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Notes toward an understanding of freedom of conscience
| . . .Discussion has not gone deep enough to address underlying disagreements about the nature of the human person that shape disputes about freedom of conscience. . .
| Ethical differences between one theory of bioethics and another may be quite as dramatic as doctrinal differences between religions, though, like religions, there are also similarities. Problems for ethical minorities arise when one version of bioethics becomes predominant, and its practitioners attain positions of influence and power in government, academic and professional circles. . .
Clearing Rhetorical Minefields
| Progress towards understanding the importance of freedom of conscience for health care workers is not infrequently hindered by rhetorical minefields . . .What follows is an attempt to clarify some of the points of dispute and identify key issues. It introduces the term "embryocide" and specifies the meaning of "abortifacient" and "contraceptive" based upon what is common to parties who hold contrary views about abortion and contraception. . .
The Problem of Complicity
| It appears that most people are willing to grant that a health care worker who has serious moral objections to a procedure should not be compelled to perform it or assist directly with it. However, many people find it more difficult to understand why some health care workers object to even indirect forms of involvement: why they might refuse to help patients obtain a morally controversial service or procedure by referring them to a more willing colleague. . .
Referral: A False Compromise
| The notion that referral is an acceptable compromise may presume that moral culpability attaches only to direct participation in X, and not to facilitating the provision of X by someone else. This presumption contradicts important religious and moral traditions that hold that we may be morally responsible for the actions of someone else. . .
Rounding the Horn with the Principle of Double Effect
| . . . The audience finds British Captain Jack (Lucky Jack) Aubrey and the crew of his man o'war on the north coast of Brazil, hunting the French privateer Acheron. The film follows the hunt down the east coast of South America, around Cape Horn and into the Pacific. . .It is remarkable to find a principle that is sometimes mocked as ethical sleight-of-hand so vividly illustrated by acting, music and script in a popular film. . .
"Take two aspirin and call me after the election"
Responding to Charo RA.
Warning: Contraceptive Drugs May Cause Political Headaches
, N Engl J Med. 2012 Mar 14
| "Take two aspirin and call me after the election" is the kind of advice one would expect from former members of President Obama's transition and HHS review teams in response to protests about the HHS birth control mandate, so the closing words of Professor R. Alta Charo in her NEJM
column are not unexpected. . .
Telephone installation, lethal injection and conscientious objection in pharmacy
Responding to Archer F. "Religious Conscience Should not Outweigh Professional Obligations to Patients."
(Holy Post BLOG),18 July, 2010.
| . . .Mr. Archer's comparison of pharmacy services to telephone service is also unsatisfactory because it presumes that all pharmacy services are morally equivalent to telephone service; that, for example, no moral or ethical questions are raised by the assertion that pharmacists are obliged to provide abortifacients and embryocides, and may eventually be required to provide drugs for suicide, euthanasia and executions.. . .
Conscientious Objection: Resisting Ethical Aggression in Medicine
Responding to Cantor JD.
Conscientious Objection Gone Awry - Restoring Selfless Professionalism in Medicine.
N Eng J Med 360;15, 9 April, 2009
| Judging from the title of her article, Professor Julie D. Cantor believes that "selfless professionalism" in medicine is being destroyed by health care workers who will not do what they believe to be wrong. She also implies that Americans have access to health care only because health care workers are compelled to provide services that they find morally repugnant . . .Such anxiety is inconsistent with the fact that religious believers and organizations have been providing health care in the United States for generations. . . .
To Market, To Market
Responding to Vischer, Robert,
The Pharmacist Wars
The American Enterprise Online, 14 February, 2006
| . . . It is remarkable that a free-market advocate should assign the state the function of ensuring access to a product - an economic function admirably achieved by free markets - while denying the state a role in the preservation of fundamental freedoms - a political function for which it exists. Happily, it is possible to resolve this contradiction, restoring to the market and to the state the functions proper to each, and to do so in a way that may prove congenial to Professor Vischer.. . .
Full Text (Legal Commentary)
The Silence of Good People and Non-cooperation with Evil
Responding to: Charo RA.
The Celestial Fire of Conscience - Refusing to Deliver Medical Care
N Eng J Med 352:24, June 16, 2005
| It is especially noteworthy that, in an essay about the exercise of freedom of conscience by health care workers, Professor R. Alta Charo has virtually nothing to say about freedom or conscience. "Conscience clauses," yes: conscientious objection, to be sure: and she mentions acts of conscience and the right of conscience. But nothing about freedom, and, on the subject of conscience itself, the most she can muster is, "Conscience is a tricky business." . . .
Service or Servitude: Reflections on Freedom of Conscience for Health Care Workers
Responding to Cantor J, Baum K.
, The Limits of Conscientious Objection - May Pharmacists Refuse to Fill Prescriptions for Emergency Contraception?
N Eng J Med 351;19, November 4, 2004
| . . .As the exercise of freedom of speech does not force others to agree with the speaker, the exercise of freedom of conscience does not force others to agree with an objector. Concerns about access to legal services or products can be addressed by dialogue, prudent planning, and the exercise of tolerance, imagination and political will. A proportionate investment in freedom of conscience for health care workers is surely not an unreasonable expectation. . .
Postscript for the Journal of Obstetrics and Gynaecology Canada:
vs. Professors Cook and Dickens
Responding to Cook RJ, Dickens BM, "In Response". J.Obstet Gyanecol Can 2004; 26(2)112; Cook RJ, Dickens BM, Access to emergency contraception [letter] J.Obstet Gynaecol Can 2004; 26(8):706.
| . . . the arguments of Professors Cook and Dickens for mandatory referral are unsupported and even contradicted by their own legal and ethical references. Regulatory officials with the power to enforce the views of Cook and Dickens are unlikely to discover this in the pages of the
, since, by editorial fiat, the discussion was terminated with the publication of their 'final word' on the subject. Here, then, is the postscript to the discussion, supplemented by developments in the United Kingdom and Belgium that have a bearing on the issue. . .
Full Text (Legal Commentary)
In Defence of the New Heretics: A Response to Frank Archer
Responding to Archer F.
Emergency Contraceptives and Professional Ethics
Canadian Pharmaceutical Journal, May 2000, Vol. 133, No. 4, p. 22-26
| Before taking action that they may later regret, those who would coerce or discriminate against conscientious objectors, or drive them from the practice of pharmacy, would do well to revisit Frank Archer's critical review . . . Although many pharmacists have accepted the review as a definitive ethical statement, it is insufficient warrant for repression of freedom of conscience within the profession.
Abortion and Prince Edward Island: Group encourages complaints against objecting physicians
(Canada: November, 2011)
| . . .The attempt to characterize the exercise of freedom of conscience by physicians as 'professional misconduct' may surprise Islanders who remember the promises made when abortion was legalized in Canada over forty years ago. . .
Clarifying the Clarification:
College of Physicians and Surgeons of Saskatchewan
Guideline on Unplanned Pregnancy
(Canada: February, 2011)
| . . . physicians who object to abortion for reasons of conscience - whether globally or, like Dr. Morgentaler, selectively - can hardly be disciplined for failing to adhere to ambiguous directives or guidelines.
Bishop protests on behalf of nurses
(Thunder Bay, Ontario, Canada:1997)
| . . . Perhaps the most interesting aspect of the Thunder Bay controversy was the case of the single nurse . . . who had been a peri-operative nurse for eleven years, [who]suffered such intense "physical and emotional anxiety" as a result of her exposure to abortions . . .that she was referred to the Employee Assistance programme. . .
The Case of the Disappearing Plaintiffs:
vs. State of Montana
(Montana, USA: 2008-2009)
| . . . Janet Murdock lived in Missoula with the four physicians, who, citing their "professional obligation to relieve suffering," convinced a judge to legalize assisted suicide in Montana. Where were they in Janet Murdock's 'hour of need'? . . .
Belgium: mandatory referral for euthanasia
|. . .The Flemish Palliative Care Federation is silent on the issue of referral, but the joint statement asserts that an objecting physician must not only give patients timely notice of his position, but must "organise a smooth referral." At another point the joint statement insists that an objecting physician work together with the patient to find a willing colleague. . .
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