Category: Ethics

Manitoba medical student expelled over ‘pro-gun and pro-life’ Facebook posts wins court ruling

Rafael Zaki said he was expelled for his conscientious and religious beliefs. The judge said the university appeared biased in its decision

The National Post

Tyler Dawson

A Manitoba medical student who was expelled after failing to satisfactorily apologize for his controversial views on guns and abortion has been granted a new adjudication of his expulsion.

Rafael Zaki, a Coptic Orthodox student at the University of Manitoba who was supposed to graduate in 2022, posted three items on his Facebook page in February 2019. He was expelled in August 2019

One year later, after losing two appeals within the university system, Zaki asked Manitoba’s Court of Queen’s Bench to review the decision made by the University Discipline Committee. Zaki said he was expelled “for holding conscientious and religious beliefs that abortion is harmful.” . . . continue reading

Joint statement in support of COVID-19 vaccine mandates for all workers in health and long-term care

News Release

For immediate release
Contact: APHA Media Relations, 202-777-3913

American Public Health Association

Due to the recent COVID-19 surge and the availability of safe and effective vaccines, our health care organizations and societies advocate that all health care and long-term care employers require their workers to receive the COVID-19 vaccine. This is the logical fulfillment of the ethical commitment of all health care workers to put patients as well as residents of long-term care facilities first and take all steps necessary to ensure their health and well-being.

Because of highly contagious variants, including the Delta variant, and significant numbers of unvaccinated people, COVID-19 cases, hospitalizations and deaths are once again rising throughout the United States.1 Vaccination is the primary way to put the pandemic behind us and avoid the return of stringent public health measures.

Unfortunately, many health care and long-term care personnel remain unvaccinated. As we move toward full FDA approval of the currently available vaccines, all health care workers should get vaccinated for their own health, and to protect their colleagues, families, residents of long-term care facilities and patients. This is especially necessary to protect those who are vulnerable, including unvaccinated children and the immunocompromised. Indeed, this is why many health care and long-term care organizations already require vaccinations for influenza, hepatitis B, and pertussis.

We call for all health care and long-term care employers to require their employees to be vaccinated against COVID-19.

We stand with the growing number of experts and institutions that support the requirement for universal vaccination of health workers.2,3 While we recognize some workers cannot be vaccinated because of identified medical reasons and should be exempted from a mandate, they constitute a small minority of all workers. Employers should consider any applicable state laws on a case-by-case basis.

Existing COVID-19 vaccine mandates have proven effective.4,5 Mandates are an essential policy to increase vaccination rates in health care and long-term care settings and protect the health care workforce and the patients and residents we serve. Simultaneously, we recognize the historical mistrust of health care institutions, including among many in our own health care workforce. We must continue to address workers’ concerns, engage with marginalized populations, and work with trusted messengers to improve vaccine acceptance.

As the health care community leads the way in requiring vaccines for our employees, we hope all other employers across the country will follow our lead and introduce effective policies to encourage vaccination. The health and safety of U.S. workers, families, communities, and the nation depends on it.

SIGNATORIES (listed alphabetically)

Academy of Managed Care Pharmacy
American Academy of Ambulatory Care Nursing
American Academy of Child and Adolescent Psychiatry
American Academy of Family Physicians
American Academy of Nursing
American Academy of Ophthalmology
American Academy of PAs
American Academy of Pediatrics
American Association of Allergy, Asthma & Immunology
American Association of Clinical Endocrinology
American Association of Colleges of Pharmacy
American Association of Neuroscience Nurses
American College of Clinical Pharmacy
American College of Physicians
American College of Preventive Medicine
American College of Surgeons
American Epilepsy Society
American Medical Association
American Nursing Association
American Pharmacists Association
American Psychiatric Association
American Public Health Association
American Society for Clinical Pathology
American Society for Radiation Oncology
American Society of Health-System Pharmacists
American Society of Hematology
American Society of Nephrology
American Thoracic Society
Association for Clinical Oncology
Association for Professionals in Infection Control and Epidemiology
Association of Academic Health Centers
Association of American Medical Colleges
Association of Rehabilitation Nurses
Council of Medical Specialty Societies
HIV Medicine Association
Infectious Disease Society of America
LeadingAge
National Association of Indian Nurses of America
National Association of Pediatric Nurse Practitioners
National Council of State Boards of Nursing
National Hispanic Medical Association
National League for Nursing
National Medical Association
National Pharmaceutical Association
Nurses Who Vaccinate
Organization for Associate Degree Nursing
Pediatric Infectious Diseases Society
Philippine Nurses Association of America, Inc
Society of Gynecological Oncology
Society for Healthcare Epidemiology of America
Society of Hospital Medicine
Society of Infectious Diseases Pharmacists
Society of Interventional Radiology
Texas Nurses Association
The John A. Hartford Foundation
Transcultural Nursing Society
Virgin Islands State Nurses Association
Wound, Ostomy, and Continence Nurses Society

REFERENCES

1. Centers for Disease Control and Prevention. Covid Data Tracker Weekly Review.
2. Weber, D., Al-Tawfiq, J., Babcock, H., Bryant, K., Drees, M., Elshaboury, R., et al. (2021). Multisociety Statement on COVID-19 Vaccination as a Condition of Employment for Healthcare Personnel. Infection Control & Hospital Epidemiology, 1-46. doi:10.1017/ice.2021.322
3. American Hospital Association. AHA Policy Statement on Mandatory COVID-19 Vaccination of Health Care Personnel
4. Hospitals in DC, across the nation follow Houston Methodist in requiring vaccination for workers (USA Today)
5. More Nursing Homes Are Requiring Staff COVID-19 Vaccinations (AARP)

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The American Public Health Association champions the health of all people and all communities. We are the only organization that combines a nearly 150-year perspective, a broad-based member community and the ability to influence federal policy to improve the public’s health. Learn more at www.apha.org.

Submission to the World Medical Association

Public Consultation on a draft devised version of the International Code of Medical Ethics

The Anscombe Bioethics Centre

The Anscombe Bioethics Centre

The Anscombe Bioethics Centre is the oldest national bioethics centre in the United Kingdom, established in 1977 by the Roman Catholic Archbishops of England and Wales. It was originally known as The Linacre Centre for Healthcare Ethics and was situated in London before moving to Oxford. The Centre engages with the moral questions arising in clinical practice and biomedical research. It brings to bear on those questions principles of natural law, virtue ethics, and the teaching of the Catholic Church, and seeks to develop the implications of that teaching for emerging fields of practice. The Centre engages in scholarly dialogue with academics and practitioners of other traditions. It contributes to public policy debates as well as to debates and consultations within the Church.

A key issue: conscientious objection

For the first time this draft Code introduces the idea of “conscientious objection”:

Paragraph 27 reads:

Physicians have an ethical obligation to minimise disruption to patient care. Conscientious objection must only be considered if the individual patient is not discriminated against or disadvantaged, the patient’s health is not endangered, and undelayed continuity of care is ensured through effective and timely referral to another qualified physician.*

* This paragraph will be debated in greater detail at the WMA’s dedicated conference on the subject of conscientious objection in 2021 or 2022. However, comments on this paragraph are also welcome at this time.

Unfortunately, this is deeply problematic as a statement of the rights of conscience in medicine. In the first place it utterly fails to establish the duty of doctors to object to practices and procedures that are unconscionable because harmful, discriminatory, unjust or unethical. The right to conscientious objection is based on the duty to be conscientious which is fundamental to medical ethics. . . continue reading

Comment on the draft International Code of Medical Ethics of the World Medical Association

European Institute of Bioethics

In the context of the International Code of Medical Ethics’ revision, the European Institute of Bioethics (EIB) would like to share some comments with the World Medical Association (WMA) Assembly on paragraph 27 of the draft.

Since 2001, the European Institute of Bioethics has developed an expertise in healthcare ethics, with a special focus on the right of healthcare practitioners to freedom of conscience in their practice.

We acknowledge that the International Code of Medical Ethics (hereafter: the Code) is not a binding instrument for the WMA member states. However, one cannot deny the considerable influence the Code may have on national codes of deontology and even on national laws. Moreover, physicians and healthcare organizations expect from the WMA to promote the highest quality of healthcare relationship between physicians and patients.

Paragraph 27 of the Code is drafted as follows:

Physicians have an ethical obligation to minimise disruption to patient care. Conscientious objection must only be considered if the individual patient is not discriminated against or disadvantaged, the patient’s health is not endangered, and undelayed continuity of care is ensured through effective and timely referral to another qualified physician.

In the following note, we discuss one by one the different parts of this paragraph which we consider, written as such, highly problematic for the physicians’ rights and the patients’ care. . . continue reading

The ethical minefield of COVID-19 vaccination: Informed consent and the obligations of doctors

Australian Broadcasting Corporation

Margaret Somerville

The ethical minefield of COVID-19 vaccination: Informed consent and the obligations of doctors

The COVID-19 pandemic has raised a multitude of complex ethical issues — and new ones present themselves daily. These issues, including those related to vaccination, arise at four levels: micro or individual (for example, when a doctor vaccinates a patient); meso or institutional (regarding, for instance, a hospital’s or aged care residence’s policy on vaccinating staff); macro or societal ( a government’s decisions or public health regulations governing distribution of vaccines and access to vaccination); and mega or global (such as a nation’s obligations to provide vaccines to those in developing countries, which are without vaccines).

In many COVID-19 related decision-making situations at each of these levels, decision makers face what is called in bioethics a “world of competing sorrows” — that is, decision making in which there is no “no harm” option, but in which, instead, they must choose to whom harm will be allocated. The ethical difficulties are exacerbated when the harms and benefits do not accrue to the same people or, at least, not in equal measure. A striking example of such a situation at the macro or societal level would be the use of “lockdowns”, when the choice is between protecting public health and inflicting serious economic harm.

What I want to focus on here is a particular micro- level issue: that of a healthcare professional’s obligation to obtain a person’s informed consent to COVID-19 vaccination.

Failure to obtain an informed consent to, or an informed refusal of, medical treatment — which includes vaccination — is medical negligence (medical malpractice). Informed consent to or refusal of medical treatment has three requirements: competence, information, and voluntariness. There is a wealth of research on what is needed to establish each element, but here is a brief summary. . . Continue reading