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 Conscientious Objection. Show all posts
Showing posts with label Conscientious Objection. Show all posts

Thursday, October 27, 2022

Frequently asked questions about abortion laws and psychology practice

American Psychological Association
Updated 1 SEPT 2022

Since the U.S. Supreme Court issued its decision to overturn Roe v. Wade, many states have proposed, enacted, or resurrected a range of laws to either prohibit, significantly restrict, or protect reproductive rights and health care. Currently, the main targets of these laws appear to be medical providers who provide abortions or individuals seeking to obtain an abortion.

APA and APA Services Inc. are striving to provide psychologists with accurate and adequate information about the potential impact on them of reproductive health care laws. Since psychologists have embraced telehealth and many use technology to provide services across state lines, it’s important to be familiar with the laws governing the jurisdiction(s) where you are licensed as well as the jurisdiction(s) where your patients live.

In addition to this FAQ and other APA resources, psychologists will want to be familiar with guidance issued by federal and state agencies, their state licensing board(s), and their liability carrier. Some frequently asked questions follow.

While the situation is dynamic, good psychological practice remains unchanged. The changing landscape in states regarding access to reproductive health care does not change the fundamental approach to psychological care. Psychologists should continue to prioritize the welfare of their patients, protect confidentiality, and ensure their patients’ safety.

Practicing in states with changing abortion laws

Am I practicing in a state where abortion is, or is soon to be, illegal under all or certain circumstances?

The Supreme Court’s decision to overturn Roe v. Wade has put the regulation of abortion in the hands of states. In anticipation of the ruling, 13 states enacted “trigger laws,” designed to ban or restrict abortion upon the Supreme Court’s reversal of Roe v. Wade. Not all trigger laws immediately kicked in, and some that did were immediately challenged in court, delaying their enforcement.

Staying current on laws affecting the states where you practice is important. For a list of existing abortion bans and restrictions within each state, the Center for Reproductive Rights has provided a map that is updated in real time. The Guttmacher Institute, a well-respected research group that collects information on abortion laws across the United States, also tracks current state abortion-related laws.

Wednesday, April 27, 2022

APA decries Florida guidance calling for withholding treatment for gender non-conforming children

American Psychological Association
Press Release
Originally release 21 APR 22

Warns that Florida document is based on flawed, cherry-picked research

WASHINGTON — Following is a statement by Frank C. Worrell, PhD, president of the American Psychological Association, reacting to new guidance issued by the Florida Department of Health opposing science-based treatment for gender non-conforming children:

“This memo from the Florida Department of Health distorts the psychological science regarding the treatment of gender non-conforming children. Research into the treatment of gender non-conforming individuals has found that withholding evidence-based treatments can be psychologically damaging, especially to children and youths who are struggling with their gender identity. Rates of self-injury, suicidal ideation and suicide attempts are much higher among gender dysphoric youth, ironically attributed to stress associated with non-affirming approaches to these very real issues.   

“The Florida memo relies not on science, but on biased opinion pieces and cherry-picked findings to support a predetermined viewpoint and create a narrative that is not only scientifically inaccurate but also dangerous.  

“The American Psychological Association urges both policymakers and psychological practitioners to follow APA’s carefully researched ‘Guidelines for Psychological Practice With Transgender and Gender Nonconforming People (PDF, 461KB),’ which call for ‘culturally competent, developmentally appropriate, and trans-affirmative psychological practice’ with such individuals, including minors.

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Please note: Psychologists are bound by APA's Ethical Principles of Psychologists and Code of Conduct and Practice Guidelines.

Psychologists may want to contemplate the concept of Conscientious Objector status to laws and regulations that conflict with ethical obligations and moral beliefs.

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.

Friday, August 23, 2019

Medical Acts and Conscientious Objection: What Can a Physician be Compelled to Do?

Nathan K. Gamble and Michael Pruski
The New Bioethics
DOI: 10.1080/20502877.2019.1649871

Abstract

A key question has been underexplored in the literature on conscientious objection: if a physician is required to perform ‘medical activities,’ what is a medical activity? This paper explores the question by employing a teleological evaluation of medicine and examining the analogy of military conscripts, commonly cited in the conscientious objection debate. It argues that physicians (and other healthcare professionals) can only be expected to perform and support medical acts – acts directed towards their patients’ health. That is, physicians cannot be forced to provide or support services that are not medical in nature, even if such activities support other socially desirable pursuits. This does not necessarily mean that medical professionals cannot or should not provide non-medical services, but only that they are under no obligation to provide them.

Friday, May 12, 2017

Physicians, Not Conscripts — Conscientious Objection in Health Care

Ronit Y. Stahl and Ezekiel J. Emanuel
N Engl J Med 2017; 376:1380-1385

“Conscience clause” legislation has proliferated in recent years, extending the legal rights of health care professionals to cite their personal religious or moral beliefs as a reason to opt out of performing specific procedures or caring for particular patients. Physicians can refuse to perform abortions or in vitro fertilization. Nurses can refuse to aid in end-of-life care. Pharmacists can refuse to fill prescriptions for contraception. More recently, state legislation has enabled counselors and therapists to refuse to treat lesbian, gay, bisexual, and transgender (LGBT) patients, and in December, a federal judge issued a nationwide injunction against Section 1557 of the Affordable Care Act, which forbids discrimination on the basis of gender identity or termination of a pregnancy.

The article is here, and you need a subscription.

Here is an excerpt:

Objection to providing patients interventions that are at the core of medical practice – interventions that the profession deems to be effective, ethical, and standard treatments – is unjustifiable (AMA Code of Medical Ethics [Opinion 11.2.2]10).

Making the patient paramount means offering and providing accepted medical interventions in accordance with patients’ reasoned decisions. Thus, a health care professional cannot deny patients access to medications for mental health conditions, sexual dysfunction, or contraception on the basis of their conscience, since these drugs are professionally accepted as appropriate medical interventions.

Monday, January 23, 2017

Selling conscience short: a response to Schuklenk and Smalling on conscientious objections by medical professionals

Jocelyn Maclure & Isabelle Dumont
J Med Ethics doi:10.1136/medethics-2016-103903

Abstract

In a thought-provoking paper, Schuklenk and Smalling argue that no right to conscientious objection should be granted to medical professionals. First, they hold that it is impossible to assess either the truth of conscience-based claims or the sincerity of the objectors. Second, even a fettered right to conscientious refusal inevitably has adverse effects on the rights of patients. We argue that the main problem with their position is that it is not derived from a broader reflection on the meaning and implications of freedom of conscience and reasonable accommodation. We point out that they collapse two related but distinct questions, that is, the subjective conception of freedom of conscience and the sincerity test. We note that they do not successfully show that the standard norm according to which exemption claims should not impose undue hardship on others is unworkable. We suggest that the main reason why arguments such as no one is forced to be a medical professional are flawed is that public norms should not constrain citizens to choose between two of their basic rights unless it is necessary. In fine, Schuklenk and Smalling, who see conscience claims as arbitrary dislikes, sell freedom of conscience short and forego any attempts at balancing the competing rights involved. We maintain the authors neglect that most of legal reasoning is contextual and that the blanket restriction of healthcare professionals' freedom of conscience is disproportionate.

The article is here.

Saturday, November 23, 2013

The Moral Responsibility of Volunteer Soldiers

Should they say no to fighting in an unjust war?

Jeff McMahan
The Boston Review
Wednesday, November 6, 2013

Here is an excerpt:

Traditional Just War Theory

The idea that voluntary enlistment in the military can be morally problematic derives from a neglected tradition of just war thinking. This approach to the ethics of war informed the work of some of the classical just war theorists, such as the 16th century Spanish philosophers Francisco de Vitoria and Francisco Suárez. It was, however, gradually abandoned by thinkers whose views together constitute what I call “traditional just war theory.” The traditional theory has been ascendant since at least the 18th century, but the older approach has recently been resurrected by a group of “revisionists.” The best way to understand revisionist just war theory is to contrast it with the traditional theory, which has had a profound influence in shaping common sense thinking about the ethics of war, in part because it was developed in tandem with the international law of armed conflict.

According to traditional just war theory, a soldier does no wrong by fighting in an unjust war, provided that he or she obeys the rules regulating the conduct of war. This theoretical idea finds powerful expression in public sentiments. For centuries it has been regarded as not merely permissible but conspicuously noble and admirable for a soldier to go to war without any concern for whether the war’s cause was just.

The entire article is here.