - The survey yielded a response rate of 56%. The results showed that 70% of pharmacists agreed that it was a patient's right to choose to die, with 57% and 45% agreeing that it was the patient's right to involve his/her doctor in the process and to use prescription medicines, respectively. Forty-nine per cent said that they would knowingly dispense a prescription for use in PAS were it to be legalised and 54% believed it correct to refuse to dispense such a prescription. Although 53% believed it to be their right to know when they were being involved in PAS, 28% did not. Most pharmacists (90%) said that they would wish to see the inclusion of a practice protocol for PAS in the code of ethics of the Royal Pharmaceutical Society of Great Britain (CE-RPSGB) in the event of a change in the law on PAS. In addition, 89% would wish to see PAS included in the Conscience Clause of the CE-RPSGB. Males were found to be significantly less likely to favour PAS than females (p<0.05), as were those declaring an ethnic/religious background of consideration when dealing with ethical issues in practice compared with their counterparts (p<0.00005).

Conclusion - Pharmacists view their professional responsibility in PAS to be more obligatory than a physician's, in having to provide the means for PAS. It is worrying that a proportion of the respondents prefer to remain in ignorance of the true purpose of a prescription for PAS; a finding at odds with current developments within the pharmaceutical profession.A practice protocol for PAS and an extension of the conscience clause should be considered in the event of PAS becoming legal. Such measures would allow the efficient provision of the pharmaceutical service whilst at the same respecting the personal beliefs of those who object to cooperating in the ending of a life.

Howes J, Bass M. Emergency contraception and conscience clauses. J Gend Specif Med. 2000 May-Jun;3(4):27-8. PubMed PMID: 11253225.


John Paul II.  The medical doctor should respond as a conscientious objector to legislation in favour of the crimes of abortion and euthanasia. Dolentium Hominum 2000;15(3):133-5 (Lecture) PMID: 11764801


Larimore W.  "Growing Debate About the Abortifacient Effect of the Birth Control Pill and the Principle of Double Effect." 16 Ethics & Med. 23 (2000).


Sacchini D, Antico L. The professional autonomy of the medical doctor in Italy. Theor Med Bioeth. 2000;21(5):441-56. Review. PubMed PMID: 11142441.

Dario Sacchini, Leonardo Antico

  • Abstract: This contribution deals with the issue of the professional autonomy of the medical doctor. Worldwide, the physician's autonomy is guaranteed and limited, first of all, by Codes of Medical Ethics. In Italy, the latest version of the national Code of Medical Ethics (Code 1998) was published in 1998 by the Federation of provincial Medical Associations (FNOMCEO). The Code 1998 acknowledges the physician's autonomy regarding the scheduling, the choice and application of diagnostic and therapeutic means, within the principles of professional responsibility. This responsibility has to make reference to the following fundamental ethical principles: (1) the protection of human life; (2) the protection of the physical and psychological health of the human being; (3) the relief from pain; (4) the respect for the freedom and the dignity of the human person, without discrimination; (5) an up-to-date scientific qualification (Art. 5). The authors underline that autonomy is an anthropological – and consequently ethical – characteristic of the human person. Different positions on autonomy in bioethics (individualistic, evolutionistic, utilitarian and personalistic models) are explained. The relation between the professional autonomy of the physician and the autonomy of the patient and of colleagues is discussed. In fact, the medical doctor is obliged: (1) to respect the fundamental rights of the person, first of all his/her life; (2) to ensure the continuity of the care, even if he can only relieve the patient's suffering; (3) to maintain, except under certain circumstances, professional secrecy and confidentiality regarding patients and their medical records. Moreover, the physician cannot deny the patient correct and appropriate information. He/she should not perform any diagnostic or therapeutic activity without the informed consent of the patient and the medical doctor must give up medical treatment in case of documented refusal of the individual. Furthermore, the medical doctor has the right to raise conscientious objections if he/she is requested to perform medical actions that are contrary to his/her conscience or medical opinion, unless this attitude would seriously and immediately harm the patient. Regarding the relationships with colleagues, the physician is obliged to solidarity, mutual respect, and care of sick colleagues. Finally, the authors discuss the Italian legislation affecting the physician's professional autonomy: (1) the SSN health care Acts; (2) the socalled Charter for Public Health Care Services; (3) the Acts on privacy; (4) Good Clinical Practice.

Smugar SS, Spina BJ, Merz JF. Informed consent for emergency contraception: variability in hospital care of rape victims. Am J Public Health. 2000 Sep;90(9):1372-6. PubMed PMID: 10983186; PubMed Central PMCID: PMC1447633.

Steven S. Smugar, Bernadette J. Spina. BA, Jon F. Merz

  • There is growing concern that rape victims are not provided with emergency contraceptives in many hospital emergency rooms, particularly in Catholic hospitals. In a small pilot study, we examined policies and practices relating to providing information, prescriptions, and pregnancy prophylaxis in emergency rooms. We held structured telephone interviews with emergency department personnel in 58 large urban hospitals, including 28 Catholic hospitals from across the United States. Our results showed that some Catholic hospitals have policies that prohihit the discussion of emergency contraceptives with rape victims, and in some of these hospitals, a victim would learn about the treatment only by asking. Such policies and practices are contrary to Catholic teaching. More seriously, they undermine a victim's right to information about her treatment options and jeopardize physicians' fiduciairy responsibility to act in their patients' best interests. We suggest that institutions must reevaluate their restrictive policies. If they fail to do so, we believe that state legislation requiring hospitals to meet the standard of care for treatment of rape victims is appropriate.

Sullivan WM. Medicine under threat: professionalism and professional identity. CMAJ 2000;162(5):673-5

William M. Sullivan

  • The professions have never been more important to the well-being of society. Professional knowledge and expertise are at the core of contemporary society. How such professional expertise is developed, how it is deployed, by whom it is deployed and for what ends are among the most pressing issues facing all modern nations. At the same time, many of the most distinctive features of the professions, especially their privileges of self-regulation and self-policing, are being curtailed. This is true even in countries such as Britain, the United States and Canada, where professions have historically been most autonomous and enjoyed the greatest social prestige. . .

Wicclair MR. Conscientious objection in medicine. Bioethics. 2000 Jul;14(3):205-27. PubMed PMID: 11658133.

Mark R. Wicclair

  • Abstract: Recognition of conscientious objection seems reasonable in relation to controversial and contentious issues, such as physician assisted suicide and abortion. However, physicians also advance conscience-based objections to actions and practices that are sanctioned by established norms of medical ethics, and an account of their moral force can be more elusive in such contexts. Several possible ethical justifications for recognizing appeals to conscience in medicine are exammed, and it is argued that the most promising one is respect for moral integrity. It is also argued that an appeal to conscience has significant moral weight only if the core ethical values on which it is based correspond to one or more core values in medicine. Finally, several guidelines pertaining to appeals to conscience and their ethical evaluation are presented.

Wunder M. Medicine and conscience: the debate on medical ethics and research in Germany 50 years after Nuremberg. Perspect Biol Med. 2000 Spring;43(3):373-81. PubMed PMID: 10893726.

Michael Wunder

  • "The question is whether we will ever be able to learn from history," Alexander Mitscherlich said in 1947. He was a member of the German Medical Commission, who by order of the German General Medical Council witnessed the Nuremberg Trial. "I believe," Mitscherlich continued, "that we won't master it by just keeping our distance morally. This is doubtless easy to achieve. However, it is useless for us as soon as we think of the dark future of this century, in which situations might occur leading to a similar coldness and ignorance towards the right to live of people more defenseless and disregarded." . . .