Conscientious objection in healthcare and the duty to refer

Journal of Medical Ethics 2017; 43:207-212.
Author: Cowley C
“Although some healthcare professionals have the legal right to conscientiously object to authorise or perform certain lawful medical services, they have an associated duty to provide the patient with enough information to seek out another professional willing to authorise or provide the service (the ‘duty to refer’).”
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Conscientious objection in healthcare: why tribunals might be the answer

Journal of Medical Ethics 2017; 43:213-217.
Author: Hughes JA
“A recent focus of the debate on conscientious objection in healthcare is the question of whether practitioners should have to justify their refusal to perform certain functions. A recent article by Cowley addresses a practical aspect of this controversy, namely the question of whether doctors claiming conscientious objector status in relation to abortion should be required, like their counterparts claiming exemption from military conscription, to defend their claim before a tribunal. Cowley argues against the use of tribunals in the medical case, on the grounds that there are likely to be fewer unjustified claims to conscientious objection in this context than in the military, and that in any case tribunals will not be an effective way of distinguishing genuine and false cases. I reject these arguments and propose a different conception of the role of a medical conscientious objection tribunal.”
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Conscientious refusal in healthcare: the Swedish solution

Journal of Medical Ethics 2017; 43:257-259.
Author: Munthe C
“The Swedish solution to the legal handling of professional conscientious refusal in healthcare is described. No legal right to conscientious refusal for any profession or class of professional tasks exists in Sweden, regardless of the religious or moral background of the objection. The background of this can be found in strong convictions about the importance of public service provision and related civic duties, and ideals about rule of law, equality and non-discrimination.”
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The BMA’s guidance on conscientious objection may be contrary to human rights law

Journal of Medical Ethics 2017; 43:260-263.
Author: Adenitire JO
“It is argued that the current policy of the British Medical Association (BMA) on conscientious objection is not aligned with recent human rights developments. These grant a right to conscientious objection to doctors in many more circumstances than the very few recognised by the BMA. However, this wide-ranging right may be overridden if the refusal to accommodate the conscientious objection is proportionate. It is shown that it is very likely that it is lawful to refuse to accommodate conscientious objections that would result in discrimination of protected groups. It is still uncertain, however, in what particular circumstances the objection may be lawfully refused, if it poses risks to the health and safety of patients. The BMA’s policy has not caught up with these human rights developments and ought to be changed.”
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Federal judge halts transgender health protections

The Hill, 31 December 2017
Author: Mallory Shelbourne
“A federal judge in Texas on Saturday halted enforcement of federal rules aimed at preventing doctors from discriminating against transgender individuals. U.S. District Judge Reed O’Connor granted the temporary injunction, saying the rules “likely violate” the Religious Freedom Restoration Act, according to The Associated Press.”
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Vaccine Refusal Revisited — The Limits of Public Health Persuasion and Coercion

N Engl J Med 2016; 375:1316-1317
Author: James Colgrove
“Many scientific, ethical, and political challenges that physicians and public health officials face today in dealing with vaccine refusal would be familiar to their counterparts of past eras. Their task entails balancing the use of coercive and persuasive approaches.”
Find abstract here.

No Jab, No Pay — no planning for migrant children

Med J Aust 2016; 205 (7): 296-298.
Authors: Georgia A Paxton, Lauren Tyrrell, Sophie B Oldfield, Karen Kiang and Margie H Danchin
“The Social Services Legislation Amendment (No Jab, No Pay) Act 2015 (Cwlth) was passed in November 2015, closing the conscientious objection exemption to immunisation requirements for family assistance payments. The intention was to reinforce the importance of immunisation and protect public health, especially for children. While these aims are sound, there are far-reaching, presumably unintended, consequences for migrant and refugee children.”
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Doctors Have no Right to Refuse Medical Assistance in Dying, Abortion or Contraception

Bioethics. doi:10.1111/bioe.12288
Authors: Savulescu, J. and Schuklenk, U.
“In an article in this journal, Christopher Cowley argues that we have ‘misunderstood the special nature of medicine, and have misunderstood the motivations of the conscientious objectors’. We have not. It is Cowley who has misunderstood the role of personal values in the profession of medicine. We argue that there should be better protections for patients from doctors’ personal values and there should be more severe restrictions on the right to conscientious objection, particularly in relation to assisted dying. We argue that eligible patients could be guaranteed access to medical services that are subject to conscientious objections by: (1) removing a right to conscientious objection; (2) selecting candidates into relevant medical specialities or general practice who do not have objections; (3) demonopolizing the provision of these services away from the medical profession.”
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Mandating Disclosure of Conscience-Based Limitations on Medical Practice

American Journal of Law & Medicine March 2016 vol. 42 no. 1 85-128
Author: Nadia N. Sawicki
“Stakeholders in law, medicine, and religion are unable to reach consensus about how best to address conflicts between healthcare providers’ conscientious objections to treatment and patients’ rights to access medical care. Conscience laws that protect objecting providers and institutions from liability are criticized as too broad by patient advocates and as too narrow by defenders of religious freedom. This article posits that some of the tension between these stakeholders could be mitigated by statutory recognition of a duty on the part of healthcare institutions or providers to disclose conscientiously motivated limitations on practice.”
Find abstract here.