2011
- Abstract: Following a discussion of some
historical roots of conscience, we offer a systematized version of
reflective equilibrium. Aiming at a comprehensive methodology for
bioethical deliberation, we develop an expanded variant of reflective
equilibrium, which we call 'triangular reflective equilibrium' and which
incorporates insights from hermeneutics, critical theory and narrative
ethics.
We focus on a few distinctions, mainly between
methods of justification in ethics and the social practice of bioethical
deliberation, between coherence in ethical reasoning, personal integrity and
consensus formation, and between political and moral deliberation. The ideal
of deliberation is explicated as a sharing of conscience within a special
commitment to sincerity and openness to persuasion. Personal growth in
wisdom is an indirect by-product of the continuous practice of moral
deliberation. This is explicated in the light of Sternberg's balance theory
of wisdom and in the context of medicine as a profession embodying
altruistic responsibilities of care in democratic and pluralistic societies.
- On February 18, the Department of Health and Human Services issued a
rule, "Regulation for the Enforcement of Federal Health Care Provider
Conscience Protection Laws," that limits health care providers' power to
shape their practice by personal conviction. The rule narrows possible
conscientious objection significantly, protecting patients' rights and
in the process eliminating public reinforcement of the harmful idea that
religion and medicine are always destined to diverge. . .
- Abstract: Defenders of medical professionals' rights to conscientious objection (CO)
regarding emergency contraception (EC) draw an analogy to CO in the
military. Such professionals object to EC since it has the possibility of
harming zygotic life, yet if we accept this analogy and utilize
jurisprudence to frame the associated public policy, those who refuse to
dispense EC would not have their objection honored. Legal precedent holds
that one must consistently object to all forms of the relevant activity. In
the case at hand, then, I argue that these professionals must also oppose
morally innocuous practices that may prevent pregnancy after fertilization.
These results reveal that such objectors cannot offer a plausible and
consistent objection to harming zygotic life. Additionally, there are good
reasons to reject the analogy itself. In either case, these findings call
into question the case supporting refusals of EC based on scruples.
- The child lies in the hospital, defeated by cancer and on the edge
of death. Clinicians advise that there is nothing more to do beyond
keeping her comfortable. The parents disagree. Wanting absolutely
everything done, they secure a court order to enforce their wishes. With
every cardiac arrest, the treating team reluctantly sets to work. She
has already arrested nearly 10 times through the day and staff dread the
next code. . .
- Introduction: A young woman visits her local
obstetrician. She tells him that she suspects, based on a home pregnancy
test, that she is pregnant. Unwed and scared, she hesitated before
seeing a doctor. The obstetrician examines her and tells her that she
is, indeed, two months pregnant. The young woman says that she would
like the pregnancy terminated and asks him if he will perform the
procedure. The doctor, an observant Jew, informs her that had she
visited sooner he might have been able to accommodate her request (as
his particular religious beliefs do not attribute full human dignity to
the embryo until it has gestated for forty days), but at this stage in
the pregnancy he is unable to do so in good conscience, as that would
involve the taking of human life. Furthermore, uncomfortable
participating remotely in an abortion, the obstetrician does not refer
the woman to a specific alternate obstetrician; he instead assures her
that there are plenty of other nearby doctors who would be willing to
perform the procedure and that she should ask around.
Catarina EC Fischer Grönlund, Vera Dahlqvist, Anna IS Söderberg
- Abstract: Background: This study is part of a major study about
difficulties in communicating ethical problems within and among
professional groups working in hemodialysis care. Describing experiences of
ethically difficult situations that induce a troubled conscience may
raise consciousness about ethical problems and thereby open the way to
further reflection. The aim of this study was to illuminate the meanings
of being in ethically difficult situations that led to the burden of a
troubled conscience, as narrated by physicians working in dialysis care.
Method: A phenomenological hermeneutic method was used to analyze the
transcribed narrative interviews with five physicians who had varying
lengths of experience in nephrology.
Results: The analysis shows that
physicians working in hemodialysis care suffered from a troubled conscience
when they felt torn by conflicting demands and trapped in irresolution. They
faced ethical dilemmas where they were forced to make crucial decisions
about life or death, or to prioritize when squeezed between time restraints
and professional and personal demands. In these ethical dilemmas the
physicians avoided arousing conflicts, were afraid of using their
authority, were burdened by moral responsibility and felt devalued and
questioned about their way of handling the situation. The findings point
to another way of encountering ethical dilemmas, being guided by their
conscience. This mean sharing the agony of deciding how to act, being brave
enough to bring up the crucial problem, feeling certain that better ways
of acting have not been overlooked, being respected and confirmed
regarding decisions made.
Conclusion: The meanings of being in ethically
difficult situations that led to the burden of a troubled conscience in
those working in hemodialysis care, indicate the importance of increasing
the level of communication within and among various professional groups -
to transform being burdened by a troubled conscience into using
conscience as a guide - in situations where no way of solving the problem
seems to be good.
- Abstract: Advances in technology have resulted in
medical procedures and practices that were unthought-of in previous
generations. Embryonic stem cell research, abortifacients, birth control, and artificial insemination
are just a few examples of these technological advances. While many
individuals readily embrace such medical advances, others find them
morally objectionable. A contentious national debate is now occurring over
whether employee pharmacists have the right to refuse to fill legal
prescriptions for emergency contraception because of conscientious
objections. In the United States, existing public policy is somewhat
muddled in both protecting and encroaching on the employee pharmacist's
right of refusal. This article discusses the legal and ethical nature of
that controversy, as well as the clash of interests, rights and
responsibilities between employers, employee pharmacists and customers
from a U.S. perspective.
Ko HK, Wang RH. [Unity of knowing and action- exploring moral courage
in
nursing practice]. Hu Li Za Zhi. 2011 Feb;58(1):102-7. Chinese. PubMed
PMID:
21328213.
- Consider the following case: Horace Johnson is a forty-year-old,
wheelchair-bound patient who has been suffering for the past ten years
from type 2 diabetes mellitus. He has wet gangrene on his fifth toe. He
doesn't visit the outpatient clinic for care of his diabetes and infection as
he is scheduled to. The infection is so severe that his physician,
Dr.
Garcia, concludes that the toe cannot be saved and that if it is not
amputated, Mr. Johnson could die. Mr. Johnson has been seen by a
psychiatrist, who finds him eccentric but believes that he has no evidence
of mental illness and must therefore be declared
competent to make his own
health care decisions. . .
- Recent debates have led some to question the legitimacy of
physicians refusing to provide legally permissible services for reasons
of conscience. In this paper, I will explore the question of whether
medical professionals have a collective duty to ensure that their
profession provides nondiscriminatory access to all medical services. I
will argue that they do not. I will also argue for an approach to
dealing with intractable moral disagreements between patients and
physicians that gives both parties veto power with regards to
participation. Finally, I will respond to three objections to allowing
physicians broad freedom to act on their consciences: such allowances
would violate the conscience of the patient, would lead to unfairness,
and would thwart important societal goals.
Parkinson 34 U.N.S.W.L.J. 281 (2011)
Accommodating Religious Belief in a Secular Age: The Issue of Conscientious
Objection in the Workplace, Am, Patrick Parkinson
[ 19 pages, 281 to 299
]
- Introduction: When New Jersey became the first state to require a
flu vaccine for children in 2008, parents protested outside the State
House. The new mandate requires children between six months and five
years old to get an annual flu shot to attend a child care facility or
day care center. According to state epidemiologist Dr. Eddy Bresnitz,
New Jersey based its decision to require flu vaccines for preschoolers on
recommendations by the Centers for Disease Control and Prevention (CDC)
and the Food and Drug Administration (FDA).
- Conscientious objection by doctors, as is commonly practised, is
discriminatory medicine. Only a fully justified and publicly accepted
set of objective values results in ethical medicine as a proper public
service with agreed and justified moral and legal standards to which
doctors should be held. . .
- Abstract: People routinely engage in dishonest acts without feeling
guilty about their behavior. When and why does this occur? Across four
studies, people justified their dishonest deeds through moral disengagement
and exhibited motivated forgetting of information that might otherwise
limit their dishonesty. Using hypothetical scenarios (Studies 1 and 2) and
real tasks involving the opportunity to cheat (Studies 3 and 4), the
authors find that one's own dishonest behavior increased moral
disengagement and motivated forgetting of moral rules. Such changes did not
occur in the case of honest behavior or consideration of the dishonest
behavior of others. In addition, increasing moral saliency by having
participants read or sign an honor code significantly reduced unethical
behavior and prevented subsequent moral disengagement. Although dishonest
behavior motivated moral leniency and led to forgetting of moral rules,
honest behavior motivated moral stringency and diligent recollection of
moral rules.
- This case raises a wealth of interesting issues about duties and
responsibilities between healthcare practitioners and patients. I will
deal in turn with each of the objections raised by the clinicians to
treating Mr. C and sum up with a brief consideration of the clinicians
who wished to treat Mr. C. The purpose of this commentary is not to give
a definitive answer to how clinicians should deal with cases like Mr.
C's, but rather to tease out some of the ethical issues raised in this
scenario.
- Abstract: Increasingly, employees maintain they should
be provided an unqualified legal right to refuse work activities that
violate their ethical, moral, personal, or religious convictions or
beliefs - in short, their conscience. This assertion has become one of the
more controversial issues confronting employers. This paper presents a
brief review of conscientious objection with special attention to objection
in medical related areas, followed by new discussion of freedom of
conscience in the workplace.
- Moral pluralism is a valuable aspect of a
free society but sometimes creates conflicts in medical care when
individual physicians object to providing certain legal but morally
controversial services, such as abortion, physician-assisted suicide
(where it is legal), and palliative sedation to unconsciousness. Genuine
conscience-based refusals (CBRs) are
refusals in which a physician
believes that providing the requested service would violate his or her
core moral beliefs (religious or secular), thereby causing personal moral
harm. Conscience-based refusals should be a "shield" to protect
individual physicians from being compelled to violate their core moral
beliefs rather than a "sword" to force their beliefs onto patients. This
partially explains why many physicians who invoke CBRs refer their
patients to physicians willing to provide the requested care.
- Hospitals sometimes refuse to provide goods and services or honor
patients' decisions to forgo life-sustaining treatment for reasons that
appear to resemble appeals to conscience. For example, based on the
Ethical and Religious Directives for Catholic Health Care Services (ERD),
Catholic hospitals have refused to forgo medically provided nutrition and
hydration (MPNH), and Catholic hospitals have refused to provide
emergency contraception (EC) and perform abortions or sterilization
procedures. I consider whether it is justified to refuse to offer EC to
victims of sexual assault who present at the emergency department (ED). A
preliminary question, however, is whether a hospital's refusal to provide
services can be conceptualized as conscience based.
- This case presents several important ethical issues. One concerns the
response to Mr. C when he asked whether there was any way to ''speed
up'' the process so that he would not have to wait several years to
receive a liver transplant. He was told that shortening his wait time
was ''not possible,'' and he only learned about the China option from
''discussions with friends.'' Was it ethically acceptable for transplant
physicians who knew about the China option but disapproved of it to
withhold information about it from Mr. C?
Young-Mason J.
Betrayal of conscience. Clin Nurse Spec. 2011
Jan-Feb;25(1):49. PubMed PMID: 21139468.
- There are many instances when nurses face situations of violence in
which there is both a perpetrator and a victim. Violence takes many
forms and occurs in domestic and public domain and in the extreme
situation of war.
The noted French scholar and Islamicist,
LouisMassignon, in his writings during the French Algerian War, asks us to
consider Gandhi's concern that assuming moral superiority
in any
confrontation can lead to further violence.
"Why is there this apparent flaw in nonviolence for
witnessing truth (and, what is indispensable, all truth)? Gandhi explained
it by observing that a brutal witnessing in favor of truth, using apparent
physical nonviolence, opens the war to a spiritual violence, to a weapon
more
menacing than the worst material weapons. When we use truth as a
privilege and monopoly to force an adversary to humiliate himself as a liar,
then the flickering conscience which he has even in his most indefensible
physical violence is unable to submit to our truth because we have refused
to recognize that he has a conscience at all."