Keywords
access to legal contraception
reproductive and sexual human rights
women’s rights
Moral Competence Test
thought experiment
How to Cite
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Abstract
This article recommends the promotion of moral competence in the health and pharmacy professions to enable them to respect human and patient health rights with a focus on the provision of reproductive and sexual health care services. In certain cultures, health care and drug providers follow their conscientious objection (conscience clause) and decline to perform specific health services, including the provision of legal contraceptives in cases protected by legal and human rights. Such malpractices may violate patients’ and purchasers’ legitime rights. The article also presents findings obtained in Poland with N=121 women experimentally interviewed to examine their experiences as contraception purchasers, to assess their preference concerning facing human vs. robotic pharmacists, to manage the risk of refusal argued by the conscientious objection, and to score their moral competence with one of the dilemmas included in the MCT by G. Lind. This study demonstrated that purchasers with higher C-score (C for moral competence) would not just prefer a robotic pharmacist without a ‘conscience’ but, rather, a competent sales staff able to instruct the patient and advice her on any related queries. It further results that participants with higher moral competence are thus less likely to trust the medical expertise of artificial intelligence. We conclude that public institutions in pluralistic societies must manage normative reproductive health contexts more inclusively, and the election, education, and practice of health professionals in the public health care sector require the development of a normative mindset toward respecting the rights of all patients instead of respecting them selectively at the diktat of particularistic conscience.
References
Achey T. S. & Robertson A. T. 2021. “Conscientious Objection: A Review of State Pharmacy Laws and Regulations,” Hospital Pharmacy 57(2):268–272. DOI: https://doi.org/10.1177/00185787211024217
American Medical Association 2006. „Broader Conscience Clauses Would Expand Physicians’ Right of Refusal.” URL: www.amaassn.org/amednews/2006/03/06/prl20306.htm (retrieved 1 March 2021).
Bozeman B. 2018. “Public Values: Citizens’ Perspective,” Public Management Review 21(6):817–838. DOI: https://doi.org/10.1080/14719037.2018.1529878
Bradley C. T. 2009. “Emergency Contraception and Physicians’ Rights of Conscience: A Review of Current Legal Standards in Wisconsin,” WMJ 108(3):156–160. PMID: 19552354.
Carr B., Gates M. F., Mitchell A., & Shah R. 2012. “Giving Women the Power to Plan Their Families,” The Lancet 380:80–82. DOI: https://doi.org/10.1016/S0140-6736(12)60905-2
Cartwright T. & Nancarrow C. 2022. „A Question of Gender: Gender Classification in International Research,” International Journal of Market Research 64(5):575–593. DOI: https://doi.org/10.1177/14707853221108663
Curlin F. A. et al. 2004. ”Religion, Conscience, and Controversial Clinical Practices,” The New England Journal of Medicine 356:593–600. DOI: https://doi.org/10.1056/NEJMsa065316
Drozd M. 2013. “Right of the Pharmacist to Conscientious Objection in Light of the Applicable of Legal Regulations,” Law, Constitution, Jurisprudence 16:267–280.
Erstad B. L. 2019. “The Conscience of a Pharmacist,” American Journal of Pharmaceutical Education 83(2):7301. DOI: https://doi.org/10.5688/ajpe7301
Flynn D. 2008. “Pharmacist Conscience Clauses and Access to Oral Contraceptives,” Journal of Medical Ethics 34(7):517–520. DOI: https://doi.org/10.1136/jme.2007.021337
Field H. M. 2000. “Increasing Access to Emergency Contraceptive Pills Through State 27 Law Enabled Dependent Pharmacist Prescribers,” UCLA Women’s Law Journal 11(1):141–253. DOI: https://doi.org/10.5070/L3111017747
Gyrd-Hansen D. 2004. “Investigating the Social Value of Health Changes,” Journal of Health Economics 23(6):1101–1116. DOI: https://doi.org/10.1016/j.jhealeco.2004.02.002
Habermas J. 2003. Truth and Justification, trans. B. Fultner. Cambridge, Mass.: The MIT Press.
Habermas J. 1988. Legitimation Crisis, trans. T. McCarthy. Cambridge, UK: Polity Press.
Hegel G. W. F. 2009. Grundlinien der Philosophie des Rechts, hg. von K. Grotsch & E. Weisser-Lohmann, GW, Bd. 14,1. Copy Rights by Nordrhein-Westfälische Akademie der Wissenschaften und der Künste, Düsseldorf. Hamburg: Felix Meiner. DOI: https://doi.org/10.28937/978-3-7873-3395-0
Hegel G. W. F. 1993. Der Begriff der Religion, in idem, Vorlesungen über die Philosophie der Religion. Einleitung. Der Begriff der Religion, hg. von W. Jaeschke, Hamburg: Felix Meiner. DOI: https://doi.org/10.28937/978-3-7873-2622-8
Herbe D. W. 2002. ”The Right to Refuse: A Call for Adequate Protection of a Pharmacist’s Right to Refuse Facilitation of Abortion and Emergency Contraception,” Journal of Law and Health 17(1):76–102.
Huijbregts R., George B., & Bekkers V. 2022. “Public Values Assessment as a Practice: Integration of Evidence and Research Agenda,” Public Management Review 24(6):840–859. DOI: https://doi.org/10.1080/14719037.2020.1867227
Kickbusch I. 2004. ”From Charity to Rights: Proposal for Five Action Areas of Global Health,” Journal of Epidemiol Community Health 58:630–631. DOI: https://doi.org/10.1136/jech.2004.021121
Kubicki L. 2008. „Sumienie lekarza jako kategoria prawna,” Prawo i Medycyna 4(1):5–7.
Lind G. 2000. “Moral Regression in Medical University Students and Their Learning Environment,” Revista Brasileira de Educação Medica 24(3):24–33.
Lind G. 2005. “The Cross-Cultural Validity of the Moral Judgment Test: Findings from 28 Cross-cultural Studies,” paper presented at the APA Congress, August 18-21, 2005. Washington, D.C.
Lind G. et al. 2010. “Testing for Moral Judgment Competence,” in G. Lind et al. (Eds.), Moral Judgment and Social Education (pp. 79–105). Rutgers, NJ: Transaction. DOI: https://doi.org/10.4324/9781003419273-5
Lind G. 2012. “Moral Competence and Democratic Ways of Life,” in W. G. Weber et al. (Eds.), Democratic Competences and Social Practices (pp. 62–85). Springer VS. DOI: https://doi.org/10.1007/978-3-531-19631-2_5
Lind G. 2019. How to Teach Moral Competence. New: Discussion Theater. Berlin: Logos.
Luhmann N. 1965. „Die Gewissensfreiheit und das Gewissen,“ Archiv des Öffentlichen Rechts 90(3):257–286.
Major M. F. 1992. “Conscientious Objection and International Law: A Human Right?,” Case Western Reserve Journal of International Law 24(2):349–378.
McGraw B. 2010. “Public Reason and Religious Conflict,” in Faith in Politics: Religion and Liberal Democracy (pp. 126–175). Cambridge University Press. DOI: https://doi.org/10.1017/CBO9780511760365.005
Merks P. et al. 2015. „Conscience Clause for Pharmacists from the Perspective of Pharmacists Working in Poland and in the UK,” Farmacja Polska 71(8):2–9.
Mishtal J. 2009. “Matters of ‘Conscience’,” Medical Anthropology Quarterly 23(2):161–183. DOI: https://doi.org/10.1111/j.1548-1387.2009.01053.x
Nelson J. 2005. „Freedom of Choice for Everyone: The Need for Conscience Clause Legislation for Pharmacists,” University of St Thomas Law Journal 3(1), #8.
Nowak E., Barciszewska A.-M., Lind G., Hemmerling K., & Kukolja-Taradi S. 2020. „What Would Hippocrates Say? Improving Moral Competence in Prospective Health Care Providers 1985-2020,” paper presented at the Annual Meeting “The Power and Possibilities for the Public Good When Researchers and Organizational Stakeholders Collaborate,” American Educational Research Association (AERA), San Francisco, April 8-12, 2021. DOI: https://doi.org/10.3102/1690973
Ogorevc M., Murovec N. et al. 2019. “Questioning the Differences between General Public vs. Patient Based Preferences Towards EQ-5D-5L defined Hypothetical Health States,” Health Policy 123(2):166–172. DOI: https://doi.org/10.1016/j.healthpol.2017.03.011
Orr Z. et al. 2021. „The Challenges and Dilemmas of Local Translators of Human Rights: The Case of Disability Rights among Jewish Ultra-Orthodox Communities,“ Journal of Human Rights 20(3):339–355. DOI: https://doi.org/10.1080/14754835.2020.1868294
Pellegrino E. D. 2002. “A Physician’s Conscience, Conscience Clauses, and Religious Belief: A Catholic Perspective,” Fordham Urban Law Journal 30(1):221–244. URL: https://ir.lawnet.fordham.edu/ulj/vol30/iss1/13
Piecuch A., Gryka M., Kozłowska-Wojciechowska M. 2014. “Attitudes towards Conscientious Objection among Community Pharmacists in Poland,” International Journal of Clinical Pharmacy 36(2):310–315. DOI: https://doi.org/10.1007/s11096-013-9878-5
Polis C. B., Bradley S. E. K., Bankolea A. et al. 2016. “Typical-Use Contraceptive Failure Rates in 43 Countries with Demographic and Health Survey Data: Summary of a Detailed Report,” Contraception 94(1):11–17. DOI: https://doi.org/10.1016/j.contraception.2016.03.011
Puppinck G. 2017. “Conscientious Objection and Human Rights. A Systematic Analysis,” Law and Religion 1(1):1–75. DOI: https://doi.org/10.1163/9789004341609
Rudolf E. I. 2016. “Zdrowie reprodukcyjne kobiet – rozważania terminologiczne,” in A. Szlagowska (Ed.), Problemy zdrowia reprodukcyjnego kobiet. Wstęp do badań (pp. 9–26). Quaestio/Medical University of Wrocław.
Soo Hyun Lim, Hae In Jang, Dong-Yun Lee et al. 2016. “Recent Trends in Contraceptive Use Among Korean Adolescents: Results from a Nationwide Survey from Year 2013 to 2015,” Obstetrics and Gynecology Science 59(6):519–524. DOI: https://doi.org/10.5468/ogs.2016.59.6.519
Stahl R. Y. & Emanuel E. J. 2017. “Physicians, Not Conscripts – Conscientious Objection in Health Care,” The New England Journal of Medicine 376:1380–1385. DOI: https://doi.org/10.1056/NEJMsb1612472
Tiernan B. K. 2021. “Reevaluating Conscience Clauses,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 46(3):297–312. DOI: https://doi.org/10.1093/jmp/jhab005
Wicclair M. R. 2006. „Pharmacies, Pharmacist and Conscientious Objection,” Kennedy Institute Ethics Journal 16(3):225–250. DOI: https://doi.org/10.1353/ken.2006.0020
Wilkinson D., Truog R. & Savulescu J. 2016. “In Favour of Medical Dissensus: Why We Should Agree to Disagree About End-of-Life Decisions,” Bioethics 2:109–118. PMCID: PMC4864446. DOI: https://doi.org/10.1111/bioe.12162
Yoder J. D. 2007. „Pharmacists’ Right of Conscience: Strategies for Showing Respect for Pharmacists’ Beliefs While Maintaining Adequate Care for Patients,” Valparaiso University Law Review 41(2):975–1025.
Zielińska E. 2000. ”Between Ideology, Politics, and Common Sense: The Discourse of Reproductive Rights in Poland,” in S. Gal & G. Klingman (Eds.), Reproducing Gender: Politics, Publics, and Everyday Life after Socialism (pp. 23–57). Princeton: Princeton University Press. DOI: https://doi.org/10.1515/9780691228013-003
Żuradzki T. 2016. ”Uzasadnienie sprzeciwu sumienia: lekarze, poborowi, żołnierze,” Diametros 47:98–128.
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