A Matter of Conscience: Examining the Law and Policy of Conscientious Objection in Health Care

2020 ◽  
Vol 21 (2) ◽  
pp. 120-126
Author(s):  
Eileen K. Fry-Bowers
Keyword(s):  
Health Care ◽  
Civil Rights ◽  
Standard Of Care ◽  
Reproductive Technologies ◽  
Conscientious Objection ◽  
Health Care Facilities ◽  
Moral Disagreement ◽  
Moral Integrity ◽  
Sexually Transmitted ◽  
Medication Assisted Treatment

Conscientious objection refers to refusal by a health care provider (HCP) to provide certain treatments, including the standard of care, to a patient based upon the provider’s personal, ethical, or religious beliefs. Federal and state rules regarding conscientious objection have expanded the scope of legal protections that HCPs and institutions can invoke in support of refusal. Opponents of these rules argue that allowing refusal of care deprives patients of care that conforms to professionally established guidelines, contradicts long-standing principles related to informed consent, interferes with the ability of health care facilities to provide safe and efficient care, and leaves the patient without means of redress for injury. Proponents respond that such rules are necessary to preserve the moral integrity of providers, including institutions. Although refusal rules are most often associated with abortion, some HCPs have cited moral concerns regarding contraception, sterilization, prevention/treatment of sexually transmitted infections, transition-related care for transgender individuals, medication-assisted treatment of substance use disorders, the use of artificial reproductive technologies, and patient preferences for end-of-life care. Evidence suggests that the burden of conscientious refusal falls disproportionately on vulnerable populations, and legitimate concern exists that moral disagreement is merely pretext for discrimination. A careful balance must be struck between the defending the conscience rights of HCPs and the civil rights of patients.

scholarly journals Increased integrated testing for HIV, hepatitis C and sexually transmitted infections in health care facilities: results from the INTEGRATE Joint Action pilots in Lithuania, Romania and Spain

2021 ◽  
Vol 21 (S2) ◽  
Author(s):  
R. Matulionytė ◽  
M. L. Jakobsen ◽  
V. I. Grecu ◽  
J. Grigaitiene ◽  
T. Raudonis ◽  
...  
Keyword(s):  
Health Care ◽  
Hiv Testing ◽  
Sexually Transmitted Infections ◽  
Health Care Facilities ◽  
Alcohol Dependency ◽  
Pilot Studies ◽  
Sexually Transmitted ◽  
Integrated Testing ◽  
Care Facilities ◽  
Hcv Testing

Abstract Background Indicator condition guided HIV testing is a proven effective strategy for increasing HIV diagnosis in health care facilities. As part of the INTEGRATE Joint Action, we conducted four pilot studies, aiming to increase integrated testing for HIV/HCV/HBV and sexually transmitted infections, by introducing and expanding existing indicator condition guided HIV testing methods. Methods Pilot interventions included combined HIV/HCV testing in a dermatovenerology clinic and a clinic for addictive disorders in Lithuania; Increasing HIV testing rates in a tuberculosis clinic in Romania by introducing a patient information leaflet and offering testing for HIV/HCV/sexually transmitted infections to chemsex-users in Barcelona. Methods for implementing indicator condition guided HIV testing were adapted to include integrated testing. Testing data were collected retrospectively and prospectively. Staff were trained in all settings, Plan-do-study-act cycles frequently performed and barriers to implementation reported. Results In established indicator conditions, HIV absolute testing rates increased from 10.6 to 71% in the dermatovenerology clinic over an 18 months period. HIV testing rates improved from 67.4% at baseline to 94% in the tuberculosis clinic. HCV testing was added to all individuals in the dermatovenerology clinic, eight patients of 1701 tested positive (0.47%). HBV testing was added to individuals with sexually transmitted infections with a 0.44% positivity rate (2/452 tested positive). The Indicator condition guided HIV testing strategy was expanded to offer HIV/HCV testing to people with alcohol dependency and chemsex-users. 52% of chemsex-users tested positive for ≥ 1 sexually transmitted infection and among people with alcohol dependency 0.3 and 3.7% tested positive for HIV and HCV respectively. Conclusions The four pilot studies successfully increased integrated testing in health care settings, by introducing testing for HBV/HCV and sexually transmitted infections along with HIV testing for established indicator conditions and expanding the strategy to include new indicators; alcohol dependency and chemsex. HCV testing of individuals with alcohol abuse showed high positivity rates and calls for further implementation studies. Methods used for implementing indicator condition guided HIV Testing have proven transferable to implementation of integrated testing.

scholarly journals An ethical issue: nurses’ conscientious objection regarding induced abortion in South Korea

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Chung Mee Ko ◽  
Chin Kang Koh ◽  
Ye Sol Lee
Keyword(s):  
Health Care ◽  
South Korea ◽  
Health Care Professionals ◽  
Conscientious Objection ◽  
Constitutional Court ◽  
Moral Integrity ◽  
Perioperative Nurses ◽  
National Health Care ◽  
Nursing Leaders ◽  
Legal Reforms

Abstract Background The Constitutional Court of South Korea declared that an abortion ban was unconstitutional on April 11, 2019. The National Health Care System will provide abortion care across the country as a formal medical service. Conscientious objection is an issue raised during the construction of legal reforms. Methods One hundred sixty-seven perioperative nurses responded to the survey questionnaire. Nurses’ perception about conscientious objection, support of legislation regarding conscientious objection, and intention to object were measured. Logistic regression was used to explore the factors associated with support of the legislation and the intention to conscientiously object. Results Only 28.8% of the responding nurses were aware of health care professionals’ conscientious objection. The majority (68.7%) felt that patients’ rights should be prioritized over health care professionals’ conscientious objection. On the other hand, 45.8% supported the legislation on conscientious objection to abortion, and 42.5% indicated a willingness to refuse to participate in an abortion case if conscientious objection was permitted. Religion, awareness of conscientious objection, and prioritizing of nurses’ right to conscientious objection were significantly associated with supporting the legislation. Moreover, religion and prioritizing nurses' rights were significantly associated with the intention to conscientiously object. Conclusions This study provides information necessary for further discussion of nurses’ conscientious objection. Nursing leaders, researchers, and educators should appeal to nurses and involve them in making policies that balance a women's right to non-discrimination and to receiving appropriate care with nurses' rights to maintain their moral integrity without compromising their professional obligation.

scholarly journals Acceptability and feasibility of self-sampling for the screening of sexually transmitted infections in cabana privacy shelters

2017 ◽  
Vol 29 (5) ◽  
pp. 461-465 ◽  
Author(s):  
Ellen Pittman ◽  
Hillary Purcell ◽  
Laura Dize ◽  
Charlotte Gaydos ◽  
Sherine Patterson-Rose ◽  
...  
Keyword(s):  
Health Care ◽  
Sexually Transmitted Infections ◽  
Health Care Access ◽  
Health Care Facilities ◽  
Sample Collection ◽  
Sexually Transmitted ◽  
Care Access ◽  
Before And After ◽  
Participant Characteristics ◽  
Doctor's Office

Screening for sexually transmitted infections (STIs) outside of traditional health-care facilities is limited by the privacy needed for sample collection. We explored the acceptability of privacy shelters for the self-collection of genital swabs and tested the use of privacy shelters during mobile STI screening. Attendees ≥14 years old at two outdoor community events completed a questionnaire that assessed participant characteristics, health-care access, and rating of acceptability of self-collecting penile or vaginal swabs in a privacy shelter and four other private spaces: portable restroom, health van, home, and doctor’s office. A privacy shelter was used during mobile STI screening. The majority (65%) of the 95 participants reported that using a privacy shelter was somewhat or very acceptable. No participant characteristics or health-care access factors were associated with the acceptability of privacy shelters. Women rated a privacy shelter more acceptable than a portable restroom or health van. Men rated a privacy shelter more acceptable than a portable restroom. During mobile STI screening, all 13 men and women who requested STI testing used the privacy shelter for self-sampling. Rating of acceptability before and after privacy shelter use was the same. Privacy shelters may enable STI screening without using a building or vehicle for sample collection.

Refining Surge Capacity: Conventional, Contingency, and Crisis Capacity

2009 ◽  
Vol 3 (S1) ◽  
pp. S59-S67 ◽  
Author(s):  
John L. Hick ◽  
Joseph A. Barbera ◽  
Gabor D. Kelen
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Care Facility ◽  
Health Care Facility ◽  
Standard Of Care ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Health Care Facilities ◽  
Surge Capacity ◽  
Care Facilities

ABSTRACTHealth care facility surge capacity has received significant planning attention recently, but there is no commonly accepted framework for detailed, phased surge capacity categorization and implementation. This article proposes a taxonomy within surge capacity of conventional capacity (implemented in major mass casualty incidents and representing care as usually provided at the institution), contingency capacity (using adaptations to medical care spaces, staffing constraints, and supply shortages without significant impact on delivered medical care), and crisis capacity (implemented in catastrophic situations with a significant impact on standard of care). Suggested measurements used to gauge a quantifiable component of surge capacity and adaptive strategies for staff and supply challenges are proposed. The use of refined definitions of surge capacity as it relates to space, staffing, and supply concerns during a mass casualty incident may aid phased implementation of surge capacity plans at health care facilities and enhance the consistency of terminology and data collection between facilities and regions. (Disaster Med Public Health Preparedness. 2009;3(Suppl 1):S59–S67)

Sexually transmitted diseases: a survey of case management in Malawi

1996 ◽  
Vol 7 (4) ◽  
pp. 269-275 ◽  
Author(s):  
D. A. Chilongozi ◽  
C. Costello ◽  
Daly L. Franco ◽  
N. G. Liomba ◽  
G. Dallabetta
Keyword(s):  
Health Care ◽  
Case Management ◽  
Health Care Providers ◽  
Transmitted Disease ◽  
Health Care Facilities ◽  
Observation Data ◽  
Care Providers ◽  
Patient Counselling ◽  
Sexually Transmitted ◽  
Genital Ulcers

A national survey of sexually transmitted disease (STD) case management was carried out at 39 health care facilities in Malawi in 1994. Fifty-four health care providers were observed managing 150 patients presenting with selected STD syndromes and 103 providers were interviewed. STD case management was assessed by calculation of WHO/GPA prevention indicators (PIs) from observation data. The overall rate for PI-6, which measures correct assessment and treatment of STD patients was 11% (81% for history taking, 46% in physical examination, and 13% correct antibiotic treatment according to national guidelines). The score for PI-7, which measures overall patient counselling was 29% (65% for partner notification and 40% for condom advice). Although Haemophilus ducreyi is at least as common as Treponema pallidum as the causative agent for genital ulcers, only 16% of patients with genital ulcers were treated effectively for chancroid vs 56% for syphilis. Female patients received less comprehensive care than male STD patients. Only 20% of STD patients were offered condoms. Overall, the survey results support the policy decision to adopt syndromic management of STDs, and provide baseline information for planning and evaluation of a national control programme.

ETHNOVETERINARY MEDICINAL USES OF SOME MEDICINAL PLANTS ON PNEUMONIA BY THE GUJJAR AND PAHARI TRIBES OF POONCH DISTRICT OF JAMMU AND KASHMIR

2017 ◽  
Vol 23 (2) ◽  
Author(s):  
JAMIL AHMED KHAN ◽  
RAJINDER PAUL
Keyword(s):  
Health Care ◽  
Medicinal Plants ◽  
Medicinal Plant ◽  
Natural Resources ◽  
Indigenous People ◽  
Health Care Facilities ◽  
Jammu And Kashmir ◽  
Medicinal Uses ◽  
Modern Health Care ◽  
Care Facilities

Poonch district of Jammu and Kashmir is a reservoir of enormous natural resources including the wealth of medicinal plants. The present paper deals with 12 medicinal plant species belonging to 8 genera of angiosperms used on pneumonia in cattle such as cows, sheep, goats and buffaloes in different areas of Poonch district. Due to poverty and nonavailability of modern health care facilities, the indigenous people of the area partially or fully depend on surrounding medicinal plants to cure the different ailments of their cattles. Further research on modern scientific line is necessary to improve their efficacy, safety and validation of the traditional knowledge.

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