Ishibashi: Conscientious Objection

Question 1

a physician’s willingness to put patients’ interests ahead of personal profit as well as a willingness to make personal sacrifices and assume some personal risk

Answer 1

fiduciary relationship

Question 2

Fiduciary relationships are guided by the principle of (blank)

Answer 2

beneficence

Question 3

When is it appropriate to refuse care for patients?

Answer 3

adversarial doctor-patient relationship
threat to personal safety
personal moral objections

Question 4

Provide some examples of times when physicians have felt a threat to personal safety

Answer 4

HIV
SARS (2002-2003)
H1N1

Question 5

laws that allow medical providers to refuse to provide services and medically necessary treatment to which they have religious or moral objections

Answer 5

conscious clauses - also known as refusal clauses

Question 6

Conscience clauses enacted in 1973 with what court case? What was the first conscience clause to be enacted into law? By 1978, virtually all states had enacted conscience clause legislation.

Answer 6

Roe vs Wade; 1973 Church Amendment

Question 7

In 1996, the law determined who is considered a health care entity. Who does this include? Recent legislation has been proposed to expand this definition.

Answer 7

Individual physicians, post-graduate physician training programs, and participants in health professional training programs.

Question 8

T/F: Most people believe that health professionals should not have to engage in medical practices about which they have moral qualms.

Answer 8

True

Question 9

T/F: Most also believe that patients should have access to legal treatments, even in situations in which their physicians are troubled about the moral implication of those treatments.

Answer 9

True

Question 10

Two conflicting forces

Answer 10

patient autonomy

right of conscience

Question 11

A patient’s right of autonomy does not trump the physician’s right to conscientiously abstain from a practice provided that:

Answer 11

(1) the physician provides the patient information that would allow her to seek care with another health care provider
(2) the physician’s refusal does not endanger the patient’s life or result in serious harm

Question 12

T/F: “In an emergency in which referral is not possible or might negatively have an impact on a patient’s physical or mental health, providers have an obligation to provide medically indicated and requested care.”

Answer 12

true

Question 13

T/F: Health care providers have a duty to perform procedures within the scope of their training when the patient’s health is at significant risk and an alternative health care professional is unavailable

Answer 13

true

Question 14

“Abortion . . . is never permitted. Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion.”
Contraception and tubal ligations are not permitted.
Controversy with regards to treatment of ectopic pregnancies

Answer 14

Catholic hospital directives

Question 15

Is autonomy an absolute?

Answer 15

no

Question 16

T/F: Physicians who, on the basis of conscience, refuse to provide particular treatments or services within the usual scope of practice for their specialty have an obligation to disclose this to potential patients. This knowledge may be important to patients in selecting physicians

Answer 16

true

Question 17

T/F: If patients are concerned about certain interventions for sexual and reproductive health and end of life care, they should ask their doctors ahead of time whether they will discuss such options.

Answer 17

true

Question 18

T/F: A physician my decline to accept applicants for their care on a wide variety of non-discriminatory grounds without assuming any responsibility to refer them to other health care professionals, but once a patient-physician or comparable relationship exists, however, the AMA, ACOG, AAP recognizes an ethical duty of referral. Courts may find it negligent or a breach of fiduciary duty for health care professionals to care for patients to whom they have not previously disclosed the procedures within their expected scope of practice that they will refuse to provide.

Answer 18

true

Question 19

T/F: When physicians were surveyed, 8% said no and 6% undecided when asked if they have the obligation to present all possible options to a patient who they have refused to provide care for.

Answer 19

True