Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Conscience. Show all posts
Showing posts with label Conscience. Show all posts

Wednesday, August 4, 2021

A taxonomy of conscientious objection in healthcare

Gamble, N., & Saad, T. (2021). 
Clinical Ethics. 
https://doi.org/10.1177/1477750921994283

Abstract

Conscientious Objection (CO) has become a highly contested topic in the bioethics literature and public policy. However, when CO is discussed, it is almost universally referred to as a single entity. Reality reveals a more nuanced picture. Healthcare professionals may object to a given action on numerous grounds. They may oppose an action because of its ends, its means, or because of factors that lay outside of both ends and means. Our paper develops a taxonomy of CO, which makes it possible to describe the refusals of healthcare professional with greater finesse. The application of this development will potentially allow for greater subtlety in public policy and academic discussions – some species of CO could be permitted while others could be prohibited.

Conclusion

The ethical analysis and framework we have presented demonstrate that conscience is intertwined with practical wisdom and is an intrinsic part of the work of healthcare professionals. The species of CO we have enumerated reveal that morality and values in healthcare are not only related to a few controversial ends, but to all ends and means in medicine, and the relationships between them.

The taxonomy we have presented will feasibly permit a more nuanced discussion of CO, where the issues surrounding and policy solutions for each species of CO can be discussed separately. Such a conversation
is an important task. After all, CO will not go away, even if specific belief systems rise or fall. CO exists
because humans have an innate awareness of the need to seek good and avoid evil, yet still arrive at disparate intellectual conclusions about what is right and wrong. Thus, if tolerant and amicable solutions
are to be developed for CO, conversations on CO in healthcare need to continue with a more integrated
understanding of practical reason and an awareness of broad involvement of conscience in medicine. We
hope our paper contributes to this end.

Tuesday, March 31, 2020

How Should We Judge Whether and When Mission Statements Are Ethically Deployed?

K. Schuler & D. Stulberg
AMA J Ethics. 2020;22(3):E239-247.
doi: 10.1001/amajethics.2020.239.

Abstract

Mission statements communicate health care organizations’ fundamental purposes and can help potential patients choose where to seek care and employees where to seek employment. They offer limited benefit, however, when patients do not have meaningful choices about where to seek care, and they can be misused. Ethical implementation of mission statements requires health care organizations to be truthful and transparent about how their mission influences patient care, to create environments that help clinicians execute their professional obligations to patients, and to amplify their obligations to communities.

Ethics, Mission, Standard of Care

Mission statements have long been used to communicate an organization’s values, priorities, and goals; serve as a moral compass for an organization; guide institutional decision making; and align efforts of employees. They can also be seen as advertising to prospective patients and employees. Although health care organizations’ mission statements serve these beneficial purposes, ethical questions (especially about business practices seen as motivating profit by rewarding underutilization) arise when mission implementation conflicts with acting in the best interests of patients. Ethical questions also arise when religiously affiliated organizations deny clinically indicated care in order to uphold their religiously based mission. For example, a Catholic organization’s mission statement might include phrases such as “faithful,” “honoring our sponsor’s spirit,” or “promoting reverence for life” and likely accords the Ethical and Religious Directives for Catholic Health Care Services, which Catholic organizations’ clinicians are required to follow as a condition of employment or privileges.

When strictly followed, these directives restrict health care service delivery, such that patients—particularly those seeking contraception, pregnancy termination, miscarriage management, end-of-life care, or other services perceived as conflicting with Catholic teaching—are not given the standard of care. Federal and state laws protect conscience rights of organizations, allowing them to refuse to provide services that conflict with the deeply held beliefs and values that drive their mission.6 Recognizing the potential for conflict between mission statements and patients’ autonomy or best interests, we maintain that health care organizations have fundamental ethical and professional obligations to patients that should not be superseded by a mission statement.

The info is here.

Friday, January 24, 2020

How One Person Can Change the Conscience of an Organization

Nicholas W. Eyrich, Robert E. Quinn, and
David P. Fessell
Harvard Business Review
Originally published 27 Dec 19

Here is an excerpt:

A single person with a clarity of conscience and a willingness to speak up can make a difference. Contributing to the greater good is a deep and fundamental human need. When a leader, even a mid-level or lower level leader, skillfully brings a voice and a vision, others will follow and surprising things can happen—even culture change on a large scale. While Yamada did not set out to change a culture, his actions were catalytic and galvanized the organization. As news of the new “not for profit” focus of Tres Cantos spread, many of GSK’s top scientists volunteered to work there. Yamada’s voice spoke for many others, offering a clear path and a vision for a more positive future for all.

The info is here.

Wednesday, December 4, 2019

Veterans Must Also Heal From Moral Injury After War

Camillo Mac Bica
truthout.org
Originally published Nov 11, 2019

Here are two excerpts:

Humankind has identified and internalized a set of values and norms through which we define ourselves as persons, structure our world and render our relationship to it — and to other human beings — comprehensible. These values and norms provide the parameters of our being: our moral identity. Consequently, we now have the need and the means to weigh concrete situations to determine acceptable (right) and unacceptable (wrong) behavior.

Whether an individual chooses to act rightly or wrongly, according to or in violation of her moral identity, will affect whether she perceives herself as true to her personal convictions and to others in the moral community who share her values and ideals. As the moral gravity of one’s actions and experiences on the battlefield becomes apparent, a warrior may suffer profound moral confusion and distress at having transgressed her moral foundations, her moral identity.

Guilt is, simply speaking, the awareness of having transgressed one’s moral convictions and the anxiety precipitated by a perceived breakdown of one’s ethical cohesion — one’s integrity — and an alienation from the moral community. Shame is the loss of self-esteem consequent to a failure to live up to personal and communal expectations.

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Having completed the necessary philosophical and psychological groundwork, veterans can now begin the very difficult task of confronting the experience. That is, of remembering, reassessing and morally reevaluating their responsibility and culpability for their perceived transgressions on the battlefield.

Reassessing their behavior in combat within the parameters of their increased philosophical and psychological awareness, veterans realize that the programming to which they were subjected and the experience of war as a survival situation are causally connected to those specific battlefield incidents and behaviors, theirs and/or others’, that weigh heavily on their consciences — their moral injury. As a consequence, they understand these influences as extenuating circumstances.

Finally, as they morally reevaluate their actions in war, they see these incidents and behaviors in combat not as justifiable, but as understandable, perhaps even excusable, and their culpability mitigated by the fact that those who determined policy, sent them to war, issued the orders, and allowed the war to occur and/or to continue unchallenged must share responsibility for the crimes and horror that inevitably characterize war.

The info is here.

Tuesday, August 28, 2018

How Evil Happens

Noga Arikha
www.aeon.co
Originally posted July 30, 2018

Here is an excerpt:

An account of the inability to feel any emotion for such perceived enemies can take us closer to understanding what it is like to have crossed the line beyond which one can maim and kill in cold blood. Observers at the International Criminal Court (ICC) at the Hague note frequently the absence of remorse displayed by perpetrators. The clinical psychologist Françoise Sironi, who assesses perpetrators for the ICC and treats them and their victims, has directly seen what Lifton called the ‘murder of the self’ at work – notably with Kang Kek Iew, the man known as ‘Duch’, who proudly created and directed the Khmer Rouge S-21 centre for torture and extermination in Cambodia. Duch was one of those who felt absolutely no remorse. His sole identity was his role, dutifully kept up for fear of losing himself and falling into impotence. He did not comprehend what Sironi meant when she asked him: ‘What happened to your conscience?’ The very question was gibberish to him.

Along with what Fried calls this ‘catastrophic’ desensitisation to emotional cues, cognitive functions remain intact – another Syndrome E symptom. A torturer knows exactly how to hurt, in full recognition of the victim’s pain. He – usually he – has the cognitive capacity, necessary but not sufficient for empathy, to understand the victim’s experience. He just does not care about the other’s pain except instrumentally. Further, he does not care that he does not care. Finally, he does not care that caring does, in fact, matter. The emotionally inflected judgment that underlies the moral sense is gone.

The information is here.

Wednesday, July 18, 2018

Can Employees Force A Company To Be More Ethical?

Enrique Dans
Forbes.com
Originally posted June 19, 2018

Here is the conclusion:

Whatever the outcome, it now seems increasingly clear that if you do not agree you’re your company’s practices, if they breach basic ethics, you should listen to your conscience and make your voice heard. Which is all fine and good in a rapidly expanding technology sector such as the United States where you are likely to find another job quickly, but what about in other sectors, or in countries with higher unemployment rates or where government and industry are more closely aligned?

Can we and should we put a price on our principles? Is having a conscience the unique preserve of the wealthy and highly skilled? Obviously not, and it is good news that some employees at US companies are setting a precedent. If companies are not going to behave ethically of their own volition, at least we can count on their employees to embarrass them into doing so. Perhaps other countries and companies will follow suit…

The article is here.

Monday, March 19, 2018

‘The New Paradigm,’ Conscience and the Death of Catholic Morality

E. Christian Brugger
National Catholic Register
Originally published February 23, 2-18

Vatican Secretary of State Cardinal Pietro Parolin, in a recent interview with Vatican News, contends the controversial reasoning expressed in the apostolic exhortation Amoris Laetitia (The Joy of Love) represents a “paradigm shift” in the Church’s reasoning, a “new approach,” arising from a “new spirit,” which the Church needs to carry out “the process of applying the directives of Amoris Laetitia.”

His reference to a “new paradigm” is murky. But its meaning is not. Among other things, he is referring to a new account of conscience that exalts the subjectivity of the process of decision-making to a degree that relativizes the objectivity of the moral law. To understand this account, we might first look at a favored maxim of Pope Francis: “Reality is greater than ideas.”

It admits no single-dimensional interpretation, which is no doubt why it’s attractive to the “Pope of Paradoxes.” But in one area, the arena of doctrine and praxis, a clear meaning has emerged. Dogma and doctrine constitute ideas, while praxis (i.e., the concrete lived experience of people) is reality: “Ideas — conceptual elaborations — are at the service of … praxis” (Evangelii Gaudium, 232).

In relation to the controversy stirred by Amoris Laetitia, “ideas” is interpreted to mean Church doctrine on thorny moral issues such as, but not only, Communion for the divorced and civilly remarried, and “reality” is interpreted to mean the concrete circumstances and decision-making of ordinary Catholics.

The article is here.

Monday, August 12, 2013

The Charitable-Industrial Complex

By PETER BUFFETT
The New York Times - Opinionator
Published: July 26, 2013

Here are some excerpts:

Because of who my father is, I’ve been able to occupy some seats I never expected to sit in. Inside any important philanthropy meeting, you witness heads of state meeting with investment managers and corporate leaders. All are searching for answers with their right hand to problems that others in the room have created with their left. There are plenty of statistics that tell us that inequality is continually rising. At the same time, according to the Urban Institute, the nonprofit sector has been steadily growing.

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As more lives and communities are destroyed by the system that creates vast amounts of wealth for the few, the more heroic it sounds to “give back.” It’s what I would call “conscience laundering” — feeling better about accumulating more than any one person could possibly need to live on by sprinkling a little around as an act of charity.

(cut)

I’m really not calling for an end to capitalism; I’m calling for humanism.

The entire story is here.

Saturday, March 3, 2012

Health Care Issues Intensify U.S. Debate Over Conscience in the Workplace

By Stephanie Simon
Reuters
Originally published February 22, 2012

Can a state require a pharmacy to stock and dispense emergency contraception -- even when the owner considers the drug immoral?

That's the question at the heart of a long-running legal battle in Washington state, expected to be decided Wednesday with a ruling from the U.S. District Court in Seattle.

It's the latest twist in a contentious national debate over the role of conscience in the workplace.

In recent weeks, the debate has been dominated by religious groups fighting to overturn a federal mandate that most health insurance plans provide free birth control. But the battle extends far beyond insurance regulations.

Asserting conscientious objections, nurses in New Jersey have said they would not check the vital signs of patients recovering from abortions. Infertility specialists in California would not perform artificial insemination on a lesbian. An ambulance driver in Illinois declined to transport a patient to an abortion clinic.

In the Washington case, a family-owned pharmacy in Olympia declined to stock emergency contraception, which can prevent pregnancy if taken within 72 hours of unprotected sex. Co-owner Kevin Stormans says he considers the drug equivalent to an abortion, because it can prevent implantation of a fertilized egg. His two pharmacists agree.

Their decision to keep the drug off their shelves came under fire in 2007, when the state Board of Pharmacy enacted a rule requiring pharmacies to stock and dispense all time-sensitive medications in demand in their community. In the case of the Olympia pharmacy, that includes emergency contraception, said Tim Church, a state Department of Health spokesman. The pharmacy's owner and employees filed suit to block the mandate.

All our family wants ... is to serve our customers in keeping with our deepest values," Stormans said in a statement issued by his attorneys.

The state argues that it has a compelling interest in protecting the right of patients to legal medication.

The conscience debate has implications for a vast number of patients. A 2007 New England Journal of Medicine study found that 14% of doctors do not believe they are obligated to tell patients about possible treatments that they personally consider morally objectionable. Nearly 30% of physicians said they had no obligation to refer patients to another provider for treatments they wouldn't offer themselves. A more recent study, published last week in the Journal of Medical Ethics, echoed the finding on referrals.

And abortion and contraception aren't the only medical services at issue. Physicians also may object to following directives from terminally ill patients to remove feeding tubes or ventilators, said Kathryn Tucker, director of legal affairs for Compassion & Choices, an advocacy group that backs physician-assisted suicide.

Entire story is here.