1999
Benedict S, Kuhla J. West J. Nurses' participation in the
euthanasia programs of Nazi Germany. Nurs Res 1999 Apr;21(2):246-63 (Historical Article) College of
Nursing, Medical University of South Carolina, USA.PMID: 11512180
Susan Benedict, Jochen Kuhla
- During the Nazi era, so-called euthanasia programs were established for
handicapped and mentally ill children and adults. Organized killings of
an estimated 70,000 German citizens took place at killing centers and in
psychiatric institutions. Nurses were active participants; they
intentionally killed more than 10,000 people in these involuntary euthanasia
programs. After the war was over, most of the nurses were never punished
for these crimes against humanity - although some nurses were tried along
with the physicians they assisted. One such trial was of 14 nurses and
was held in Munich in 1965. Although some of these nurses reported that they
struggled with a guilty conscience, others did not see anything wrong
with their actions, and they believed that they were releasing these
patients from their suffering.
Teresa Stanton Collett
- Ask any American lawyer whether there is a duty to represent any
particular person or cause, and I suspect you will get a swift and
emphatic "no."' Give the lawyer a little time for reflection, and he or
she might modify the answer to "well... not unless the court appoints the
lawyer to represent the client." Ask if there are any other
circumstances in which a lawyer may have a moral duty to undertake
representation, and some lawyers will maintain that there is a duty to
represent prospective clients who are too poor to have any other real
options in obtaining legal services. Probe further still, and those well
versed in the literature of professional responsibility may amend their
answers to suggest a duty to represent prospective clients in those cases
where the' lawyer is "the last lawyer in town," and the prospective
client has no other reasonable expectation of obtaining legal
representation.
- Abstract: The potential and actual applications of reproductive
technologies have been reviewed by many governmental committees, and laws
have been enacted in several countries to accommodate, limit and regulate
their use. Regulatory systems have nevertheless left some legal and
ethical issues unresolved, and have caused other issues to arise. Issues
that regulatory systems leave unresolved, or that systems have created,
include disposal of embryos that remain after patients' treatments are
concluded, and multiple implantation and pregnancy. This may result in risks
to maternal, embryonic and neonatal life and health, and the contentious
relief that may be achieved by selective reduction of multiple
pregnancies. A further concern arises when clinics must or choose to
publicize their success rates, and they compete for favorable statistics
by questionable patient selection criteria and treatment priorities.
Stephanie E. Harvey, Ei-Lun Lu, Oscar Rivas, Julie Rodgers
- Introduction: The purpose of this article is to discuss legal and ethical issues regarding the pharmacist's right to refuse to dispense
based on personal beliefs. Five ethical principles - nonmaleficence, beneficence, autonomy, loyalty, and justice are used to deliberate the issue. Legal facts are used to clarify the position that pharmacists may
find themselves in should the decision to refuse to dispense be made. It is imperative that pharmacists assume responsibility for reducing the severity of the implications of this issue by taking a proactive
approach in considering the impact of these and other moral dilemmas before they are presented in the workplace. The recommendation is made that each state, employer, pharmaceutical organization, and individual
pharmacist develop, communicate, and implement a conscience clause that protects the pharmacist's rights without denying the patient access to treatment. A conscience clause is a declaration of conscientious
objection to an issue. It explains the position a person, organization, or entity takes on a specific moral issue. The conscience clause can be used as an opening for discussion between all relevant parties. These
measures are intended to limit problems that may arise by minimizing conflict in the workplace and preventing legal battles in the courtroom while providing outstanding patient care.
. .
H.A. Monsanto, S.M. Fabregas, A.E. Velez
- Objective: To determine the number of professional associations and boards of
pharmacy in the United States that have adopted or are considering to adopt
a conscience clause as part of their codes of ethics, rules, laws or
regulations.
Background: Pharmacists are often exposed to ethical dilemmas in their day-to-day
practice and their response depends on a number of factors, including the
personal beliefs and values of those involved. This has lead some
professional associations to address whether their members have the right to
refuse to participate in procedures which are contrary to their conscience
or moral convictions. The outcome of these discussions is usually the
development and adoption of a conscience clause.
Methods: A one-page self-administered questionnaire was sent by Fax to the highest
ranking officer of 108 pharmacy organizations in the United States.
Results: Thirty-five completed questionnaires were received for a 32.4% response
rate. In general, it was found that there is a lack of knowledge as to what
a conscience clause is. Only two state associations and one board of
pharmacy responded that they have a conscience clause as part of their code
of ethics or regulations. Reasons given for not having a conscience clause
included lack of interest and low priority. Nevertheless, four state
associations, one national association and one board of pharmacy responded
that they are considering developing a pharmacist conscience clause. More
professional associations than boards of pharmacy expressed interest to
obtain information about conscience clauses.
Conclusion: Although many state associations and boards of pharmacy that responded do
not have a conscience clause as part of their codes of ethics, laws or
regulations, this survey shows an increasing interest to learn about it.
This is expected as the pharmacist assumes increasing responsibility in
patient care.
Ridley DT
Jehovah's Witnesses' refusal of blood: obedience to
scripture and religious conscience. Med Ethics 1999 Dec;25(6):469-72 [Comment in: J Med Ethics. 1999
Dec;25(6):463-8; J Med Ethics. 2000 Oct;26(5):375-80; J Med Ethics. 2000
Oct;26(5):381-6] PMID:
10635500
Donald T. Ridley
- Jehovah's Witnesses are students of the Bible. They refuse
transfusions out of obedience to the scriptural directive to abstain and
keep from blood. Dr Muramoto disagrees with the Witnesses' religious
beliefs in this regard. Despite this basic disagreement over the meaning
of Biblical texts, Muramoto flouts the religious basis for the
Witnesses'position. His proposed policy change about accepting
transfusions in private not only conflicts with the Witnesses'
fundamental beliefs but it promotes hypocrisy. In addition, Muramoto's
arguments about pressure to conform and coerced disclosure of private
information misrepresent the beliefs and practices ofJehovah's
Witnesses and ignore the element of individual conscience. In short,
Muramoto resorts to distortion and uncorroborated assertions in his
effort to portray a matter of religious faith as a matter of medical
ethical debate.
Thatcher C. Conscience clause: moral compromise.
CPJ. Canadian Pharmaceutical Journal 132.7 (Sep 1999): 10-11
Chris Thatcher
- Abstract: Conscience clauses are not new, but the idea
gained prominence in California in 1996 when the state pharmacy
association passed a policy to recognize pharmacists' rights of conscience
and guaranteed that the association would protect those who objected to
the performance of any act on ethical, moral or religious grounds. In a
1997 article for The California Pharmacist, Richard Abood and David
Brushwood, both pharmacy law and ethics professors, made the case that
conscientious objection does have its limits. "The patient's right to
receive medication is worthy of as much respect as is the pharmacist's
rights of conscience...It is improper to assert conscientious objection
to deny therapy to a patient. Conscientious objection is not a 'trump
card' that automatically defeats all other interests." When the
morning-after-pill came on market, the Washington State Pharmacists
Association avoided a conscience clause by conducting an exhaustive
education campaign. In over 50 training sessions, it spelled out what the
pill actually does and what the pharmacist's responsibilities are; "that
resulted in virtually no opposition to providing the service and no
organized movement to impose a conscience clause," said Don Downing,
pharmaceutical care coordinator. Pharmacists may refuse, he said, but they
must refer the patient. Downing also raised the always present issue of
legal liability. "If you deny the only option available to that woman, and
it's a recognized standard of care, you have some risk exposure that you'll
have to live with and it may not be very nice."
Katherine A. White
- In this note, Katherine A. White explores the conflict between religious
health care providers who provide care in accordance with their religious
beliefs and the patients who want access to medical care that these
religious providers find objectionable. Specifically, she examines Roman
Catholic health care institutions and HMOs that follow the Ethical and
Religious Directives for Catholic Health Care Services and considers other
religious providers with similar beliefs. In accordance with the Directives,
these institutions maintain policies that restrict access to "sensitive"
services like abortion, family plan- ning, HIV counseling, infertility
treatment, and termination of life-support. White explains how most state
laws protecting providers' right to refuse treatments in conflict with
religious principles do not cover this wide range of services.
Furthermore, many state and federal laws and some court decisions guarantee
patients the right to receive this care. The constitutional complication
inherent in this provider-patient conflict emerges in White's analysis of
the interaction of the Free Exercise and Establishment Clauses of the First
Amendment and patients' right to privacy. White concludes her note by exploring the success of both provider-initiated and legislatively mandated
compromise strategies. She first describes the strategies adopted by four
different religious HMOs which vary in how they increase or restrict access
to sensitive services. She then turns her focus to state and federal "bypass"
legislation, ultimately concluding that increased state supervision might
help these laws become more viable solutions to provider-patient
conflicts.