William W. Basset
- Abstract: Contemporary managed care imperatives have
severely limited an individual's right to make free and informed choices
regarding his or her own health care. The author posits that legislation
allowing private, religiously affiliated hospitals to refuse patient
requests for legitimate health care services - particularly reproductive
medicine - must be reconsidered.
Ethical exemptions allowing religious hospitals to refuse sensitive
and controversial medical services such as abortion, sterilization and
prescription of contraceptive drugs, AIDS counseling, and fertilization
are virtually unlimited. However, these institutional privileges cannot
remain absolute. Private hospital exemptions should be re-written, with
clear limitations conditioned upon newly evolving public policy
imperatives for informed choice in comprehensive patient health care
plans.
Marianne Daverschot, Hugo Van Der Wal
- Introduction: In the autumn of 2000, opposing
views on euthanasia and physician-assisted suicide clearly came to light
when members of the Second Chamber of the Dutch Parliament discussed the
new euthanasia Bill, titled `Review Procedures For The Termination Of
Life On Request And Assisted Suicide. . .
de Kantor IN. [Conscience objection]. Medicina (B Aires).
2001;61(1):115. Spanish. PubMed PMID: 11265614.
Bernard M. Dickens
- Abstract: Reproductive health services address
contraception, sterilization and abortion, and new technologies such as
gamete selection and manipulation, in vitro fertilization and surrogate
motherhood. Artificial fertility control and medically assisted
reproduction are opposed by conservative religions and philosophies,
whose adherents may object to participation. Physicians' conscientious
objection to non-lifesaving interventions in pregnancy have long been
accepted. Nurses' claims are less recognized, allowing nonparticipation
in abortions but not refusal of patient preparation and aftercare.
Objections of others in health-related activities, such as serving meals
to abortion patients and typing abortion referral letters, have been
disallowed. Pharmacists may claim refusal rights over fulfilling
prescriptions for emergency (post-coital) contraceptives and drugs for
medical (i.e. non-surgical) abortion. This paper addresses limits to
conscientious objection to participation in reproductive health
services, and conditions to which rights of objection may be subject.
Individuals have human rights to freedom of religious conscience, but
institutions, as artificial legal persons, may not claim this right.
Jeffrey P. Kahn, Anna C. Mastroianni
- The ethics of clinical research are long-standing; researchers
confronted ethical issues long before the implementation of federal
oversight and regulations and continue to be challenged by the sometimes
fuzzy distinctions between ethically acceptable and ethically
unacceptable research. New technologies (gene therapy, stem cell
transplants, and bioartificial organs, to name a few) raise new ethical
issues, but at the same time, so many of the issues that researchers
must deal with are recurring. This is a time not only of great
opportunity and promise for the pursuit of biomedical research, but also
of great responsibility.
Kissling F.
The place for individual conscience. J Med
Ethics. 2001 Oct;27 Suppl 2:ii24-7. PubMed PMID: 11574655; PubMed
Central PMCID: PMC1765545.
Frances Kissling
- Abstract: From a liberationist, feminist, and Catholic point of view, this
article attempts to understand the decision of abortion. People are
constantly testing their principles and values against the question
of abortion. Advances in technology, the rise of communitarianism and
the rejection of individualism, and the commodification of
children are factors in the way in which the abortion debate is being
constructed in society. The paper offers solutions to end the
ugliness of the abortion debate by suggesting that we would be able
to progress further on the issue of abortion if we looked for the
good in the opposing viewpoint. The article continues with a
discussion of Catholics For a Free Choice's position on abortion, and
notes firstly that there is no firm position within the Catholic
Church on when the fetus becomes a person; secondly that the
principle of probablism in Roman Catholicism holds that where the
church cannot speak definitively on a matter of fact (in this
case, on the personhood of the fetus), the consciences of individual
Catholics must be primary and respected, and thirdly that the
absolute prohibition on abortion by the church is not infallible. In
conclusion, only the woman herself can make the abortion decision.
Lejarraga H. [Conscience objection]. Medicina (B Aires).
2001;61(3):377-8. Spanish. PubMed PMID: 11474892.
May T. Rights of conscience in health care. Soc Theory
Pract. 2001 Jan;27(1):111-28. PubMed PMID: 12564446.
Thomas May
- Professional life in a liberal constitutional society involves a
balancing of values between professional and client. While this is
most commonly accomplished through negotiation, in some areas of life
the values in question are so fundamental and important that
negotiated compromise is difficult, if not impossible. This is
especially true in health care, where the values at stake are
attached to issues of life and death, and the fundamental capacities
and abilities that give meaning to people's lives. Because health
care touches upon profound issues of life, death and quality of life,
the practice of health care can at times call for participation in
activities that some health care professionals might find morally
inappropriate. Requests for physician-assisted suicide, abortion,
euthanasia, and the withdrawal or withholding of life support are
just a few examples of controversial issues that leave little room
for conqjromise. . .
K.A. Puntillo, P. Benner, T. Drought, B. Drew, N. Stotts, D.
Stannard, C. Rushton, C. Scanlon, C. White
- Objective: To investigate the knowledge, beliefs, and ethical
concerns of nurses caring for patients dying in intensive care units.
Methods: A survey was mailed to 3000 members of the American
Association of Critical-Care Nurses. The survey contained various
scenarios depicting end-of-life actions for patients: pain management,
withholding or withdrawing life support, assisted suicide, and voluntary
and nonvoluntary euthanasia.
Results: Most of the respondents (N = 906) correctly identified the
distinctions among the end-of-life actions depicted in the scenarios.
Almost all (99%-100%) agreed with the actions of pain management and
withholding or withdrawing life support. A total of 83% disagreed with
assisted suicide, 95% disagreed with voluntary euthanasia, and 89% to
98% disagreed with nonvoluntary euthanasia. Most (78%) thought that
dying patients frequently (31%) or sometimes (47%) received inadequate
pain medicine, and almost all agreed with the double-effect principle.
Communication between nurses and physicians was generally effective, but
unit-level conferences that focused on grief counseling and debriefing
staff rarely (38%) or never (49%) occurred. Among the respondents, 37%
had been asked to assist in hastening a patient's death. Although 59%
reported that they seldom acted against their consciences in caring for
dying patients, 34% indicated that they sometimes had acted against
their conscience, and 6% had done so to a great extent.
Conclusions: Intensive care unit nurses strongly support good pain
management for dying patients and withholding or withdrawing
life-sustaining therapies to allow unavoidable death. The vast majority
oppose assisted suicide and euthanasia. Wider professional and public
dialogue on end-of-life care in intensive care units is warranted.
Monica Sloboda
- Introduction: Increasingly, public and
privately-owned hospitals are merging with religious health care
systems, which are often Catholic. Many hospitals experiencing
financial troubles assert that merging with a religious health care
system is the only way to stay in business. However, the
nonfinancial cost for saving a hospital in this manner may be severe.
Such mergers may reduce or eliminate women's health services in the
affected communities, especially abortion. contraception, sterilization,
infertility services, and emergency contraception for rape survivors.
The women most affected by these cutbacks are low-income and minority
women, particularly those living in rural areas, because these women
have fewer health care options. This essay will provide a brief
overview of the growing trend of these hospital mergers, the
resulting loss of women's health services,' and the various legal and
grass-roots methods that activists have employed to preserve full
access to women's health services.
Aaron Spital
- Abstract: Despite nearly 50 years of experience with living kidney donation,
ethical questions about this practice continue to haunt us today. In
this editorial I will address two of them: (1) Given the possibility of
limited understanding and coercion, how can we be sure that a person
who offers to donate an organ is acting autonomously? and (2) Do
people have a right to donate? The universal requirement for informed
consent is the traditional method for ensuring that a person is
acting autonomously. But, while obtaining fully informed consent is
desirable, it may not always be achievable or necessary. When the
recipient is very dear to the potential donor, the donor may base his
decision primarily on care and concern rather than on a careful weighing
of risks and benefits. I will argue that consent that emanates from
such deep affection should be considered just as valid as consent that
is fully informed. But consent is not enough. There is no absolute
right to donate an organ. If there were such a right, then some
physician would be obligated to remove an offered organ upon request,
regardless of the risks involved. I do not believe that physicians
have such an obligation. Physicians are moral agents who are responsible
for their actions and for the welfare of their patients. Therefore,
while the values and goals of the potential donor should be given
great weight during the decision-making process, physicians may
justifiably refuse to participate in living organ donation when they
believe that the risks for the donor outweigh the benefits.
William T. Thompson, Margaret E. Cupples, Caryl H. Sibbett, Delia I.
Skan, Terry Bradley
- Objective: To explore general practitioners' perceptions of the
effects of their profession and training on their attitudes to
illness in themselves and colleagues.
Design: Qualitative study using focus groups and indepth
interviews.
Setting: Primary care in Northern Ireland.
Participants: 27 general practitioners, including six recendy
appointed principals and six who also practised occupational medicine
part time.
Main outcome measures: Participants' views about their own and
colleagues' health.
Results: Participants were concerned about the current level of
illness within the profession. They described their need to portray a
healthy image to both patients and colleagues. This hindered
acknowledgement of personal illness and engaging in health screening.
Embarrassment in adopting the role of a patient and concerns about
confidentiality also influenced their reactions to personal illness.
Doctors' attitudes can impede their access to appropriate health
care for themselves, their families, and their colleagues. A sense of
conscience towards patients and colleagues and the working
arrangements of the practice were cited as reasons for working
through illness and expecting colleagues to do likewise.
Conclusions: General practitioners perceive that their
professional position and training adversely influence their
attitudes to illness in themselves and their colleagues.
Organisational changes within general practice, including
revalidation, must take account of barriers experienced by general
practitioners in accessing health care. Medical education and
culture should strive to promote appropriate self care among
doctors.
M. von Cranach
Abstract: Between 1939 and 1945 180.000
psychiatric patients were killed in Nazi-Germany. After a brief
introduction reflecting the ways of and reasons for addressing this
issue today, the details of the so called euthanasia program are
presented: The killing of patients by gas in special hospitals between
1939 and 1941 in its first phase and the continuation in the psychiatric
hospitals until 1945. In this second phase patients were killed with
lethal injections and through the introduction of a hunger diet. The
fate of the Jewish patients and forced labourers as well as human
experiments are mentioned. Finally some thoughts are presented to
answer the question of why this could happen. The giving up of
individual responsibility in an authoritarian system leads to the loss
of the individual conscience and soul.
Weber L, Bissel MG.
Employee conscientious objection. Clin
Leadersh Manag Rev. 2001 Mar-Apr;15(2):114-5. PubMed PMID: 11299902.
Zoloth L. Limiting Access to Medical
Treatment in an Age of Medical Progress: Developing a Catholic
Consensus: A Response from Jewish Tradition. Christian Bioethics
2001, Vol. 7, No. 2, pp. 193-201
Laurie Zoloth
The efforts of Christian colleagues to articulate a clear framework
of specific Christian moral values to assess clinical treatments are
a necessary contribution to the debates about justice and resource
allocation in health care. Such efforts not only make clear the way
in which all such judgement is located, understood and interpreted
from a particular social venue and from a particular ethical stance;
finding one's moral location is the first task of critical theory and
concomitant practice. The clinical epistemology required in medical
resource allocation is framed by cultural and theological stance just as
surely as any knowledge, and Christians must be fully responsible for
making overt the often covert assumptions that undergird such work.
It is only after such clarity and definition that it is possible to
make the shared, civic negotiations for allocation, speaking in
comprehensible moral sentences about justice and limits in a language
held in common by a plurality of different religious traditions. . .