2009
- . . . The introduction of discriminatory legislation into North American
pharmacy practice that began in the mid-1990s is a sign of the times. .
.Ensuing policies promote patient choice above all else and take no account
of the democratically protected rights of freedom of conscience, religion,
and expression of all individuals. . .
- Abstract: Health care professionals may have moral objections to particular
medical interventions. They may refuse to provide or cooperate in the
provision of these interventions. Such objections are referred to a
conscientious objections. Although it may be difficult to characterize or
validate claims of conscience, respecting the individual physician's
moral integrity is important. Conflicts arise when claims of conscience
impede a patient's access to medical information or care. A physician's conscientious objection to certain interventions or treatments may be
constrained in some situations. Physicians have a duty to disclose to prospective patients treatments they refuse to perform. As part of
informed consent, physicians also have a duty to inform their patients of
all relevant and legally available treatment options, including option
to which they object. They have a moral obligation to refer patients to
other health care professionals who are willing to provide those services
when failing to do so would cause harm to the patient, and they have a
duty to treat patients in emergencies when referral would significantly
increase the probability of mortality or serious morbidity. Conversely,
the health care system should make reasonable accommodations for
physicians with conscientious objections
Baker R.
Conscience and the unconscionable. Bioethics. 2009
Jun;23(5):ii-iv.
Review. PubMed PMID: 19476456.
- A year ago I sat between a Catholic priest and a bioethicist on a
panel debating President Bush's initiative to extend 'antidiscrimination' protections to health professionals who refuse to
perform a 'legal medical service or procedure' for 'reasons of
conscience.' These 'civil rights' protections were designed to protect
health professionals against their professional societies and their
employers who, the Bush administration claimed, 'would force physicians
to either violate their conscience by referring patients for abortions .
. . or risk losing their board certification,' or their job. As Assistant
Secretary of Health Garcia, MD, explained, 'health providers shouldn't
have to check their conscience at the hospital door. The proposed rule
will help ensure that doesn't happen.' . . .
- A new rule from the Department of Health and Human Services (DHHS)
has emerged as the latest battleground in the health care conscience
wars. Promulgated during the waning months of the Bush administration,
the rule became effective in January. Heralded as a "provider
conscience regulation" by its supporters and derided as a "midnight
regulation" by its detractors, the rule could alter the landscape of
federal conscience law. . .
Bhattacharya D. (2009)
Conflicts of Conscience in Health Care.
Journal of Legal Medicine, 30:2, 289-298, DOI: 10.1080/01947640902937827
- Introduction: The confluence of modern technology, skill, and medical
necessity allows health care providers to occupy a unique position that
inevitably invites moral scrutiny. To some, ensuring access to
contraceptives, abortions, or assisted reproductive therapy is inherently
inexcusable (their legality notwithstanding). For others, modern medicine
ought to be a patient-driven enterprise with physicians as mere
facilitators who provide services in response to patient'wants. Lost in
this debate at the extremes is a recognition that moral dilemmas emerge
from instances of human suffering, a complex phenomenon from which
nobody-including physicians-are immune. In issues of conscience and moral
quandaries, parsing rights, duties, and ethical obligations is
challenging for both providers and patients. Indeed, physicians are people
too.
- Abstract: Recent legislation in Wisconsin
mandating provision of emergency contraception to victims of sexual
assault may create a conflict of
conscience for some health care professionals. Although disputes exist
over the exact mechanism of action of emergency contraception, those
professionals who espouse a particularly strict stance may be reluctant
to dispense the medication for fear that it could prevent a fertilized
embryo from implanting in the uterus. While no objection of conscience
clause was written into the new law, Wisconsin law has a long tradition
of recognizing rights of conscience in matters of religious conflict.
This legal tradition both at statutory and common law levels is
summarized with application to the recent emergency contraception
mandate. A case is made for a potential legal defense should a health
care professional abstain from dispensing emergency contraception.
- Abstract: This paper argues that the provider
conscience regulation recently put into place in the USA is misguided.
The rule is too broad in the scope of
protection it affords, and its conception of what constitutes assistance
in the performance of an objectionable procedure reveals that it is
unworkable in practice. Furthermore, the regulation wrongly treats
refusal of other reproductive services as on a par with conscientious
objection to participation in abortion. Finally, the rule allows
providers to refuse even to discuss "objectionable " options with
patients and serves to protect discriminatory refusals of medical care.
For all of these reasons, this regulation is unwise.
- Abstract: We provide comprehensive, practical guidance for physicians on when to
offer, recommend, perform, and refer patients for induced abortion and
feticide. We precisely define terminology and articulate an ethical
framework based on respecting the autonomy of the pregnant woman, the
fetus as a patient, and the individual conscience of the physician. We
elucidate autonomy-based and beneficence-based obligations and distinguish
professional conscience from individual conscience. The obstetrician's
role should be based primarily on professional conscience, which is
shaped by autonomy-based and beneficence- based obligations of the
obstetrician to the pregnant and fetal patients, with important but
limited constraints originating in individual conscience.
Cook RJ, Olaya MA, Dickens BM.
Healthcare responsibilities and
conscientious
objection. Int J Gynaecol Obstet. 2009 Mar;104(3):249-52. Epub 2008 Nov 29.
PubMed PMID: 19041970.
- Abstract: The Constitutional Court of Colombia has issued a decision of
international significance clarifying legal duties of providers,
hospitals, and healthcare systems when conscientious objection is made to
conducting lawful abortion. The decision establishes objecting providers'
duties to refer patients to non-objecting providers, and that hospitals,
clinics, and other institutions have no rights of conscientious objection.
Their professional and legal duties are to ensure that patients receive
timely services. Hospitals and other administrators cannot object,
because they do not participate in the procedures they are obliged to
arrange. Objecting providers, and hospitals, must maintain knowledge of
non-objecting providers to whom their patients must be referred.
Accordingly, medical schools must adequately train, and licensing
authorities approve, non-objecting providers. Where they are unavailable,
midwives and perhaps nurse practitioners may be trained, equipped, and
approved for appropriate service delivery. The Court's decision has
widespread implications for how healthcare systems must accommodate
conscientious objection and patients' legal rights.
- Introduction: The dangerous intersection
between a pharmacist's right of moral belief and a woman's right of
contraceptive use continues to be an important topic for debate across
the nation. In fact, the area of contraceptive rights has been a
controversial issue since the United States Supreme Court's decision in
Griswold v. Connecticut in 1965, which recognized a constitutional right
of privacy in family planning decisions implicit within the meaning of
the Bill of Rights. Now, over forty years since this landmark decision,
courts continue to grapple with the notion of women's rights and how
contraceptive use should be protected.
New developments in
pharmaceutical research and technology have resulted in the formation of
new legal and ethical issues. The most recent dilemma faced by both
federal and state courts features women who desire a recently FDA
approved contraceptive drug called Plan B and pharmacists who are
morally opposed to the mode of action of the drug. This newfound ability
to prevent birth using a drug taken after sexual activity presents a
scenario the Griswold Court would have never anticipated. Nonetheless,
the precedent beginning with Griswold has created a necessary collision
between these two fundamental rights.
Pharmacists are placed in a
unique position in this controversy. Pharmacists are licensed by the
state yet some believe that they cannot comply with state requirements
due to their individual religious beliefs. As nearly all Americans are
familiar, the right to religious belief has been protected since the
drafting of the Bill of ...
- Abstract: The right to conscientious objection is
founded on human rights to act according to individuals' religious and
other conscience.
Domestic and international human rights laws recognize such entitlements.
Healthcare providers cannot be discriminated against, for instance in
employment, on the basis of their beliefs. They are required, however, to
be equally respectful of rights to conscience of patients and potential
patients. They cannot invoke their human rights to violate the human
rights of others. There are legal limits to conscientious objection. Laws
in some jurisdictions unethically abuse religious conscience by granting
excessive rights to refuse care.. In general, healthcare providers owe
duties of care to patients that may conflict with their refusal of care
on grounds of conscience. The reconciliation of patients' rights to care
and providers' rights of conscientious objection is in the duty of
objectors in good faith to refer their patients to reasonably accessible
providers who are known not to object. Conscientious objection is
unethical when healthcare practitioners treat patients only as means to
their own spiritual ends. Practitioners who would place their own
spiritual or other interests above their patients' healthcare interests
have a conflict of interest, which is unethical if not appropriately
declared.
- Introduction: First defined by Jamtjton in 1984 as a phenomenon that
occurs when nurses cannot carry out what they believe to be ethically appropriate
actions because of institutional constraints, moral distress has
recently gained attention as an important problem experienced by multiple
healthcare disciplines. Although it is not a new topic, recent
attention to moral distress (specifically, an article in the New York
Times by surgeon Pauline W. Chen, "When doctors and nurses can't do the
right thing, " and a fourfold increase in articles on the topic in
MEDLINE in the past two years) has highlighted its presence and effect on
healthcare providers and on the delivery of healthcare. While the
majority of published research has been in nursing journals, current work
has expanded to other disciplines, including medicine, psychology,
pharmacy, and respiratory therapy. It is increasingly clear that moral
distress is not solely a nursing issue, but one that potentially
influences all healthcare professionals. . .
- The harm caused by the interrogation methods described by Pope and
Gutheil goes far beyond the considerable damage, sometimes fatal, of
methods commonly understood to be torture. . .
- Abstract: Abortion is one of the most divisive
topics in healthcare. Proponents and opponents hold strong views. Some health
workers who oppose abortion assert a right of conscientious objection to
it, a position itself that others find unethical. Even if allowance for
objection should be made, it is not clear how far it should extend. Can
conscientious objection be given as a reason not to refer when a woman
requests her doctor to do so? This paper explores the idea of the general
practitioner (GP) who declines to make a direct referral for abortion,
asking the woman to see another GP instead. The purpose is to defend
the claim that an appeal to conscientious objection in this way can be
reasonable and ethical.
Grealis C. Religion in the Pharmacy: A
Balanced Approach to Pharmacists' Right to Refuse to Provide Plan B.
97 Geo. L.J. 1715, 1722-26 (2009)
- Background: Despite changes to the abortion legislation in
South Africa in 1996, barriers to women accessing abortion services still
exist including provider opposition to abortions and a shortage of trained
and willing abortion care providers. The dearth of abortion providers
undermines the availability of safe, legal abortion, and has serious
implications for women's access to abortion services and health service
planning.
In South Africa, little is known about the
personal and professional attitudes of individuals who are currently working
in abortion service provision. Exploring the factors which determine health
care providers' involvement or disengagement in abortion services may
facilitate improvement in the planning and provision of future services.
Methods: Qualitative research methods were used to
collect data. Thirty four in-depth interviews and one focus group discussion
were conducted during 2006 and 2007 with health care providers who were
involved in a range of abortion provision in the Western Cape Province,
South Africa. Data were analysed using a thematic analysis approach.
Results: Complex patterns of service delivery were
prevalent throughout many of the health care facilities, and fragmented
levels of service provision operated in order to accommodate health care
providers' willingness to be involved in different aspects of abortion
provision. Related to this was the need expressed by many providers for
dedicated, stand-alone abortion clinics thereby creating a more supportive
environment for both clients and providers. Almost all providers were
concerned about the numerous difficulties women faced in seeking an abortion
and their general quality of care. An overriding concern was poor pre and
post abortion counselling including contraceptive counselling and provision.
Conclusion: This is the first known qualitative study
undertaken in South Africa exploring providers' attitudes towards abortion
and adds to the body of information addressing the barriers to safe abortion
services. In order to sustain a pool of abortion providers, programmes which
both attract prospective abortion providers, and retain existing providers,
needs to be developed and financial compensation for abortion care providers
needs to be considered.
Project note: A survey was
undertaken in 1996. See
Are State Doctors in
the Western Cape willing to implement the Choice of Termination of Pregnancy
Act of 1996?
- Q. A technologist in my lab refuses to perform pregnancy tests
from a
local crisis pregnancy clinic. She claims it violates her conscience,
because she feels most of the women getting these tests will go on to
have abortions. She feels the same way about genetic testing. Can we
force her to do these tests? They are in the usual course of her work,
and her refusal is causing problems, mostly because of strong
political opinions on the subject. . .
- The headline on the cover of the BMJ's 16 May issue, "Interrogating
detainees: why psychologists participate and doctors don't," is, at best,
an example of poor communication. It violates Grice's maxims of good
communication: avoid obscurity of expression, make your contribution one
that is true, and be sufficiently informative. . .
- The influence of conscience on nurses in terms of guilt has frequently
been described but its impact on care has received less attention. The
aim of this study was to describe nurses' conceptions of the influence of
conscience on the provision of inpatient care. The study employed a
phenomenographic approach and analysis method. Fifteen nurses from three
hospitals in western Sweden were interviewed. The results showed that
these nurses considered conscience to be an important factor in the exercise
of their profession, as revealed by the descriptive categories:
conscience as a driving force; conscience as a restricting factor; and
conscience as a source of sensitivity. They perceived that conscience
played a role in nursing actions involving patients and next of kin, and
was an asset that guided them in their efforts to provide high quality care.
- The purpose of this paper is to present the theoretical and philosophical
assumptions of the Nursing Manifesto, written by three activist scholars
whose objective was to promote emancipatory nursing research, practice,
and education within the dialogue and praxis of social justice. Inspired
by discussions with a number of nurse philosophers at the 2008 Knowledge
Conference in Boston, two of the original Manifesto authors and two
colleagues discussed the need to explicate emancipatory knowing as it
emerged from the Manifesto. Our analysis yielded an epistemological
framework based on liberation principles to advance praxis in the
discipline of nursing. This paper adds to what is already known on this
topic, as there is not an explicit contribution to the literature of this
specific Manifesto, its significance, and utility for the
discipline.While each of us have written on emancipatory knowing and
social justice in a variety of works, it is in this article that we
identify, as a unit of knowledge production and as a direction towards
praxis, a set of critical values that arose from the emancipatory
conscience-ness and intention seen in the framework of the Nursing
Manifesto.
- This paper explores the issue of conscientious objection and looks
specifically at ways in which it may be managed to minimize its effect on
patients. It discusses how the issue of conscientious objection is
addressed in practice and examines some of the issues surrounding
access to abortion services and the potential impact of staff attitudes
on accessibility. The way in which conscientious objection is managed within
the law and within professional codes of conduct is then explored.
- Abstract: There is controversy today concerning conscience, conscientious
objection, and health care professionals. Nurses reportedly have said
that they are expected to "set aside" or "deaden" their conscience to work
in health care. Given the morally serious work that nurses do, this
expectation is puzzling and concerning. It suggests a misunderstanding of
the meaning of conscience, a conundrum which could be contributing to the
persistent problem of nurses' moral distress and to the chronic shortage
of nurses. This conundrum may be confounding efforts by society to formulate
coherent policy on conscience and conscientious objection by health care
professionals. In this essay I offer reflections on various
understandings of conscience as they relate to nurses. I suggest that
when conscience is conceptualized in terms of relativism and subjectivism,
setting aside one's conscience may seem possible and even understandable
in a morally pluralistic society. However, conscience may not be entirely
subjective or relative but, rather, deep-seated and grounded in objective
moral norms, and, as a result, it is difficult to completely ignore one's
conscience and troubling to act contrary to it. Because persons of good will
may disagree in their conscientious judgments, tolerance, or mutual
respect for conscience, is needed. Thus, reasoned discussions are
necessary to formulate policy on conscientious objection that is coherent,
morally defensible and avoids misunderstandings. It is my hope that this
essay contributes to the discussion and to clearing up the conundrums.
- Abstract: Purpose: To explore physicians' beliefs
about whether physicians
sometimes have a professional obligation to provide medical services
even if doing so goes against their conscience, and to examine
associations between physicians' opinions and their religious and ethical
commitments.
Method: A survey was mailed in 2007 to a stratified
random sample of 1,000 U.S. primary care physicians, selected from the
American Medical Association Physician Masterfile. Participants were
classified into three groups according to agreement or disagreement with
two statements: "A physician should never do what he or she believes
is morally wrong, no matter what experts say," and "Sometimes physicians
have a professional ethical obligation to provide medical services even if
they personally believe it would be morally wrong to do so."
Results: The response rate was 51% (446/879 delivered
questionnaires). Forty-two percent and 22% believed they are never and
sometimes, respectively, obligated to do what they personally believe
is wrong, and 36% agreed with both statements. Physicians who are more
religious are more likely to believe that physicians are never
obligated to do what they believe is wrong (58% and 31% of those with
high and low intrinsic religiosity, respectively; multivariate odds
ratio, 2.9; 95% CI, 1.2–7.2). Those with moral objections to any of
three controversial practices were more likely to hold that physicians
should never do what they believe is wrong.
Conclusion: A substantial minority of physicians do not believe
there is ever a professional obligation to do something they personally
believe is wrong.
- Abstract: Throughout history,warriors have been confronted with moral and ethical
challenges andmodern unconventional and guerilla wars amplify these
challenges. Potentially morally injurious events, such as perpetrating,
failing to prevent, or bearingwitness to acts that transgress deeply held
moral beliefs and expectationsmay be deleterious in the long-term,
emotionally, psychologically, behaviorally, spiritually, and socially (what
we label as moral injury). Although there has been some research on the
consequences of unnecessary acts of violence in war zones, the lasting
impact of morally injurious experience in war remains chiefly unaddressed.
To stimulate a critical examination of moral injury, we review the
available literature, define terms, and offer a working conceptual
framework and a set of intervention strategies designed to repair moral
injury.
- Pellegrino defines professionalism as "those qualities and modes of
conduct proper to professions." In each patient encounter, the
physician, as a professional, "professes" both technical competence and a
commitment to use that competence in the patient's best interest. A
good physician is therefore characterized by virtues that enable him or
her to achieve what he or she professes: benevolence, confi dentiality,
compassion, and courage are just a few examples. Specific to family
medicine, Dr Cal Gutkin, Chief Executive Officer of the College of
Family Physicians of Canada, has identified "key principles and
actions" of professionalism, including knowledge, commitment to ongoing
education, evidence-based practice, liability, self-regulation, and
the provision of "ethical" and "altruistic" care. Given that the
qualities described above are noble and worthy of emulation, one might
wonder why FPs do not agree on what professionalism is. . .
- Abstract: This article examines the issue of expanding rights of
conscience for health-care professionals to include rights grounded in
claims of complicity.Our concerns relate to the nature of professional expertise,
on the one hand, and an individual's right to live by his or her values,
on the other.The fact that a patient is dependent on a physician's
counseling about treatment options requires limiting conscience-based
refusal to provide information, since allowing refusal would deprive
patients of even knowing the options that exist for them. Sanctioning
such claims of conscience not only would supplant one person's moral
judgment with another's, it would also allow professional standing to be
used as a justification for imposing one person's moral views on another.
- Abstract: This article examines to what extent nurses can at present opt out of
clinical procedures on the basis of conscience in English law. It
considers the current rights to opt out on the basis of conscience
contained in section 4 of the Abortion Act 1967 and section 38 of the
Human Fertilisation and Embryology Act 1990. It examines how through
codes of practice and guidance, there is recognition of the ability to
opt out beyond theses statutes. It suggests that rather than let practice
evolve to enable persons to opt out, the fundamental issues as to whether
it should be a right or a privilege needs careful consideration across
healthcare professions as a whole and a broader public debate.
- The fall of state socialism in Poland in 1989 constituted a critical
moment that redefined policies regulating reproductive health and access
to care. As the Polish state adopted the discourse and agenda of the
Catholic Church in its health policies, reproduction and sexuality became
sites of moral governance through the implementation of the Conscience
Clause law, which permits healthcare providers to deny medical services
citing conscience-based objections. Based on ethnographic fieldwork, this
article explores the effects of the implementation of the conscience
clause and argues that the adoption of this law for individual use paved the
way for restrictions on reproductive healthcare on a systemic scale. The
special status afforded to the church is highly significant for access to
health services deemed by the church to be matters of morality. The
Polish case raises concerns about the place of women's rights in
postsocialism and the nature of Polish democratization.
- Introduction: Recently a resurgence of interest in issues of conscience, as they relate
to health care practice, has led to fervent writing on the topic. This
paper will show the importance of respecting claims to conscience in
light of its value for directing ethical decision making within the
health care context. Although conscientious judgments may on occasion be
erroneous or lead to conflict, it is best to respect conscientious
warning and educate Health Care Professionals (HCPs) to examine and
defend their beliefs. This paper will address the issue of defining
conscience, and consider how that definition illuminates the
contradictory nature of asking HCPs to act according to conscience on
some occasions, but to ignore their conscience on others. These issues
are addressed in light of conscientious objection and its potential
relationship to moral distress.
- . . . It would seem as mad an approach to a discussion on the
relationship between torture and attachment and the role of psychologists in
the "Global War On Terror" (GWOT)-through the filters of medieval Persian
poetry-as it would be through the rationality of behavioral science or
ncuro-psychoanalysis. But to my mind, to sanction torture, to measure
torture, to monitor torture, or to perform torture are all forms of the same
madness, no matter how it is measured or by whom.
Ohto H, Yonemura Y, Takeda J, Inada E, Hanada R, Hayakawa S, Miyano T,
Kai K,
Iwashi W, Muto K, Asai F; Japanese Society of Transfusion Medicine and Cell
Therapy (JSTMCT).
Guidelines for managing conscientious objection to blood
transfusion. Transfus Med Rev. 2009 Jul;23(3):221-8. PubMed PMID: 19539876.
- Parents sometimes deny their children blood transfusion because of
their religious beliefs. The Japanese Joint Committee on the Refusal of
Blood Transfusion on Religious Grounds asserts that the health and life
of every child younger than 15 years should be guarded by the
collective efforts of health, welfare, and advocacy institutions when a
parent or guardian seeks to withhold transfusion therapy. Patients 18
years or older should receive treatment without transfusion after signing
andsubmitting a "Certificate of Refusal Blood Transfusion and Exemption
from Liability." For a patient younger than 18 years, but 15 years or
older, essential transfusion can be performed if the patient or at least
one guardian consents. Without patient's or guardian's consent,
guidelines for patients 18 years or older shall apply. Health care
providers should offer the best possible care that is consistent with a
patient's age and competency.
- This article offers a critique of the likely impact of the Abortion Act
2008 (Vic) in light of the fact that the Act was intended to reflect
rather than alter current clinical practice surrounding abortion. The
author traces the development of abortion law in Victoria and compares
the two models for regulating abortion: the "common law model" and the
"legislative model". The author argues in favour of legislative
intervention. The author also discusses current uncertainties that exist
due to the unclear effect of the Charter of Human Rights and
Responsibilities Act 2006 (Vic) on abortion legislation, focusing on the
intersection between women's rights to an abortion and doctors' rights to
freedom of conscience.
- Introduction: The day before the inauguration of his Democratic
successor, President George W. Bush oversaw the promulgation of an
administrative rule that extended "sweeping" new conscience protections
to healthcare providers, one which would allow them to refuse to
participate in or refuse to refer for medical services to which they
morally or religiously object. Enacted in a funding regulation through
the Department of Health and Human Services ("HHS"), the rule - commonly
called the Provider Conscience Regulation ("Regulation") - purported to
clarify and implement existing federal law; by its own terms; however,
the Regulation pushed the boundaries of those laws, granting protections
to a broader class of individuals and across a wider range of services.
In so doing, the Regulation sought to resolve an ongoing tension between
patient access and provider autonomy, yet it served to reignite a
long-standing debate over the proper role of morals in medicine. . .
- To deem itself civilized, a society must protect the personal
integrity of its citizens. Without such protection, the integrity of the
society itself unravels as more and more effort goes into protecting
individuals against the chicanery of their fellow citizens. Perhaps
this is why Plato called integrity "the goodness of the ordinary
citizen." If integrity is the characteristic value for the ordinary
citizen, then it's even more important for those whose social roles are
defined primarily in terms of personal trust- doctors, lawyers, ministers,
and teachers. Ordinary citizens cannot be healed- or provided with
advocacy, spiritual counsel, or learning- without trust in these
helping professions. (Unfortunately, history recounts how some physicians
in every age have failed in the trustworthiness integral to medicine.)
When such professions lack integrity, those who need their services
will seek to protect themselves by assuring greater individual or public
control over their relationships with these professions. . .
- Excerpt: In the wake of Roe v. Wade, a public
policy debate arose concerning the right of public health professionals
and institutions to refuse to perform abortions based on religious and
moral objections. Over the past two decades, that debate has expanded to
encompass similarly grounded objections to other interventions. One
quite controversial addition to that debate concerns so-called
"emergency contraception," an intervention that involves high doses of
contraceptives taken within seventy-two hours after intercourse to
prevent fertilization of the egg or, failing that, implantation of the
fertilized egg in the uterus. Believing that emergency contraception is
designed to, at least in some instances, end human life, some
pharmacists opposed to its use have refused to dispense it. These
refusals have led, in turn, to debates over whether to protect such
conscience-based choices as the free exercise of religious beliefs, or
instead to require pharmacies and pharmacists to dispense with their
objections as a condition of licensing.
Recently, in Stormans, Inc. v. Selecky, the
Ninth Circuit overturned a preliminary injunction barring enforcement of
Washington state regulations that required pharmacists to dispense emergency
contraception and other drugs despite religious objections. Finding that the
regulations were neutral toward religion and were generally applicable, the
court held that they were subject merely to rational basis review. However,
the panel erred by refusing to consider the targeting of religiously
motivated behavior shown by the regulations' administrative history, and by
improperly analyzing the individualized exceptions to ...
- Moral certainty, very simply, is knowing that you are right. The answer is a
"sure thing," a foregone conclusion. Moral certainty is founded on an
absolute belief to which the person is committed, without doubt. For
some, religion provides moral certainty. Those who believe in religion
trust that the written or spoken word and teachings of a supreme being
are absolutely correct. An adherent to those teachings acts in good
conscience according to those beliefs.
A look back through history is replete with examples of wars fought and
injustices applied to impose or compel specific beliefs. Whether
religious or ideologic, the certainty that only one's beliefs are correct
and must at all costs be forced on others is alarming. Seeing the world
as simply black or white, right or wrong may provide individuals
reassuring certainty about their actions, but it also negates the need for
critical, reflective thinking that enhances ethical practice. . .
- Assessment of clinical competency in professional roles especially in
crucial situations can improve the nursing profession. This qualitative
research was conducted to determine the process of acquiring clinical
competency by nurses in its cultural context and within the health care
delivery system in Iran. This study, using grounded theory methodology, took
place in universities and hospitals in Tehran. Nurses (36) included nurse
managers, tutors, practitioners, and members of the Iranian Nursing
Organization. Simultaneous data collection and analysis took place using
participant semistructured interviews. Three categories emerged: (a)
personal characteristics such as philanthropy, strong conscience, being
attentive, accepting responsibility, being committed to and respecting
self and others; (b) care environment including appropriate management
systems, in-service training provision, employment laws, and control
mechanisms, suitable and adequate equipment; and (c) provision of
productive work practices including love of the profession, critical
thinking, nursing knowledge, and professional expertise. Professional
ethics has emerged as the core variable that embodies concepts such as
commitment, responsibility, and accountability. Professional ethics
guarantees clinical competency and leads to the application of
specialized knowledge and skill by nurses. The results can be used to form
the basis of guiding the process of acquiring clinical competency by
nurses using a systematic process.
von Bergen, C.W.
Conscience in the Workplace.
Employee Relations Law Journal Vol. 35, No. 1, Summer, 2009
- A current trend in employment law is that workers feel they should be
protected in the exercise of their conscience - even if doing so is
contrary to their employers' wishes or to the demands of their jobs.
Workers are increasingly claiming that they should be provided an
unqualifi ed legal right to refuse work activities that violate their
ethical, moral, personal, or religious convictions or beliefs and this
assertion has become one of the more controversial issues confronting
employers. After a brief review of conscientious objection, special
attention is given to such objection in medically related areas, followed
by a discussion of the expansion of freedom of conscience to the general
workplace.
- Abortion is the most politically contested social issue in the United
States, a debate that manifests itself in extensive regulation of
abortion as a health care service. This study provides a brief history
of the judicial acceptance of abortion regulation and an overview of the
most common forms of abortion regulation affecting physicians in the
United States. The article concludes with a discussion of pending
threats to the legal right to abortion in the United States and
recommended resources where physicians can find assistance to comply with
existing laws.
- Dr Leong gives several examples that she believes demonstrate how
"[f]amily physicians do not agree what professionalism is." I submit that
these examples do not prove her argument. Essentially, professionalism
pertains to the claim to competence regarding certain skills and
knowledge domains and the commitment to deploy these for the primary
benefi t of the patient, in keeping with the moral norms of the
profession. This is pretty much what Dr Leong, glossing Pellegrino, says
professionalism is. Nothing in the examples she furnishes indicates
disagreement about this core idea. . .