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