1993
Jeffrey Blustein
- No profession has undergone as much scrutiny in the
past several decades as that of medicine. Indeed, one might well argue
that no profession has ever undergone so much change in so short a time.
An essential part of this change has been the growing insistence that
competent, adult patients have the right to decide about the course of
their own medical treatment. However, the familiar and widely accepted
principle of patient self-determination entails a corollary that has
received little attention in the growing literature on the ethics of
physician-patient relations: if patients are to direct the course of
their own medical treatment, then physicians are at least sometimes to be
guided in their actions on behalf of patients by values that are not, and
may even be incompatible with, their own values. Unless it is supposed
that it would be best if physicians were simply to accommodate any and
all patient requests, a possibility I consider and reject in this paper,
there are bound to be numerous instances of legitimate moral conflict
between the preferences of physicians and patients. In this paper, I
examine the implications of this sort of moral conflict from the
standpoint of the integrity of the physician.
Brushwood DB.
Conscientious
objection and abortifacient drugs. Clin Ther 1993 Jan-Feb;15(1):204-12; discussion 168
University of Florida, Gainesville. PMID: 8458050
D.B. Brushwood
Abstract: The legal right to assert a conscientious objection is
reviewed, using as an example the dispensing of abortifacient drugs by
pharmacists. The three areas of law that most significantly concern the
right to assert a conscientious refusal are employment law, conscience
clauses, and religious discrimination law. Each of these is reviewed, with
descriptions of recent cases. It is concluded that employment law protects
refusals that are consistent with public policy, but does not permit an
employee's personal policy to determine how a business will be run; that
conscience clauses appear to provide protection for pharmacists who object
to dispensing abortifacients, but that the precise meanings of critical
words and phrases in some clauses need to be defined; and that even though
laws of religious discrimination require that employers accommodate
religious beliefs, they may not protect a pharmacist who objects to
dispensing abortifacients if the accommodation becomes unreasonably
burdensome.
Leah L. Curtin
- Three critical care nurses in Michigan worked together efficiently as
they resuscitated an irreversibly dying man. All the while, tears ran
down their cheeks. This man had suffered for weeks. He had begged them to
let him die. But there were orders and policies, and ...
A delivery room nurse in California was accused of attempted
manslaughter because she obeyed a "verbal order" to set a severely
deformed neonate aside to die. Others saved the infant who later died of
dehydration and starvation when another physician ordered all
treatment(including food and water) withheld . . .
Curtin LL.
Conscience and clinical care.
Nurs Manage 1993 Aug;24(8):26-8 PMID: 8345933
Leah L. Curtin
- . . . If the state itself does not presume to order the consciences of
Its citizens, how can employers, physicians or hierarchical superiors assume
such authority? For those in positions of power, it Is all too easy to
stifle the criticisms and consciences of subordinates by a summons to
authority - or by an accusation of insubordination. The irony of it is that
whether you succeed or fail in your attempts to force obedience through such
tactics, you will have Jost your most valuable asset - a inan or woman of
Integrity. Within the ethical, professional and legal restraints to which
all of us are subject, we can and must create a system that allows for
respectful dissent and conscientious objection. . .
Daar JF. A clash at the bedside:
patient autonomy v. a physician's professional conscience. Hastings Law J. 1993 Aug;44(6):1241-89. PMID: 11652683
Judith F. Daar
- . . . Judge Belois's holding gave Helga Wanglie the right to demand, and
perhaps implicitly the right to receive, intensive medical treatment that at
least some physicians felt was medically inappropriate. Thus, if Cruzan is
properly pegged as a case about the "right to die," Wanglie surely stands as
a contrasting, yet complimentary case about the "right to live." On a
factual level, Cruzan stands in contrast to Wanglie in that Cruzan's family
sought to withdraw life-sustaining treatment, while the Wanglie family
sought to continue treatment in the face of physician objection. Given this
contrast, at first blush it may appear that the principles that emerged from
the Cruzans' battle for the right to die could not accommodate the dilemma
faced by the Wanglies in their quest for continuation of life. But a closer
look reveals the complimentary nature of these two situations: In both cases
the rights asserted by the patients' families were met with resistance and
ultimate opposition from the health care providers caring for the
incompetent patients. In the end, both courts looked favorably on the
principle of patient self-determination and held that, given a sufficient
level of evidence, patients or their surrogates have the right to direct the
patients' medical care even in the face of physician opposition. . .
U. Hogberg
Eike-Henner Kluge
- Suppose a physician is asked to perform a procedure that has no
recognized medical value and may harm the person who undergoes it.
Suppose that the person requesting it is doing so not on her behalf,
but for her young daughter. How should the physician respond?
The answer is easy. The doctor will probably say that medical
ethics forbids undertaking any procedure that is potentially harmful
and has no therapeutic value.
But suppose that the request is so deeply rooted in the cultural
background of the woman making the request that the mere suggestion
that the procedure is inappropriate would be regarded as a deep insult
to her cultural identity. . .
W. Kymlicka
- Abstract: In this paper, I will express some
reservations about the usefulness of moral philosophy for the analysis of
public policy issues.... My question is whether taking morality seriously
requires taking moral philosophy seriously. This paper focuses on one
particular public policy context -- namely, government commissions into new
reproductive technologies, such as Britain's Warnock Committee, Australia's
Waller and Michael Committees, Canada's Baird Commission, and many
others.... Moral philosophers are sometimes asked to participate in these
commissions, either as Commissioners, staff, or expert advisers. How can
moral philosophers contribute to the analysis of public policy
recommendations on NRTs? A survey of the literature suggests that there are
two main views on this question, one of which is ambitious, the other more
modest. The ambitious view says that moral philosophers should attempt to
persuade Commissioners to adopt the right comprehensive moral theory (e.g.
adopt a deontological theory, rather than utilitarianism or
contractarianism), and then apply this theory to particular policy
questions. The more modest view shies away from promoting a particular moral
theory, given that the relative merits of different moral theories are a
subject of dispute even amongst moral philosophers. Instead, it says that
moral philosophers should attempt to ensure that the Commission's arguments
are clear and consistent. On this view, philosophers should focus on
identifying conceptual confusions or logical inconsistencies within the
Commission's arguments without seeking to influence its choice of the
underlying theory.
R. M. Veatch, C.M. Spicer
- Abstract: Eighteen years after the era of Karen Ann
Quinlan, the debate over futile care has shifted. Now some patients are
asking for treatment that care givers believe to be useless. In virtually
all cases of so-called futile care, the real disagreement is not over
whether a treatment will produce an effect; it is over whether some
agreed-on potential effect is of any value. An obvious reason to resist
providing care believed to be futile is that is appears to consume scarce
resources and therefore burden others. However, for care that affects the
dying trajectory but appears to most of us to offer no benefit, the proper
course is for society--not clinicians--to cut patients off. Under certain
circumstances patients should have the right to receive life-prolonging care
from their clinicians, provided it is equitable funded, even it the
clinicians believe the care is futile and even if it violates their
conscience to provide it. Society is not in a position to override a
competent patient who prefers to live even if life prolongation is
burdensome. For incompetent patients, if a clinician believes a treatment is
actually hurting a patient significantly, he or she may appeal to a court to
have it stopped. A society that forces people to die against their will
produces more offense than one that forces healthcare providers to provide
services that violate their conscience. And medical professionals have a
social contract with society to control the use of medical, life-prolonging
technologies
Lynn D. Wardle
- Abstract: Although the federal government and most
states have enacted laws protecting healthcare providers' rights to refuse
to provide or participate in procedures to which they have moral or
religious objections, most such laws are deficient and many have been met
with hostile judicial interpretations that have diminished their scope and
strength. Deficiencies found in nearly all conscience clause laws include
limitations on the specific conduct or procedures protected, restrictive
definitions of the healthcare providers covered, and inadequate implementing
procedures and remedies. Most conscience clause statutes fail to provide
more than token protection for healthcare providers' rights of conscience.
Increasing duress on healthcare providers who assert rights of conscience
can be expected from three sources. First, some medical schools have
considered refusal to participate as a negative factor in the admission
process. Second, greater financial pressures on the American healthcare
system may cause nonmonetary factors to be sacrificed to the exigencies of
the moment. Third, all healthcare reform plans propose an increase in the
federal government's role in providing healthcare. At present, the only
federal statutory protection for healthcare providers' rights of conscience
covers participants in only a few federal programs, is poorly conceived, and
is sorely inadequate.
Lynn D. Wardle
- A growing number of healthcare practices implicate serious moral concerns
for growing numbers of healthcare providers. Social, legal, and medical
developments, including abortion, contraception, euthanasia, withdrawal of
feeding, blood transfusions, organ transplants, and routine autopsies, have
put healthcare providers in the vortex of some of society's most
controversial moral dilemmas.
Westerholm B, Edgren M. [We are opposing the conscience
clause] Lakartidningen 1993 Sep 29;90(39):3302 (Letter)[Article in
Swedish] PMID: 8412423
B. Westerholm, M. Edgren
K.W. Wildes
- Abstract: Practices such as physician assisted
suicide, even if legal, engender a range of moral conflicts to which many
are oblivious. A recent proposal for physician assisted suicide provides an
example by calling upon physicians opposed to suicide to refer patients to
other, more sympathetic, physicians. However, the proposal does not address
the moral concerns of those physicians for whom such referral would be
morally objectionable.