As you may have heard, the Trump Administration has announced an expanded policy on conscientious objection in medicine, with institutional support in the form of a Department of Health and Human Services office that will be responsible for protecting objectors. It will be called the Division of Conscience and Religious Freedom.
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There are many possible responses to this, ethically speaking. Over the coming week, IJFAB Blog will be running several responses. While these will focus on the US context, this issue is by no means limited to the US. Women in Italy, for instance, have a remarkably difficult time accessing abortion even when it is allowed because providers have such a high rate of refusal, rising from 59% in 2005 to 70% in 2016.
Regardless of where you live or practice medicine or do bioethics, I encourage you to check in regularly to see the array of considerations.
Before we get started, some of you might want to learn a bit more about the current situation and about medical conscience claims AKA conscientious objection.
Here are some links if you want to learn more about the current situation:
- Trump Admin Will Protect Health Workers Who Refuse Services on Religious Grounds (NPR)
Trump Will Give Healthcare Workers the Right to Refuse to Treat LGBT People (LGBTQ Nation) - US Government to Shield Health Workers Under ‘Religious Freedom’ (Channel NewsAsia)
- HHS Announces New Conscience and Religious Freedom Division (HHS.gov)
And here are just a few links/cites to prior IJFAB, IJFAB Blog, and some useful bioethics work on conscientious objection. Many of these strive to balance respect for conscience claims against the interests or rights of patients. There is so much more out there. But these are a decent place to start.
- Where can I go? Conscientious Objection, the Catholic Church, and Patient Access to Care by Alison Reiheld (IJFAB Blog)
- Recognizing Conscience in Abortion Provision by Lisa Harris (Md, PhD) New England Journal of Medicine 367: 981-983. 2012.
- Conflicts of Conscience in Health Care by Holly Fernandez Lynch (MIT Press)
- Review of Conscientious Objection in Health Care: An Ethical Analysis by Mark Wicclair by Lori Kantymir IJFAB 7(2): 253-261.
- “Dishonourable Disobedience”–Why refusal to treat in reproductive healthcare is not conscientious objection by Christian Fiala and Joyce Arthur Woman – Psychosomatic Gynaecology and Obstetrics 1:12-23. 2014.
- The Limits of Conscientious Objection–May Pharmacists Refuse to Fill Prescriptions for Emergency Contraception? by Julie Cantor and Ken Baum New England Journal of Medicine 351:2008-2012. 2004.
- Work by Feminist Approaches to Bioethics stalwart Carolyn McLeod on conscience claims
- Harm or Mere Inconvenience? Denying Women Emergency Contraception, Hypatia 25(1):11-30. 2010.
- Taking a Feminist Relational Perspective on Conscience. In Being Relational: Reflections on Relational Theory and Health Law and Policy. Ed. J. Downie and J. Lewellyn. UBC Press. 2011. pp. 161-181.
- with C. Fitzgerald. Conscientious Refusal and Access to Abortion and Contraception. In the Routledge Companion to Bioethics. Ed. J. Arras, E. Fenton, and R. Kukla. Routledge. 2015. pp343-356.
In addition, Carolyn McLeod has a forthcoming book from Oxford University Press called The Power of Conscientious Objectors that you might want to seek out in the future.
I am excited about the posts we will have in this series. Stay tuned.
Common acceptance of the term “conscientious objection” for these refusals to serve patients is a mistake, I believe. It confuses the traditional meaning of “refusing to serve in wartime based on religious principle, when I have no choice about the demand for service” and making a commitment to a profession, the education for which was often funded by others, then betraying that commitment, allbeit(possibly) based on religious principle. The war example is one where the objector has little power and made no choices implying his/her compliance with the decisions of others. The medical example is one where the “objector” has considerable popwer and is probably harming those he has committed and trained to serve.
Power and choice surely are relevant in how we discuss these issues. I don’t choose to treat these situations as morally equivalent.
What’s worse, many of these medical objectors are now refusing to refer to other practitioners who may provide the service. That is not only the expression of power and the effort to remove choice, but it is also an expression of profound disrespect for the wishes and thinking of others.
To me, it seems that there is something punitive in many of these so-called “principled” refusals.