CEU eTD Collection Hungary 9. Nadorutca 1051 Budapest, University Central European PROFESSOR: Judit Marcella Sándor Century First Twenty in the Rights Patients’ COURSE: THESIS SHORT LL.M. COMPARATIVE OBJECTIONS LEGAL ANALYSISOF CONSCIENTIOUS by Slavomíra Slovinská IN HEALTHCARE © Central © Central European University March 29,2010 CEU eTD Collection between the competing interests of health care professionals patient. and care professionals of interests health competing the between find balance to in appropriate order legislations national inbe theshouldof regulation met health care and finally, it suggests conditions andlimitations of conscientious objection that in objection conscientious acceptability of the on opinions different analyses also The thesis in consists vaguebutgeneral for clausefuture controversies. creating possibilities the limitations. Furthermore, it submits that regulation of conscientious objection in Slovakia objection certain with model regulation conscientious of of appropriate muchmorepresents objectionconscientious in far the USAcan go too andbeexcessive,too the while UK regulation majorand differences include. Thethesis which they suggests the protection that of such to of of USA, appropriateness UKwith the the respect the Republic Slovak and the legal in systems objection the of conscientious regulation the analyzes this thesis Therefore, health care. to access right individual’s and his conscience with toactin accordance right professional’s care – health the conflictinginterests two the between balance secure proper would however, legislations, of some countries’ national them fail toprovide which safeguards inmany areregulated These inhealth objections objections care. of regulation conscientious model would whatappropriate demonstrate the of bean The isto thesis this of purpose ABSTRACT i CEU eTD Collection ocuin...... 53 Conclusion Acceptability,limitation and the best model of regulation of conscientious ...... 40 objection CHAPTER III...... 40 of America, the United Kingdom and the ...... 15 Slovak Republic Regulation of conscientious objections in health care in the legal systems of the United States CHAPTER II...... 15 Conscientious objection and conflict of interests...... 5 CHAPTER I...... 5 INTRODUCTION...... 1 Table ...... 1 of Contents: i ABSTRACT...... Limitation of conscientious objection and the 3.2. best model for its ...... 47 regulation 3.1. Acceptability of conscientious objection and variety of opinions...... 40 precondition for future controversies...... 31 2.3.The Slovak Republic – The lack of specific regulation of conscientious objection as a rights and rights of patients...... 25 United2.2.The Kingdom – Way a fine to balance between conscientiousthe objectors’ expense of patients’ right toaccess health care...... 16 2.1. The United States of America – Excessive protection of conscientious objectors at the 1.2.Patients’ right toaccess ...... 10 to health care 1.1. Health Care Professional’s right toconscientiously object...... 7 K. Legally available remedies...... 52 J. Securing an appropriate number of non-objecting health care professionals...... 52 I. Limitation on the invocation of conscientious objection...... 51 H. Duty to refer the patient to a non-objecting health care professional...... 51 prognosis and possibilities furtherof ...... 50 treatment G. Disclosure of the information relating tohealth state of the patient, his diagnosis, F. Disclosure of procedures towards which conscientious objector objects...... 50 when invoking objection...... 49 E. Prohibition of discriminatory approach towards patients by objector conscientious that directly perform the objected service or directly participatein such service...... 49 D. Invocation of conscientious objection only with respect to health care professionals objection...... 48 C. Non-discriminatory specification of grounds for the invocation ...... 48 be invoked of conscientious B. Clear specification of health care services towards which conscientious objection can A. Conscientious objection as the right of individual...... 47 Table of Contents: i CEU eTD Collection which they which they are entitled. to having not health incare services resulting tothelegally available patients patient access conscientiously to abuse the andcause right the of towards object discriminative behavior in result they extensively used are if they hand other the on but reasonable, and lawful be can betend to the most invoking common forground such objection. Many these of objections patient rights. These objections can bebased on different grounds – however, religious beliefs the on influence negative a have not will treatment patient’s the to relating objection the that so responsibly and carefully very objections these approach to necessary is it Therefore, professional towardsthem. responsibility knowledge with respecthealth to health issues receive aparticular and to patient the interest of isan there theother, care on hisconscience with reciprocally service healthnot actin act to accordance or to careprofessional is health the interestof an hand,there one care professionals or law but also thetreatment. medicalbear ethics. Two competing interests are placed theagainst each other. On the medicine and of heart the into deeply only go not in health care does objection Conscientious Patients arehave many dreams, possessmany material butnonethings of them can equal health and life. dependant health valuesinconsequently are themost beings.People precious human of can possession on them area health the being of care. Oneis not surprised life why.Human andthus health of controversial most probablythe Yet, of life. human areas into other the penetrated quickly care professionals’it military services, performance of to respect with appeared originally Although, discuss. to term a new not but challenging is objection conscientious discussions, of topic hot a Being INTRODUCTION 1 CEU eTD Collection March 13, 2010 at: 3 2009, Vol. 25,No. 12, p. 133-144, p. 135 Medical Ethics Advisor,“ 2010 at: treatment or procedure on the basis of health worker’s conscience - however, in general in general way however, conscience- worker’s health onthebasis of procedure or treatment of refusal the regulates legislation national the country, post-communist typical Slovakia, lawsKingdom’s include limitation on conscientiousthe objection rights abuseconscientious the for the of chance the far and offering conscientiousinthe cases clauses objection and certain going Mississippi suchasthe too one regulation of has aheterogeneous USA be As inthis scope. the thesis, will shown narrower in in is or of health itinvokedcare either broader sphere beingthe the contrary, already the but yetin on appeared practice a phenomenon hasnot that is not objection conscientious However, even though are opinions these itmust well-founded, be thatremembered the have a duty to inform and refer a patient who approached them still health care professionals that heemphasizes sametime the at However, their conscience. and that for the health inhealth care objection is conscientious for a place that there believe FarrA.Curlin, example care professionals to refuse delivery of treatment contradicting with 2 1 peoplelegally availablebe to should andthusthey provided. care should be illegal inhealth objection conscientious that considers For example, Savulescu suggest compromise. and that it is the lawandclear-cut rather so arenot atall,medicine others in not haveaplace do contemporary which stipulates which disparity of While issignificant. opinions some opinions conscientious suggestthat objections health care servicesThe opinions on whether it should should or notbe allowed and ifso towhat extentare vary. The http://www.statutelaw.gov.uk/documents/1967/87/ukpga 4 analyzed inChapter 2.1. of paperthis Mississippi Health Care Rights of Conscience Act 2004,Section 2(a), 2(b), 3(2) and 3(3) last accessed on Curlin, FA, et al. “ J. Savulescu, “ Abortion Act 1967, section 4(1) and 4(2), last accessed on March 20, 2010 at: http://www.bmj.com/cgi/content/full/332/7536/294?ijkey=6NtRebQvp8GVGYn&keytype=ref Conscientious objection in medicine”, BMJ http://billstatus.ls.state.ms.us/documents/2004/html/SB/2600-2699/SB2619SG.htm Religion, Conscience and Controversial Clinical Practices Should health care providers have the rightof conscientious refusal 2 further analyzedChapter in 2.2. of paperthis 2006, 332, 294-297, last accessedMarchon 16, 2 . 1 Other authors, such as for .” 3 NEJM , on the other hand United 4 and in the example of example in the and . 356;6:593-600 ?”, December ?”, further in CEU eTD Collection http://jaspi.justice.gov.sk/jaspiw1/htm_zak/jaspiw_maxi_zak_fr0.htm regulations, Appendix 4- Code of ofEthics Medical the worker,by clauselater 3, available amended as at: laws, certain supplementing and amending and service, health the in organisations 5 objection certain with model regulation conscientious of of appropriate muchmorepresents protection excessive, objectionof farconscientious istoo thus can gotoo and theUK that US the that will beshown It Republic. Slovak the and Kingdom United the America, of States objections with respectThus, the aim of this paperisanalyse to the appropriateness to of the regulation of conscientiousreproductive health care services thesein days are the end-of-lifethe decisions, however, these will not belegislation discussed in this of paper. issue controversial Another contraception. emergency and procedures of abortion the provide the United refusalto the to with respect –especially services reproductive sphere - controversial its most in objections theconscientious will analyse inmy I thesis is broad, care health of As thearea in place. first the is patients the care about that fact the respecting sametime the at course of their conscience, services in country the on while other hand wouldnotcompel act contrary to doctors to access individualsthe legally timely to the and proper health available reproductive care most suitable way for regulation of these objections which would on the one hand safeguard is Thus,it tokeepin between interests. competingmind important factfind andtry this to the what with limitations extent, scopewhat in and broad inhow tofindorder thefinebalance not be berather to it discussion but should about whetherBecause of should allowed that, not objection usagesufficiently. regulate do provisions conscientious these the majority itof seems that states, particular of legislations in national the appear clauses which which can lotsraise issuesof in thefuture paper Act No.578/2004Coll. of 21 October2004 on healthcare providers, workershealth and professional 5 . Thus, despite various conscientious objection 3 further analyzed inChapter 2.3. of this CEU eTD Collection fulfilled by states regulationsfulfilled by onconscientious objection. states and the suggests appropriate model its regulation of by setting upconditions thatshouldbe acceptabilityoverview to opinions objection of different the inconscientious health of care an provides chapter thirdarticles. Finally, legislations the andexpert state referring to the conscientious of regulation the analyzes The secondone health care. access to to right and patient’s object objectionconscientiously to right professional’s health care the between arising interests of conflict in theThis paper is chapters, intodivided from three explainswhich one first the the forgrounds legal systems of the regulation of USA,conscientious objection will be offered. the UK possibilitiesthe for future controversies. Based on findings,these model appropriate for and Slovakia,limitations and thethat Slovak regulation consistingin vaguegeneral and clauseopens that by 4 CEU eTD Collection last access onMarch 20, 2010 at: March 16, 2010 at: Journal of theAmerican Medical Association 10 9 accessedMarch on 17,2010 at: 8 2010 at: 49, Article 18, Office of the United Nations High Commissioner for Human Rights, last accessed on March 17, 7 last accessedMarch on 17,2010 at: Committee general comment 22, para. 11, Office of the United Nations High Commissioner for Human Rights, 6 some states the comprehensive conscience laws were enacted where the regulation of the of regulation wherethe enacted lawswere conscience comprehensive the states some varies. In careservices health reproductive in the objections conscientious The of regulation end-of-life related decisions. to those servicesor planning family- contraception, emergency asfor abortion, services,such example reproductive to related arethose most frequently appear objections where conscientious procedures manythough conscientiousthe of objections arebased grounds.on religious beliefs, moral ethical basis of the on religious, or in takepart procedures perform certain or refuse for to to health careprofessionals usually allow objections Provisions onconscientious right to object towards particular treatment orhealth care service and refuse toperform them. the professionals care health the giving by care health of sphere the into also spread freedom thisHowever, isnottheonly freedom field wherethe canbeinvoked.of This conscience conscience “freedom of andreligion”.claiming internationally thought, recognized in partwhen military the take individual refused serviceto onthebasisofhis conscience, services, military of context the within perceived traditionally was objection Conscientious B.M.Dickens, Conscientious objection and professionalism, and objection Conscientious B.M.Dickens, last Practice, Medical and Beliefs onPersonal Council Medical General ofthe Guidance Supplementary International Covenant onCivil and Political Rights entry into force 23 March 1976, in accordance with Article Framework forCommunications, Conscientious objection, Freedom of Religionor Belief, Human Rights A.Grandy, “ http://www2.ohchr.org/english/law/ccpr.htm Legal Protection for Conscientious Objection by Health Professionals” www.virtualmentor.org Conscientious objection and conflict of interests http://www.gmc-uk.org/static/documents/content/Personal_Beliefs.pdf http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1372865 http://www2.ohchr.org/english/issues/religion/I3k.htm , May 2006, Volume 8, Number 5:327-331, last accessed on CHAPTER I 5 Expert Rev. Obstet. Gynecol 10 , Virtual Mentor ., 4(2), 97-100 (2009), 6,7 9 Medical , Ethics of Ethics 8 CEU eTD Collection sources of conflict of interests between the Health care professional and Patient stemming Patient and care professional betweentheHealth interests of of sources conflict the introduce will I section next in the individuals.Thus, the of rights the against placed are professionals ofhealth care therights is becausecase insuch This careservice. health the exercise of conscientious objection right can have an adverse impact on the individual seeking It is generally known that any limitation of accesstreatment -are atto stake. health care that can be or individuals whom as professionalsitis the requesting towards those patients directed and caused by the when conscientious is rightsboth of objection health the -personsinvoking raised, as itcare because is This service. care health of need in a or treatment medical requesting individual’s issuefor asignificant butalso becomes of his concern just isamatter not care professional diagnosis, Raising andpossible prognosis by objection conscientious health treatments. the legally available health care service including toreceive right information on his health status, accessto to the patient the of theright with collides health careprofessional or provider care health the by objection contentious of use the when arises problem the practice, In care services. health available have on very objections usegeneral the any rules applicable of conscientious to legally apply, subjects who can invoke them and similar. There are also states such states as Slovakia also There are can invokethem similar. whoand apply, subjects which to they by limited scope the andare service health care controversial to related Acts in –such others as Unitedthe Kingdom http://jaspi.justice.gov.sk/jaspiw1/htm_zak/jaspiw_maxi_zak_fr0.htm regulations, Anex by 4, later Code amended as of laws, Ethics certain of Healthsupplementing Workerand amending to and be service, seen health at:the in organisations 13 http://www.statutelaw.gov.uk/documents/1967/87/ukpga 12 http://billstatus.ls.state.ms.us/documents/2004/html/SB/2600-2699/SB2619SG.htm 11 and scope of extent usage rightsthe isof conscientious such very broad, as USMississippi Act No.578/2004Coll. of 21 October2004 on healthcare providers, workershealth and professional Abortion Act 1967c87 , last accessedMarch on 20,2010 at: Mississippi Health Care Rights of Conscience Act 2004, last accessed onMarch 13, 2010 at: 12 conscientious clauses became a part of particular apartof became clauses conscientious 6 13 that 11 , CEU eTD Collection http://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf 21 http://www.un.org/en/documents/udhr/ 20 http://www2.ohchr.org/english/law/cescr.htm Nations HighCommissioner forHuman Rights, lastly accessed onMarch 18, 2010 at: 19 http://www.un.org/en/documents/udhr/ 18 http://www.un.org/womenwatch/daw/cedaw/text/econvention.htm at: 2010 18, March on accessed last Affairs, Social and of Economic Department of Women, Advancement 17 http://www2.ohchr.org/english/law/cescr.htm Nations HighCommissioner forHuman Rights, lastaccessedon March 18,2010 at: 16 http://www2.ohchr.org/english/law/ccpr.htm Commissioner forHuman Rights, last accessed onMarch18, 2010 at: 15 http://www.un.org/en/documents/udhr/ 14 thought and religion” to freedom of “rightconscience, the example as for such objections, conscientious to relating “ICESCR”) as to referred (hereafter Rights Cultural and Social Economic, on Covenant International Rights of Human Declaration Universal The example: for only the being one not but renowned most the states, of majority by ratified were objections conscientious the for framework the regulating instruments These legislations. domestic in as well as instruments inrecognized found be the internationally careservice health can of orprovisions treatments The roots of the right1.1. Health CareProfessional’s right to conscientiously object to conscientiously object care. access health towardsfrom the Healthexercise care ofprofessional’s certain medical right to conscientiously object and the Patient’s right to (hereafter referred to as “CEDAW”) to referred (hereafter as “ICCPR”) to referred (hereafter Rights Civilon Political and Covenant International Preamble of the Constitution of the World HealthOrganization, lastly accessed onMarch 18, 2010 at: at: 2010 18, March on accessed last Rights, ofHuman Declaration Universal of The 25 Article Article 12 of The International Covenant on Economic, Social and Cultural Rights, Office of the United at: 2010 18, March on accessed last Rights, ofHuman Declaration Universal of The 18 Article the for Division Women, Against ofDiscrimination Forms of All Elimination the on Convention International Covenant on Economic,Social and Cultural Rights, entry into force 1976,Office Unitedof the International Covenant onCivil and Political Rights, entry into force 1976, Office of the United Nations High TheUniversal Declarationof HumanRights (1948), accessed on March 18,2010 at: 16 , Convention on Elimination of All Forms of Discrimination Against Women Against Discrimination of Forms All of Elimination on Convention , 18 or the “right to the highest attainable standard of health” of standard attainable highest the to “right the or 17 . They regulate fundamental human rights and freedoms and rights human fundamental regulate They . 7 19-20-21 14 15 often , the , , the , CEU eTD Collection right to indiscriminate recourse to conscientious objection. When an asserted freedom turns into licence or licence into turns freedom asserted an When objection. conscientious to recourse indiscriminate to right a confer not does of conscience freedom that be noted should “It stipulates: which Person,” ofEvery Conscience 25 24 http://www2.ohchr.org/english/law/ccpr.htm Commissioner forHuman Rights, last accessed onMarch18, 2010 at: 23 http://www.un.org/en/documents/udhr/ 22 A similar isincluded provision inArticle 18(1)of ICCPRthe private, tomanifesthis religion or belief in teaching, practice,worship andobservance.” eitheraloneorcommunitywithreligion or andfreedom, othersandinpublicor in belief, tochangehis ofthought, conscienceandreligion;this rightincludesfreedom to freedom thought, conscience and religion’ in Article 18,which stipulates that: provides the‘freedom for Human Rights Universal of Specifically,of Declaration the and provide religion’ the basic ground for conscientious objections. thought, of conscience, as health’. ‘freedom the on Thus, provisions ‘right the to referred to respective citizens. respective be abused for limiting would freedom conscience of in the when that cases hemade astatement this, to With regards the rights of the others butunlimited.is not bythe State guaranteed freedom be should conscience expressed that of it is for the State Catholicto protect the of head former the the by Churcheven recognized was rights others’ of ‘rights the with religion’ and - ofpope its John Paul conscience of ‘freedom thought, to balance right the to necessity mentioned II –the one The last – who, with respect to Article 18(3)such limitations are the protection of health, morals and rights of ofothers. the ICCPR,is subject tocertain limitations inas for Article provided 18(3)of ICCPR.the The forgrounds manifestation their limited, be not can thought’ and religion conscience, of ‘freedom to right John Paul II - Message for the 24 Ibid., Article 18(3) Article 18(1) of The International Covenant onCivil and Political Rights, Office of the United Nations High Article 18 of the Universal Declaration of Human Rights, accessed onMarch 18, 2010 at: 25 th World Day of Peace 1991, para. 24, “If You Want Peace, Respect the 8 23 . However, while the general the while . However, “Everyone has the right 24 22 CEU eTD Collection http://aappolicy.aappublications.org/cgi/reprint/pediatrics;124/6/1689.pdf p.1690, accessedMarch on10, 2010 at: on the Basis of Claims of Conscience”, Pediatrics 2 of paper. this inChapter described are health careservices to respect with legislation objections contentious services towardswhich objectionsthe apply.These differences and analysis of the differencesthe in mainly consisting the details regulationthe of of and the and scope actions narrowly. The extent and scope of the contentious clauses in different legal systems vary, with moreform in eitheror wider states individual of legislations national by regulated the careisalso inhealth object tocontentiously careprofessionals health of particularthe right rights, contentious the regulate that instruments international above-mentioned the Besides and self-belief. self-respect one’s destroy and guiltintegrity, feelingof the of one’s such understanding cause the weaken pressure can his contrary act conscience, to isforced to if and person the decisions each person’s influence conscience, and reason them, of both that admit must One integrity. personal beings’ human 27 http://www.un.org/en/documents/udhr/ 26 world-day-for-peace_en.html http://www.vatican.va/holy_father/john_paul_ii/messages/peace/documents/hf_jp-ii_mes_08121990_xxiv- inalienable rights of its citizens against such abuses”, lastly accessed onMarch 18, 2010 becomesat: anexcuse forlimiting the rights of others, the State is obliged to protect, also by legal means, the brotherhood.” of another inaspirit with“All humanbeings… endowed reasonandconscienceshouldacttowardsone are stipulates, Rights Human on Declaration Universal the of 1 Article As integrity. individual’s The right of Health Care Professionals to conscientiously object is closely related with the American Academy of Pediatrics , “ Article 1of The Universal Declaration of Human Rights, last accessed on March 18, 2010 at: Policy Statement –Physician Refusal to Provide Information or Treatment 26 It is exactly this reason and conscience that constitute that conscience and reason this exactly is It 27 Volume 124, Number 6,December2009,p1689-1693, 9 CEU eTD Collection 30 Rights (1994 Amsterdam), ConventiononHuman Rights and Biomedicine (1999) the Protectionof Human Rights and Fundamental Freedoms (1950), Declarationon the Promotion of Patients’ 29 Law and Legislation on Patients’ Rights and Cross-Border Health Care, p. 17-37 28 Charters. Patients’ form of in or the of Acts Parliaments of agreements, in international and various pivotal carewere treaties by the health position recognized To secure the rights of patients many rights. individual’s legal rules evolved. as rights includedin particular andthese provisions rights aresupposed to safeguard the The rights of patientsprovide social these areobliged to right. States social patient mostsignificant care being the health to and right the with rights social their and rights individual into bedivided can rights patients’ As Dr. Bert Hermans, anAssociate Professor at the Erasmus University Rotterdam points out, 1.2.Patients’ right toaccess tohealth care in such instruments. in such ishealth recognized also to patients’ right paper,the this of insection 1.1. mentioned already Besides conscientious rights having thebasis ininternational and instruments national as his conscience. basedon objection invokes professional access healththe carewhen to right patient’s the and object conscientious to right health care professional’s the between arises Onceis relationship ofthe the health patientcare professional and established, the the conflict was established.rights Ibid., Footnote 28 for Convention European (1961), of Europe Council of the Charter Social European the example: for as Such Case European of Recent Impact The Law ofMedical Institute The 2005, Law Medical European of Yearbook 29 as well as by the national legislations of the particular states either in the form in the either states particular the of legislations national the by as well as 28 10 30 Thus, the legal basis of patients’ CEU eTD Collection treatment on the basis of conscience. This is because many of many is conscientious of the because objectors treatment on conscience. This basisthe of issues which is also the one violated when health care professional refuses toperform specific Another imminent part of this right is the “right to receive information” receive to “right is the right this of part imminent Another necessary. isalso quality and their good livemustwhether urbanareas.quantity they inrural beof they Furthermore, or a sufficient matter no people for reachable be easily must they rights these of protection effective the for Governments role.play animportant As further Special the explainsRapporteur inhis report, health. of conditions essential the to right healthcare,includes the butalso not only right to rightattainablehealth, the this of standard the highest on rightthe to Rapporteur of UNSpecial inthe report As was specified the health’. of standard attainable highest ‘Right the Health’ or to to ‘Right 35 http://www.essex.ac.uk/human_rights_centre/research/rth/docs/REVISED_MAY07_RtH_8pager_v2.pdf Standard of Health“, University of Essex, Human Rights Centre, p. 3, available at: 34 http://www.un.org/esa/socdev/enable/rights/ahc7srhealth.htmat: available 2005, of health, standard attainable highest the to 33 http://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf 32 http://www2.ohchr.org/english/law/cescr.htm HighCommissioner forHuman Rights, lastly accessed onMarch 18, 2010 at: 31 the highest attainablestandard of physical and mental health” example the ICCPR or CEDAW, it providesstatus orpersonal identification. Recognized in international various instruments, such for as for the fundamental right of Theall people right regardless to access of their race, health religion, care societal, is politicala part orof other the right to health. The right to health is a Ibid. International Federationof Health and Human Rights Organisations, “Our Right to the Highest Attainable E/CN.4/2005/51/Add.2, Report of Specialthe Rapporteur, Paul Hunt, Addendum: Mission toPeru on the right Preamble of the Constitution of the World HealthOrganization, lastly accessed onMarch 18, 2010 at: Article 12, The International Covenant on Economic, Social and Cultural Rights, Office of the United Nations 34 11 33 In reaching such conditions, the States’ “Right of everyone to the enjoymentof everyone tothe of “Right 31-32 often referred to as tothe referred often 35 about the health the about CEU eTD Collection attainable standard of physical and mental health, preamble and para. 6, last accessed on March 18, 2010 at: 2010 18, March on accessed last 6, para. and preamble health, mental and of physical standard attainable 39 18, 2010 at: standard of physical and mental health, UN Doc. No. A/HRC/7/11 (2008), para. 100, lastly accessed on March 38 18, 2010 at: Standard of Physical and Mental Health, UN Doc. No. A/HRC/7/11 (2008), para. 42, lastly accessed on March 37 36 also forms attainable physical and psychical health And standard. sexualthus, and reproductive health an integral highestindividual’sthe in to the to various right care order protect services health access to part of to right the includes Health generally to the Right the section, in this earlier mentioned As was ‘right to the highesttransparent and accessible mechanism on the type of which the State itself can decide. attainable securing for responsible shouldbe this right made effective,the accountable through standardhealth,those to right the of and exercise fulfillment for successful the Furthermore, right. of health’. of this fulfillment to more they contribute the health care services, legally available access to influence securing of can the professionals health health. However, to the right for safeguarding responsibility right to health, as well.Moreover, The the Specialmore Rapporteur bringsthey to attention obey the fact that thethe State has patients’the main legal right to any status or identification. specification andother mental health regardless of their sex, race, religion, age, disability, sexual orientation, political enjoy have peopleattainable to highest the equal opportunities to standard of physical and should must enjoy.Thus, afunctioninghealth protection of system be for established inorder As the right to health is one of the fundamental human rights, itis a right that all people also to inform a patient on his diagnosis, prognosis or possibilities of further treatment. refuse not only to perform or participate in a particular treatment to which they object, but Commission on Human Rights resolution 2003/28 on the right of everyone to the enjoyment of the highest the of enjoyment the to of everyone right the on 2003/28 resolution Rights Human on Commission Report of the UN Special Rapporteur on the Right of everyone to the enjoyment of the highest attainable Report of the UN Special Rapporteur on the Right of everyone to the Enjoyment See of the ChapterHighest 2 Attainable http://daccess-dds-ny.un.org/doc/UNDOC/GEN/G08/105/03/PDF/G0810503.pdf?OpenElement http://daccess-dds-ny.un.org/doc/UNDOC/GEN/G08/105/03/PDF/G0810503.pdf?OpenElement 12 37 38 36 39 CEU eTD Collection consequently cause increase in the rates of illegal or unsafe abortions. No less important is the less important No unsafe or abortions. ofillegal in rates increase the cause consequently care services unavailable ‘ unavailable care services http://www.essex.ac.uk/human_rights_centre/research/rth/docs/Conscientious_objection_final.pdf Human Rights Center, University of Essex,p.1-16, 10, last accessed onMarch 18,2010 at: ‘ can then render Such obstructions available. providers are treatmentor service andno geographically,other financially timely or accessible alternative contentious objection right, when the health care professionalof exercise refuses the by to providebe undermined particular to happen conditions these Again, time. appropriate professionals who can offer them. They should also be financially available care and availablehealth the in and services such of number sufficient be a must there that basically [reproduce]” 43 accessedMarch on 18,2010 at: 42 at: 2010 18, March on accessed last 7.2., 41 accessedMarch on 2010 10, at: http://www.iisd.ca/cairo.html 40 fault_collection&access=p&oe=UTF-8 28.doc+2003%2F28&ie=utf8&output=xml_no_dtd&client=en_frontend&proxystylesheet=en_frontend&site=de RES-2003- http://search.ohchr.org/search?q=cache:WYbR-LE4zl0J:ap.ohchr.org/documents/E/CHR/resolutions/E-CN_4- accessible. quality and The basic conditions laid on the health care services are that they must be available, of a good frequently mostaffected. and objection,arethose rights sexualandreproductive exercise conscientious services the of in convention. CEDAW the etc.) information, education, access to and timing childrenthe of to havethey want recognized withhave (together to rightthe (ICPD) in Cairo. Action Program of andDevelopment Population on Conference at theInternational 1994 Reproductive health rights and the reproductive health itself were comprehensively in defined J. B. de Mesquita and L. Finer, Convention on the Eliminationof All Forms of DiscriminationAgainst Women (1979), article 16(1e), last Programme of Actionof UN the ICPD,A. Reproductive rights and reproductive Basishealth, for action, point last 1994 Cairo of Action, Program Development and Population on Conference International Nations United 41 which isfreely right connected to the to and numberthe responsibly decide on 40 This the program recognized 43 The availability and accessibility of the health care services mean http://www.un.org/womenwatch/daw/cedaw/text/econvention.htm#article16 “Conscientious objection: Protecting Sexual and Reproductive Rights”, de facto’ http://www.iisd.ca/Cairo/program/p07002.html and, for example, in cases of refusal of abortion 13 “freedom to decide whenif, andhow to often de iure’ de legally available health available legally 42 With respect to the CEU eTD Collection http://www.essex.ac.uk/human_rights_centre/research/rth/docs/Conscientious_objection_final.pdf Human Rights Center, University of Essex,p.1-16, 10, last accessed onMarch 18,2010 at: http://www.un.org/womenwatch/daw/cedaw/recommendations/recomm.htm 24 on Women and Health,1999, paragraph 11 with respect to Article 12(1), last accessed onMarch 14, 2010 at: 46 http://www2.ohchr.org/english/law/cescr.htm Commissioner forHuman Rights, Article 2(2), last accessed onMarch 18, 2010 at: 45 44 healthproviders.” womenensurereferred toalternative are that to objection,measuresshould beintroduced perform suchservices basedonconscientious reproductive healthserviceswomen. for Forinstance,ifhealth service providers to refuse paragraph 11, to respect with CEDAW convention of 24 Recommendation General the According to ifeven itis legally in available country. the it havenot accessto health would careservice reproductive this particular arearequesting from women that happen could it acase such In one. objecting is the area the in professional health for only care the example incasewhen can appear Discrimination violated. be can benot against discriminated to right care this health objectionin conscientious discrimination of prohibition the also but care, health to access of right the includes only not health to right basic the addition, In of provider.the professional quality shouldbewhich affected not by personal moral, religious ethical or views must a high be by of patient the received Theservice careservice. quality health the of and who will be discriminated against when compared to men. to when compared against will beand discriminated who affected be health whose adversely can women are those services, of reproductive provision isto in carecommonly usedwith respect health most objection conscientious that the consider International Covenant on Economic, Social and Cultural Rights, Office of the United Nations High J. B. de Mesquita and L. Finer, General Recommendation made by the Committee onthe Elimination of Discrimination against Women, No. “It is discriminatory for a State party to refuse …performance “It isdiscriminatoryforaStatepartytorefuse certain of 44 “Conscientious objection: Protecting Sexual and Reproductive Rights”, 45 in this sphere. However, through the exercise of exercise the through However, sphere. this in 14 46 Nevertheless, if we Nevertheless, CEU eTD Collection http://www2.ohchr.org/english/law/ccpr.htm#art16 48 http://www.un.org/en/documents/udhr/ 47 religion”. and though conscience, of freedom the to “right the as instruments international inAs described Iof rightsChapter arerecognizedthis paper,conscientious inseveral morals and the rights of others particular section is devoted and is of regulations particular section already devoted those discussed. the which to country the of regulation the between differences major out point will that section analyzed, subsequent byeach offered perspective comparative through reached regulation,claim subjects entitled such to objection and theirThis willbe restriction. of in the scope especially major differences also are all them, there of between features limitationsas they providethere good example of how far the conscientious objection can go and what are. respect reproductiveTheto health care servicesin legalsystemsthe of USA,UKandthe SR aim is to Chapter, Iwill andshow introduce analyze of regulation conscientiousthe objections with thatin this Thus, systems. legal national in their clauses even conscientious regulate themselves though there are some common Article 18(3), International Covenant on Civil and Political Rights, last accessed onMarch 18, 2010 at: Article 18, The Universal Declaration of Human Rights, last accessed onMarch 18, 2010 at: Regulation objections in ofconscientious health care inthelegal systems of the United States of America, theUnited Kingdom and theSlovak Republic 47 Nevertheless, certain limitations are recognized – such as protection of health, 48 . Besides these international instruments, states CHAPTER II 15 CEU eTD Collection http://www.law.cornell.edu/uscode/42/usc_sec_42_00000300---a007-.html 50 /Default.aspx http://www.ncsl.org/IssuesResearch/Health/PharmacistConscienceClausesLawsandLegislation/tabid/14380 49 health careanother referral the or informationto person with the legallyavailable procedures on providerprovide affected duty the the to person nor notify theaffected to objector duty the of or institutionneither the its premises. on such Moreover, allowprocedures of performance required to ableparticipate to provide to forced be not can individuals that stipulated it clauses three all In sterilization. insuch abortion and contraception abortion, to respect service with clauses conscientious the enacted Arkansas or sterilization was stipulated. example, For clauses. conscientious enacted their own many states time Since that proceduresperform abortion moral sterilization procedures. or object to or grounds religious on The and even USAinthe 1970’sthe with firstthe FederalAct protecting health care providers’ to right that hospitalsin introduced wasfirst health services to care respect objection with The conscientious can not be theseclauses. upon limitations placed certain are whether there or treatment to the objecting not care provider another health is to of referral aduty there whether assistance, itself, even the procedure or apply includingto which only apply,whetherto they they extent apply, they whom to subjects in the especially consist differences The regulation. in is their agreatvariety and thereobjections refusal for aground treatmentof as use conscientious care providers to health of laws possibility for provide the state the Federal, wellas of as states. 50 composed federation is ofAmerica a The United States objectors at theexpense of patients’ right to accesshealth care 2.1. The United States ofAmerica –Excessive protection ofconscientious 42 U.S.C. 300a-7(b), Public HealthService Act,enacted in 1970, last accessedMarch on18, 2010 at: Legislatures: ofState Conference ofNational site internet on the be seen can As 16 49 50 CEU eTD Collection http://billstatus.ls.state.ms.us/documents/2004/html/SB/2600-2699/SB2619SG.htm 53 http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1483363 unethical”, Med Law http://billstatus.ls.state.ms.us/documents/2004/html/SB/2600-2699/SB2619SG.htm 54 52 Ann. §20-16-304, enacted in 1973 51 Dickens M. Emeritus of Health Law and Policy at the Faculty of Law, University of Toronto, Bernard Professor by analyzed conscience, on act Mississippi newer of example the use will I this, demonstrate far.To too go can sometimes this right of protection the instruments, national and international various by recognized rights human fundamental the of one While the right of people to act in conformity with their conscienceparamedic personnel. is considered to be in applied orother samewayalsotopharmacists contraception refusal the clause In 2004, Health Care Rights of Conscience Act of Conscience CareRights Health health care, such as for example prescribing the pills, instructing the patient, referral referral of instructing thepatient, pills, the prescribing for example care,such health as the the delivery of accompanying services alsoallbut treatment theadditional service or care provider under the objection of conscience not only with respect todirect delivery of institutions” provide be used not only by those directly delivering the heath care service, but also those who Mississippi Health Care Rights of Conscience Act 2004, last access onMarch 13, 2010 at: Mississippi Health Care Rights of Conscience Act 2004, Section 2(a), last access on March 13, 2010 at: B.M. Dickens, “ Ark. Code Ann. § 20-16-601, enacted in 1969, Ark. Code Ann. §20-16-304, enacted in 1973, Ark. Code “any other care or treatment rendered by health care providers or health care orhealth healthcareproviders rendered by treatment careor “any other Mississippi 52 . 54 . Thus, the Act covers the refusal to provide health care service by a health by a service health providecare to refusal the Actcovers Thus,the Legal protection and limits of conscientious objection: When conscientious objection is (2009)28: 337 – 347, available at: enacted a comprehensive act on the Mississippi conscience called on act acomprehensive enacted 51 53 . According to its Section 2(a), the objection can 17 CEU eTD Collection care provider, thehealthcare institution or health care payer” here as is understood ‘Conscience’ under ‘conscience’.is word clarifies understood thisthe Furthermore, what Act itaccompanying and any involvedpersons in it. any to health servicealso procedure care or for refusal treatment ground of liable for declining to participate in a health care service that violates his or her conscience. However, this However, conscience. orher his violates that service care a in health participate to declining for liable 58 57 procedure.” care a health of,who furnishing person inthe other orassists any or furnishes, paraprofessional, professional, any or worker social counsellor, employee, or student faculty, school or nursing medical researcher, employee, pharmacy pharmacist, employee, assistant, nurse, nurses' aide, medicalphysician's assistant, aphysician, to: hospitallimited employee, but not clinic including, employee, service, care nursing a homehealth in way any in participate 56 institutions.” care orhealth providers or care drug, byhealth rendered device, treatment any or care other or any surgery, administering or medication, dispensing prescribing, instruction, research, prognosis, or diagnosis procedure, including, but not limited to, the following: patient referral, counselling, therapy, testing, 55 liability in such cases. administrative and criminal civil, any from immune is He him. against launched be can proceedings liability no Act, in this stipulated as conscience his of basis the on treatment provider participation refuses delivery the or treatment deliveryof towards such of careservice health also all the other personsto be not only physicians,whonurses, pharmacists, their assistants,deliver researchers and others, but the health areconsidered providers health care that Actspecifies Conscience this time same Atthe care or are assisting in delivery of the not using the objection,instructing the patient on the diagnosis and prognosis, etc. the patient to another treatment or health care service provider who is able to deliver it Ibid, section3(2) stipulating: “No healthcare providershall be civilly,2(h) criminally, section Ibid, oradministratively Ibid, section2(b) stipulating: “‘Health care provider’ means any individual who may be asked to or treatment care, medical ofpatient any phase means service" care "Health stating: 2(a) section Ibid, 56 . Thus it gives a broad possibility possibility use broad asa objection conscientious . Thus a itto gives 58 Moreover, any discrimination with respect to health care to respect with any discrimination Moreover, “religious, moral or “religious,ethical principleheldbyahealth moral 18 57 . When the health care 55 CEU eTD Collection wages or benefits, refusal to award any grant, contract, or other program, refusal to provide residency provide to refusal training opportunities,program, other or or any othercontract, penalty, grant, disciplinary any award to or retaliatoryrefusal action.” benefits, or wages administrative action, demotion, loss of career specialty, reassignment to a different shift, reduction oflimited to: termination, not but is transfer,includes, refusal of… discrimination staff privileges,conscience. or her refusal his violates of that board certification, service care a health in adverse participate to declining her or on his based manner any in provider care health any against discriminate to specialties institution, public or private institution, public official, or any board whichcertifies competency in medical 59 orientation.” sexual or creed religion, sex, ethnicity, origin, national colour, race, patient's the of because apatient regarding service care a health in participate to refusing for liability from provider care ahealth exempt not does subsection or moral religious, personal his from be to considers physician the which treatment undertake in order, for example, to avoid the situationon theirwhen diagnosis, the medical patient prognosis and the wouldoptions for the treatmentgo for they thechoose to operative care topatients that underwent abortions, physicians’ refusal informto a patient situations, such as forprovide example:nurses to refusing any,preas well as post- extreme really along bring could professionals care health the of rights conscientious Thus, asB. M.Dickens furtherindescribed his Article, regulation suchbroad of the health. - value precious most patients’ the affect adversely thus an abusehealth such objections basedon andpersonal preferences of of the care provider care providers prevailto over the needs of patients. Consequently, they can often resultin subordinatein a service or position treatment a medical of need in individuals or patients place in fact terms, and allow the religious,The laws moral such or asethical this one, preferences regulating of usethe ofhealthalso prohibited. the conscientious objection delivery providersis objectingActof according this towards particularthe treatment to in such broad Ibid, section 3(3) stipulating: “It shall be unlawful for any person, health care provider, health care health provider, care health person, any for beunlawful shall “It stipulating: 3(3) section Ibid, 59 19 CEU eTD Collection http://www.nytimes.com/2005/04/19/national/19pill.html?pagewanted=1&_r=1 Times, April 19,2005 last accessedMarch on 20, 2010 at: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1483363 unethical”, Med Law appeared when these objections were being claimed by appeared when objectionswerebeingclaimedby pharmacists. these in especially several the Unitedsuch initial States cases Notwithstanding deductions conscience based on theserefusals associate usually people care services, health refusalsthe of withthe the physicianswhen about However, hearing is rare. not care services inhealth objections conscientious or nurses not providing the treatment to the patient. 62 /Default.aspx 60 publicized in mediainthe 2004,when in pharmacists Devon refused provide the to campaign regarding the pharmacists’ right to conscientious objection was the issue ‘morning-after-pill’ or storing such as the known for emergency contraception filling legalprescription relate to generally a pill. Probably one of the first cases that set off the laws conscientious comprehensive separate clausesor objection As the USA is composed of 50 states, the majority of which enacted certain conscientious patients’thus andrights, mainly health, would be placed risk.at significant in and impossible etc.could factbecome prognosis, diagnosis, medications, possible the information on reproductive services, isit accessthe to that clear themselves, institutions rightsconscientious guaranteedindividual not only to health professionalscare butalso his against conscience. ethical perspective http://www.ncsl.org/IssuesResearch/Health/PharmacistConscienceClausesLawsandLegislation/tabid/14380 61 M. Davy, P. Belluck. “ B. M. Dickens, “ As can be seen on the internet site of National Conference of State Legislatures: ofState Conference ofNational site internet on the be seen can As Legal protection and limits of conscientious objection: When conscientious objection is (2009)28: 337 – 347, available at: Pharmacies Balk on After-SexPill and Widen Fight inManyStates 20 60 As a result of such broad application of , last accessed on16 March, 2010 61 , utilization of the of utilization , 62 Their objections Their ”, New Your CEU eTD Collection withheld the prescription, last accessed on March 15, 2010 at: 2010 15, March on accessed last prescription, the withheld Michigan Example - when married woman with children visited pharmacy to get pillthe and pharmacy Ethics Journal of the American Medical Association http://thelancet.it/journals/lancet/article/PIIS0140-6736(05)66531-2/fulltext 9472, p1677-1678, May 14, 2005, lastly accessedMarch on 14,2010 at: objections allowing pharmacists to refuse to dispense these pills on the basis of their contentious USA/Conscience-Laws-USA-07.html Violationof Federal Law, enacted in Practices 2008,or to Policies be seenDiscriminatory or at: Coercive NotSupport Do Funds Services Human and Health of 67 /Default.aspx http://www.ncsl.org/IssuesResearch/Health/PharmacistConscienceClausesLawsandLegislation/tabid/14380 66 /Default.aspx http://www.ncsl.org/IssuesResearch/Health/PharmacistConscienceClausesLawsandLegislation/tabid/14380 65 assn.org/2006/05/hlaw1-0605.html 64 63 newfederal for theprotection introduced of conscience. regulation Services Human and Health of Department the his administration, of end before the recently, also wasdemonstrated hottopic, which isjusta very still health careservices provision of before The issue theof conscientious objections with respect to refusalend of medical treatment or of the president’s George proposalsintroduced compel that tofill pharmacists prescriptionsy prescribed Bush administration. moral began objections even though states’ the views onthismatter differ. Some prescription to the patient.Shortly return sucha to refused a pharmacist provide evencaseswhen pillsor the to willing prescription butalsoanother toreferto pharmacist pharmacy patient the would or whobe fill a to only notrefused pharmacists when noticed were some cases Furthermore, so. doing firedfor consequently a rapevictim were and to contraception emergency Regulation 45CFR Part 88,U.S. Department of Health and Human Services, Ensuring That Department Such as for example: Arkansas, South Dakota, Mississippi and Georgia, to be seen at: Such as for example: California, Missouri and New Jersey and Michigan to be seen at: A. Grady, “ T. Zwillich, “ 66 , last accessed on March 20, 2010 , last accessed on March 20, 2010 Legal Protection for Conscientious Objection by Health Professional” . US Pharmacies vow withholdto emergency contraception 64 Thus, a big campaign for the pharmacist use of religious or , May 2006, Volume 8, Number5: 327-331, p.327 21 http://www.consciencelaws.org/Conscience-Laws- http://virtualmentor.ama- ”, The Lancet 67 , Virtual Mentor, , Volume 365, Issue 65 , others 63 CEU eTD Collection Mentor however, should not be prejudiced by their personal judgments and preferences. The fact providers health anddependantcare on professional knowledge which, are providers’ goal of their job.mentionto patients’ that and beis physical psychical well-being to supposed theprimary Patientsnecessary is it so and professions their joining after immediately gain they areresponsibility in a vulnerable position when compared to health care http://nejm.highwire.org/cgi/content/short/360/15/1484?query=prevarrow NewThe England Journal of Medicine,Volume: 360, April 9, 2009,p. 1484-1485,1485, available at: patients. the towards bear personnel care health the which responsibility deficiencies of this regulation is considered to be the ignorance of the special professional assn.org/2009/09/oped2-0909.html 70 USA/Conscience-Laws-USA-07.html Violation of Federal Law, § in 88.2Practices or , to bePolicies seenDiscriminatory at: or Coercive NotSupport Do Funds Services Human and Health of 69 68 ‘ would become services reproductive the this with regulation likelymore it that seems in practice discrimination, against careproviders health be protection the of to wassupposed aim Even thoughits primary services. obtainable in sterilization) butalsoof types other of participating legally provision these the contraception, voluntary asabortion procedure, service(such health reproductive care or treatment the of delivery direct to respect with care personnel health the of protection the interest of the patients. abandonment of and of patients the placing theinterests health providersthe care above resulting much ‘power’, inthe too treatments careservicesor health legallythe available This regulation muchwas very criticized for giving health care professionals objecting to B. M. Dickens, “ Regulation 45CFR Part 88,U.S. Department of Health and Human Services, Ensuring That Department J.D. Cantor , September2009, Volume 11, Number 9:725-729, available at: , “Conscientious Objection Gone Awry – Restoring Selfless Professionalism in Medicine” Unethical Protection of Conscience: Defending the Powerfulagainst the Weak 69 68 , last accessed March 18, 2010 The reason for this criticism was that it not only includes only not it that was criticism this for reason The de facto http://www.consciencelaws.org/Conscience-Laws- 22 ’ unavailable. One of the most important http://virtualmentor.ama- , last, accessed18, March 2010 ”, 70 Virtual This , CEU eTD Collection Mentor, http://www.californiachronicle.com/articles/view/87999 January 15, 2009, last accessedMarch on 19,2010 at: 74 accessed on23 March, 2010 http://www.chrismurphy.house.gov/index.php?option=com_content&task=view&id=260&Itemid=55 15, 2009, to be seenat: 73 March 18,2010 at: beseen to effect, or force no 72 assn.org/2009/09/oped2-0909.html 71 professional misconductand is beto followed by disciplinary proceedings failure tocomply this in with resulted duty that stipulated also make. Thisproposal they can choices information regarding reproductive the can inwomen get California woman Mrs.Maryintroduced who Assembly the ensure Hayashi, Bill 120 aiming that to federal regulation. and Act ProtectingHealth the Care of Patient 2009, introduced who Murphy, Chris Congressman, Connecticut the was opponents the of One rose. criticism waveof the introduced, was regulation this after earlier, As mentioned integrity as they are dependant on them as concernstheir in the believe treatment. and professionals the trust to is patients the of possibility only the where from in places and patient, thehealth the an care providers patients position unequal andwithholdinformation personnel allows the to health thiscare that regulation protects by the Attorney General, other two were filed on behalf of National Family Planning & Planning Family National of behalf on filed were two other General, Attorney the by filed and was Massachusetts and Illinois California, Jersey, New Oregon, Island, Rhode namely Connecticut, states, seven represented One of them Court. District Connecticut U.S. inthe filed were lawsuits three federal regulation, the tooppose Furthermore, ‘Murphy pushes legislation to stop Bush’s “Refusal Clause” Limiting Access to Health Care’, January Care’, Health to Access Limiting Clause” “Refusal Bush’s stop to legislation pushes ‘Murphy HR 570: Protecting Patients and Health Care Act, introduced in2009, To certainmake regulations have B. M. Dickens, “ ‘Hayashi legislation in response to controversial medical “conscience rule”’ September 2009, Volume 11, Number 9:725-729, available at: Unethical Protection of Conscience: Defending the Powerfulagainst the Weak”, Virtual 73 Thisfederal was regulation opposed by Assemblyalso Californiathe http://www.govtrack.us/congress/bill.xpd?bill=h111-570 , last accessed March 18, 2010 23 72 whose aim was to oppose this new this oppose to was aim whose http://virtualmentor.ama- 71 , California Chronicle, 74 , last accessed on accessed last , . , last , CEU eTD Collection http://www.whitehouse.gov/the_press_office/Remarks-by-the-President-at-Notre-Dame-Commencement/ the University of Notre Dame, South Bend, Indiana, May 17, 2009, last accessed onMarch 20, 2010 at: 76 adlines http://www.washingtonpost.com/wpdyn/content/article/2009/01/15/AR2009011502059.html?hpid=morehe January 16, 2009, last accessedMarch on 14,2010 at: 75 the always is generally patient The patient. the and professional care health the between relationship ‘equal’ an form to impossible, not if is difficult, it care health of field the In services. health care to access of the effectiveness the a dangerto present that and interest patient’s the above health care professional of the will conviction the They personal and place to whocanuse in canbeexercised. with these them respect and objections scope which to say that overbold not is someit analysis, above the of basis the on of that suppose I these Nevertheless, subjects regulations,to respect with regulation. in heterogeneity the is reason The such objections. contentious as the Mississippi to USA the of describetheapproach one to isdifficultit very section,conclude this To are extremely broad conscience. professionals’ care health access health care and to rights patients’ the between balance meet the remain in force and will clauses conscientious federal that the that itwas proclaimed on later regulation, federal the way of ‘sensible’ Even thoughthenewadministration aimrevoke Obama the president this to of presented conscientious clauses should be used Federation of America. Planned Parenthood to Reproductive Association Health by American Civil the Liberties Association and by the The White House Office of the Press Secretary, Remarks by the President in Commencement address at address Commencement in President the by Remarks Secretary, Press the of House Office White The Rob Stein The Washington Post, “Lawsuits filed over Rule that Lets Health Workers Deny Care”, 76 24 75 CEU eTD Collection but at the same time, it lays certain limitations on it. Section 4(1) of this Act stipulates: Act this of 4(1) Section it. on limitations certain lays it time, same the at but http://www.statutelaw.gov.uk/documents/1967/87/ukpga 78 77 objection. provide in health useof on such the objection afinelimitation to of care seems thefield Compare the USMississippi, to legislation United Kingdom’s the on conscientious objections. useof these the on limitation UK offers unlimited, the isalmost objection rely contentious the on to whose right objection.conscientious analyzed unlike in USA Mississippi above the the However, in its clauses on enacted isThe legislation also Kingdom acountry that United objectors’ rights andrights ofpatients 2.2.The United Kingdom –Way to afine balance between the conscientious right. patient’s the and conscience their of basis the on object to right professional’s care health the between balance the reach to in order limited sufficiently objections Because aretoobroad. conscientious of if this, such laws they exist should be on laws the when is undermined balance this Yet, section. next in Kingdom United the legally foravailable options his further treatmentas it will be be shown in recognizedto the informing ofhishealth, or about prognosis, also thestatus diagnosis, the patient but discrimination any without care health of provision the only not include that rights this relationship. Thus,this unequal shouldrelationship bebalanced through patients’the one without sufficientmedical knowledge and education and thus ismore vulnerable in Abortion Act 1967, section 4,last accessedMarch on 20,2010 at: Note that neither the Abortion Act 1967 nor the HumanFertilisation Act 1990 apply to Northern Ireland 77 Its Abortion Its Act1967 78 includes the provision on objection,includes on conscientious provision the 25 CEU eTD Collection hospital - who refused to type a letter referring a patient to a different healthetc., care itself but also the referral of patient, counseling, information on prognosis and diagnosis, treatment only direct not the including broadly, wasinterpreted careservice health in the participation wherethe objection oncontentious regulation Mississippi to the By contrast rely on the conscientious objection provision and refuse toprovide the treatment. 82 at: 81 http://www.statutelaw.gov.uk/documents/1967/87/ukpga 80 http://www.statutelaw.gov.uk/documents/1967/87/ukpga 79 pregnant woman” a physicalormentalhealthof ortoprevent tothe gravepermanentinjury save thelife section(1) ofthis shalleffectany duty to participate whichin treatment isnecessaryto section 4(2) of this actputslimitation itby upon stipulating that: a conscientiousobjection” legal requirement, toparticipateinany treatment authorised bythiswhichAct to hehas “no personshall bewhether any under duty, by contractoranystatutoryother This was recognized by the court in caseof the bythecourt This wasrecognized her conscience as stipulated by the Abortion Act. do can notrefuse secretary suchaletter tobasedso byonthetyping objection on relying the Thus, procedure. in the participate’ meaning‘to be as considered not abortion can for letter areferral typing courts that it by was madethe clear example, narrowly. For Mississippi Health Care Rights of Conscience Act 2004, Section 2(a), last accessed on March 13, 2010 Abortion Act1967, section 4(2), last accessedMarch on 20, 2010 at: Abortion Act 1967, section 4(1) last accessedMarch on20, 2010 at: Janaway Salford v. Health Authority http://billstatus.ls.state.ms.us/documents/2004/html/SB/2600-2699/SB2619SG.htm 81 in the UK the right not to participate in the abortion procedures wasinterpreted in abortion the procedures in toparticipate not UK the right the . 80 Thus, when the life or health of woman is at stake, persons can not can persons stake, at is woman of health or life the when Thus, 79 Thus, the right is preserved, however, the latter provision in provision latter the however, is preserved, right the Thus, , [1989] A. C. 537 (House of Lords) 26 Barbara Janaway “Nothing insubsection 82 - a secretary in the -asecretary CEU eTD Collection http://www.opsi.gov.uk/Acts/acts1990/ukpga_19900037_en_3#pb12-l1g38 85 84 2010 at: 86 83 with itsbeingin dutiesprovide one established Kingdom to the doctors United of with as “GMC”) was to referred (hereafter Council Medical General the In addition, objection. of use the on limitations the Human Fertilisation and EmbryologyFertilisation 1990. andEmbryology Act Act inthe is clause regulated also conscientious the Act1967, Besides the Abortion does not state in furtherand can not rely on conscientious objection towards such referral. sections hasas ‘participation’ thus aduty refer intheprocedure, objectingthe doctor to patient the any be considered can not treatment deliver the is to willing that one tothe doctor objecting relevance. indirect thislegally Abortion objection include Act recognized in not the action does such of because justified not was herconscience onthebasisof letter referral the type to refusal her that stated and employer former her of decision the upheld Court the However, review for wrongful termination of her employment and claimed conscientious objection. judicial was and Consequently, sought she job hermisconduct terminated. contract authority for abortion. As a result of this, her action was identified as professional under so.” arising,any duty,however todo conscientiousactivity governed toparticipatingAct shallbe objection inany bythis Human Fertilisation and Embryology ActChapter 1990 37, para. 38,last accessedMarch on 20,2010 at: Human Fertilisation and Embryology Act 1990,Chapter 37,section38(1), lastaccessedMarch on 20, Barr Matthewsv. Janaway Salford v. Health Authority http://www.opsi.gov.uk/Acts/acts1990/ukpga_19900037_en_3#pb12-l1g38 [2000],52 B.M.L.R. 217 (Queen’s Bench Division) 83 Equally, it was recognized that the referral of a patient by the , [1989] A. C. 537 (House of Lords), p.570 C-G 85 Section 38(1) stipulates: 38(1) Section 27 86 However, compared to the Abortion Act, Abortion the to compared However, 84 “No personwho hasa Human CEU eTD Collection 53 http://billstatus.ls.state.ms.us/documents/2004/html/SB/2600-2699/SB2619SG.htm 92 accessedMarch on 20,2010 at: 91 uk.org/guidance/good_medical_practice/good_clinical_care_decisions_about_access.asp at: 90 uk.org/guidance/good_medical_practice/good_clinical_care_decisions_about_access.asp at: 89 http://www.gmc-uk.org/guidance/good_medical_practice.asp 88 http://www.statutelaw.gov.uk/content.aspx?activeTextDocId=1042982 87 inform from patient, and tothe refer care providersduties even practice medical GMC issued also supplementarythe ethical guidance for doctors on Personal beliefs and misconduct. Otherwise,disciplinary thecan him forstart GMC professional proceedings against the doctor has a duty informto a patient about it and about his right tosee another doctor. medical treatment, on havean affect could personal perception doctor’s the cases when in However, is itin rights. there patients’ noplace respecting for modern medical care the Practice. Medical medical guidanceethics. on Moreover, itdespitestipulated that of personal beliefs perceptions must thedoctor of particular the treatment. towards himself evenobjects ifthis doctor can legally undertake which patient of treatment procedure the about inform a patient hasto doctor clear that doctor’s personal perception or belief. his personal perception provision whichhealth care hebares to of because services professional of responsibility or view of a patient’s lifestyle or belief that may oppose the Mississippi Health Care Rights of Conscience Act 2004, Section 2(a), last access on March 13, 2010 at: last 2008, Council Medical General of the doctors for guidance – practice medical and beliefs Personal 2010 20, March on accessed 8,last para. care, medical to access about Decisions Practice: GoodMedical 2010 20, March on accessed 7,last para. care, medical to access about Decisions Practice: GoodMedical at: 2010 20, March on accessed last (2006), Council Medical General the of Practice Medical Good at: beseen to 1858, Act Medical the under established was Council Medical General http://www.gmc- http://www.gmc- 90 91 88 . Compare to the Mississippi act on conscience, which protected health On the basis of this guidance, a doctor can not be On guidance, adoctorcannot prejudicedthis inthe basisof the http://www.gmc-uk.org/guidance/ethical_guidance/personal_beliefs.asp 87 In issued Council 2006, this theon guidance Good the 89 Such an approach Such wouldan beapproach discriminatory and 28 92 this madeguidance it for details see footnote see details for CEU eTD Collection http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(06)68884-3/fulltext?_eventId=login 9527, p1980, 17 June 2006, last access onMarch 15, 2010 at: Ethics As Lynsey Balmer in described herarticle http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(06)68884-3/fulltext?_eventId=login 9527, p1980, 17 June 2006, last access onMarch 15, 2010 at: 98 2010 at: 97 http://www.rpsgb.org/pdfs/coeppt.pdf 96 95 at: beseen to pharmacists, Welch and 94 2010 at: 93 provide. pharmacy which services health care accessof the to entitlement patients’ guarantee to steps necessary all the canundertake pharmacy the has a duty inform to employerthe about factthis accepting before thejob. In such a way, duties, his professional of as apart normally provide certain heshould services towards Moreover, she reiterates must service.as welland they beinformedrequested patients on where can get in the article be must respected beliefs patient’s that in cases such that itstipulates however contraception, pharmacist who bearsdispense especially theto emergency objection too, pharmacists’ objections, contentious objection The professional body of pharmacists in the UK is the Royal Pharmaceuticalprohibited. Societyis objection discriminatory of kind any that and respect with patient to behave L. Balmer, “ 20, March on accessed last 3(4), Section Technicians, Pharmacy and Pharmacists for ofEthics Code at: 2010 20, March on accessed last Technicians, Pharmacy and Pharmacists for ofEthics Code L. Balmer, “ Royal Pharmaceutical Society of Great Britain is professional and regulatory body of English, Scottish 20, March on accessed last 20-25, para. belief, personal Doctors’ practice, medical and beliefs Personal 96 http://www.rpsgb.org/pdfs/coeppt.pdf http://www.gmc-uk.org/guidance/ethical_guidance/personal_beliefs.asp#5 which places on them a duty to act in the best interest of the patient. It recognizes 93 Royal Pharmaceutical Society and conscientious objectors”, The Lancet, Royal Pharmaceutical Society and conscientious objectors”, The Lancet http://www.rpsgb.org.uk/ 29 95 , the pharmacists have their own Code of Code own havetheir pharmacists , the 98 The newest case of Thenewest , Volume 367, Issue Volume 367, Issue 94 97 . CEU eTD Collection http://archive.student.bmj.com/issues/08/07/life/264.php Student BMJ, religion”’, MailOnline in patient andthe health toanother regards this refer him care professional. inform he should objects, which thedoctor to service care health or is a treatment there if that by reiterating objection conscientious to right the upholds it Moreover, patients. uk.org/guidance/good_medical_practice/good_clinical_care_decisions_about_access.asp 2010 at: 102 2010 http://www.gmc-uk.org/guidance/good_medical_practice/duties_of_a_doctor.asp 101 100 1256602/Pharmacist-refuses-mother-38-contraceptive-pills-religion.html 99 Medical Practice values for patients as well as doctors The General Medical Councildoctor todo, not what thepatienthasdoneor how the patient lives” recognizesobjection shouldbebased ona deeply heldobjection towhat thepatientisasking the theWilliams: Charles by written article in the argued importanceAs patients. of benefit the for autonomy their of portion certain up give should They of the moralduties should be importanceof utmost for them and prevail over their personalbeliefs. and religious patients. these These should beawareof towards professionals their professional duties all of conscience, invoke can careprofessionals Health of whatcategory of Regardless pills on the basis of religious belief occurred in media just recently, on March 10, 2010. – Mrs.Deeleyrefused togivepharmacist who legally contraceptive patient – prescribed C.Brooke, Good Medical Practice: Decisions about access to medical care, para. 8, lastly accessed on March 20, March on accessed 8, lastly para. care, medical to access about Decisions Practice: GoodMedical at: be seen to Council, Medical General of the (2006) Doctor ofa Duties Practice: GoodMedical C. Williams, “ http://www.gmc- Volume 16, July 2008, 264 – 265, to be found at: ‘Pharmacist refuses to give mother,38, contraceptive pills for period pain “because of her Contentious objection 101 , 10 - the respect for human life and principle of nondiscrimination of nondiscrimination of principle and life human for respect -the th March 2010, to be seen at: be seen to 2010, March ”, discussion of doctors’ right to stand by their moral convictions, moral by their stand to right of doctors’ discussion ”, . It mentions the central principle of the Good the of principle central the mentions It . 30 http://www.dailymail.co.uk/news/article- “A legitimateclaimforconscientious accessed on March 16, March on accessed . 100 102 99 CEU eTD Collection limits the existing right by reiterating that these rights Slovak the Republic Constitution the of of 24(4) at Article sametime, the However, Further, it is regulated also in article 24 (1) of the 105 http://jaspi.justice.gov.sk/jaspiw1/htm_zak/jaspiw_maxi_zak_fr0.htm constitutional act No 23/1991 Coll, Article 15, para. 1 to be seenat: 104 http://www.gmc-uk.org/guidance/good_medical_practice/duties_of_a_doctor.asp 103 the recognized asone of human fundamental andthe rights in is articleaddressed 15(1)of In theSlovak general Republic,the freedom is tothe of right conscience andthought objection as a precondition for future controversies 2.3.The Slovak Republic –Thelack of specific regulation ofconscientious ‘competing’ interests. UK USA, the between those certain balance for provides health Unlikeaccess the care services. to to legally patients’ reproductive rights available and right care professional’s health between balance reach the to attempt rules least these time, at to time from in practice mayappear objection theconscientious abuseof cases of duty the act inof doctors the to bestinterestthe of patient. the islastnot one, butbe the must observed, aim first that The isnecessary. limitation that make itclear guidance supplementary and Medical Practice GMOguidanceGood on the contrary, itis to be balanced by the patient’s right. Both, the Abortion Act 1967 as well as the On unlimited. not is right this time same the at but conscience their with conformity or in the carefully developed guidance allows the contentious objectors to act in acts legislative in the incareeither health objection conscientious of the UK’s regulation http://www-8.vlada.gov.sk/index.php?ID=1376 Constitution of the Slovak Republic (Act No. 460/1992 Coll. Of September 1 Charter of Fundamental Rights and Basic Freedoms of the Slovak Republic introduced by the Good Medical Practice: of Duties a doctor, lastly accessedon March 20,2010 at: Charter ofFundamentalRightsandBasicFreedomsCharter oftheSlovakRepublic 31 Constitution of the SlovakRepublic Constitution of “can belegallyrestricted onlyasa 103 Thus, even though the though even Thus, st , 1992), to be seenat: 105 104 . . CEU eTD Collection Act1967 patients” hisemployerand conscientious objection,he/shehasadutytoinformaboutthis fact further stipulates: provision same The ishealth threatened. the people.” or heath of life immediate threat to of when isarisk conscience situations there exceptin required suchto provide treatmentor in treatmentparticipation thatcontradictswith his provisionthe in objection ontheconscientious this Code, 110 http://www.statutelaw.gov.uk/documents/1967/87/ukpga 109 108 accessed onMarch, 17, 2010 at: beseen to regulations, by later amended as laws, certain supplementing and amending and service, health the in organisations 107 106 worker’. of Health of Ethics ‘Code heading the under service health the in organisations and professional workers Act health providers, healthcare the 4 tothe on in conflict with their conscience. Conscientious objection is regulated in the appendix No treatment perform any refuse to to health workers allows that objection conscientious the on provision general introduced Republic Slovak care, heath the of area the Regarding morality, andrights offreedoms other people” measure taken inademocraticsociety fortheprotectionthe publicorder, ofhealth, Ibid, Appendix 4 - Code of Ethics of the Medical worker, clause 3 Abortion Act 1967, Section 4(2), last accessed onMarch 20, 2010 at: Ibid, Appendix 4 - Code of Ethics of the Medical worker, clause 3 Act No.578/2004Coll. of 21 October2004 on healthcare providers, workershealth and professional Ibid, Article 24(4) 110 109 and so it creates the basic duty to inform a patient about the aboutobjection. the apatient inform basicduty the to itcreates andso , it provides limitation on the invocation of conscientious clause when life or 108 Thus, similarly to the UK’s conscientious objection clause in the Abortion http://jaspi.justice.gov.sk/jaspiw1/htm_zak/jaspiw_maxi_zak_fr0.htm 32 106 . “If the healthworker the “If uses “the healthworker cannotbe 107 According to , last CEU eTD Collection http://jaspi.justice.gov.sk/jaspiw1/htm_zak/jaspiw_maxi_zak_fr0.htm without medical indication upon the request of a woman, last accessedMarch20, on 2010 at: 113 http://www.kbs.sk/?cid=1184747346 112 : on available of people, http://rodicovstvo.wordpress.com/antikoncepcia/historia/rights reproductive fundamental of respect and health reproductive with 111 objection when contentious of toexercise mediarespect appeared in with the found that approach another doctor who is willing to perform the procedure. Still, afew cases can be itreport ‘authority’ relationship inandnot – doctor andbasically patient just thus do tobethe paststill adoctor maybebecause of totalitarian consider ‘normal’the and itas take bythisobjection is affected individuals it once very used or exercisedoften, services in the Slovak withreproductive workers to objectionsareexercisedbyhealth respect contentious Republic. There can frequency the report the exact numberwith isitwhich to or However, impossible be several reasons for this. Either it is not pregnancy. of limit time specified within course of woman, the by request of basis the on also but fetus the of defect the or woman of life or health the to risk the example for as such indication Abortions arelegally available inthe justSlovak not Republic on basisthe health of it when arise such procedures. abortion as matters much criticized very theconcerns religiously care health of provision the in objections contentious the of majority vast Poland, still a majority of Slovak population - 73% - report to be Catholics. Even influence of though isnot the for Church Catholic asstrong the in exampleas organizations whichwould publiclysupportthe women’ reproductive arerare. rights The Slovak Republic isatypical country.post-communist Maybebecause thethat of Act No. 73/1976 Coll., AbortionAct, Article 4, time limit was set to 12 weeks when abortion performed Statistics used from the Official website of the Catholic Church in Slovakia, to be seenat; AssociationforParenthood Planning and Education on Parenthood was established 1991in and deals 113 33 112 Thus, the Thus, 111 CEU eTD Collection 2001, to be seen at: be seen to 2001, ý of in size Slovak town in hospital for average example, the particular happened,one This site the woman.on of the indicated reason health was there only when performed abortion procedures was prohibited in the whole hospital or where the abortions were the of performance whenthe examples been have there inpractice this, Despite Ethics. refusal of treatment participation or in controversial treatment as stipulated in the Code of http://www.sme.sk/c/1953484/lekar-v-presove-odmietol-podat-pacientke-liek-na-potrat-prepustili-ho.html give a patient drug for abortion and was dismissed), that such a decision was within his competence and that he and that was such his within competence that a decision was he stated issue, this on was interviewed of hospital the When director the in country. the without any health indication in the even whole hospital, though such aprocedure is legal natural person” 117 http://jaspi.justice.gov.sk/jaspiw1/htm_zak/jaspiw_maxi_zak_fr0.htm regulations, Article 27, lastly accessedMarch on 10, 2010 at: by later amended as laws, certain supplementing and amending and service, health the in organisations 116 http://jaspi.justice.gov.sk/jaspiw1/htm_zak/jaspiw_maxi_zak_fr0.htm regulations, Annex 4 – Code of ofEthics Worker,Health lastlyby later accessedMarch on amended as 10, 2010 laws, at: certain supplementing and amending and service, health the in organisations 115 114 can invokeworkers it. be raisedby itself institution the aswell,according toSlovak legislation, only health the While in USA the as mentionedin section 2.2 of this objection paper,conscientious can decision court on this matter. the abortion was refused by the doctor, however, till now none of them were subject to adca, where the director prohibited the performance of abortions requested by women abortions requested of prohibited performance the director the adca, where Act No.578/2004Coll. of 21 October2004 on healthcare providers, workershealth and professional Act No.578/2004Coll. of 21 October2004 on healthcare providers, workershealth and professional “ “Prerusenie tehotenstva – kde ano, kdenie”,(Abortion –where yes, where no), Lekár v Prešove odmietol poda 116 http://moment.ref.megaloman.sk/2001-08/index01-s.html and so in no way the institution itself can rely on the clause about the about clause the on rely can itself institution the way no in so and 115 The legislative provision specifies that specifies provision legislative The 114 Ģ pacientke liek na potrat, prepustili ho“(Physician in Presov refused to 34 SME , 2.3.2005, last accessedMarch on 9, 2010 at: , last accessed onMarch, 17, 2010 , last accessed onMarch, 17, 2010 “health careworker is a “just tryingtoprotect Moment, Volume 8, Volume 117 CEU eTD Collection at: magazine Moment, „ where no“ Here, notonly – physiciansdoctors are defined ashealth care professionals,alsobut for http://jaspi.justice.gov.sk/jaspiw1/htm_zak/jaspiw_maxi_zak_fr0.htm regulations, Article 27, lastly accessedMarch on 10, 2010 at: by later amended as laws, certain supplementing and amending and service, health the in organisations 120 119 08/index01-s.html 118 health profession” inworker Article 27bystating that: andis in the health professional workers the identifies service health who organisations health providers, healthcare the on Act The USA. in the or UK the in can they like itinvoke not subjectscan other that mean indicate or not it objections,does doctors’ the only concerned now in media till appeared which cases the fact that the despite However, procedure. hospital performed the requested nearest that visitedsuch no the patients instead a practice and that complained really about one be might reason the Again, it. about anything did courts the nor bodies state the neither upon wrong necessarily people’sother not perception sharingAnd opinion. the same his particularindividual the is andwhatperception conscience places of morally or good This example clearly illustrates the abuse of the director’s position and the situation when to perform abortionthe only receivingafter his consent. them regulation allows director’s the that and conscience matter ofindividual doctors’ the prohibition laid on the abortion procedures with no health indication by the director is not lives” Act No.578/2004Coll. of 21 October2004 on healthcare providers, workershealth and professional MUDr. Pavol Hartel, Head of the Gynaecological and Obstetric Department in MUDr. Jozef Valko, Director of the http://moment.ref.megaloman.sk/2001-08/index01-s.html 118 . Furthermore, the doctor employed in this hospital also responded that the , Volume 8, 2001, last accessedMarchon 17, 2010 at: Abortion – where yes, where no“ 120 and further in it this paragraph specifies health which professions. ý adca hospital for magazine Moment, „ “Health worker“Health isanaturalperson performing 35 , Volume 8, 2001, last accessed onMarch17, 2010 http://moment.ref.megaloman.sk/2001- 119 , last accessed onMarch, 17, 2010 Abortion – where yes, ý adca Hospital for CEU eTD Collection 53 http://billstatus.ls.state.ms.us/documents/2004/html/SB/2600-2699/SB2619SG.htm 122 121 Holy the the See and between BasicTreaty the of signature the was Republic. This Slovak in the event significant one was there objections conscientious the Regarding in future. controversies the significant can cause intheregulation such isit that a ‘hole’ clear Thus, professional. or provider care health alternative to the refer thepatient his to basis on conscience of the procedure Code ofEthics, would which health the care workerobjecting oblige or tothe treatment in the nor laws, care health in the neither legislation in Slovak nothing is there time same health care provider another refer to apatient refusal the to covers also thebasisof conscience careon health Moreover, unlike the USMississippi having aprovision expressing refusalthe that of in will his appear media. the conscience, the hospital refusing to provide massage to a woman who underwent abortion invoking in evenpills contraceptivemasseur the patient the and give prescription or employed the the fill to refusing pharmacists of example, for cases, first when time of question a just is it and broad is conscience their with conflicts that treatment the in participation Thus, scopeofindividuals the providecould who to refuse thetreatment or the etc. ambulance-man, masseur, assistant, nutrition physiotherapist, nurse,pharmacist, example dentist, the Mississippi Health Care Rights of Conscience Act 2004, Section 2(a), last access Ibid, Article 27 on March 13, 2010 at: 122 121 , there is no similar provision in the Slovak Republic. But at the 36 for details see footnote see details for CEU eTD Collection should cover also those people with no religious affiliation to conscientiously object. it be is regulated, to objection if conscientious fundamental, are andrights freedoms objection only beliefs on groundthe of religious several strong deficiencies. strong several were there treaty, to this Draft respect made with analysis the of inone As described with lots of criticism which consequently lead to its rejection. was accompanied treaty Draft the objection, contentious to the right the of application Right to Objection of Conscience discussions lasting onlong been had there this though even However, Draft parties. contracting mentioned Treaty between the Slovak treaty above between the which tobeseparate it to supposed refersspecial accord was Republic and the Holy See on the defined by special Accord between the [Holy See andtheSlovakRepublic]” byspecialAccordbetweendefined the[HolySee willthe Catholic Church. of be the applicationofthisright The extentconditionsof and the rightofall to obey their conscience accordingto the doctrinal principles and morals states that: It beliefs. religious basedthe on objection Laws/International/Intl01.html at: available Conscience, of 127 %20medzi%20SR%20a%20Svatou%20stolicou.doc http://www.voltaire.netkosice.sk/archive/nabozenstvo/Analyza%20Zmluvy%20o%20vyhrade%20svedomia at: available Conscience 126 http://www.consciencelaws.org/Proposed-Conscience Laws/International/Intl01.html 125 http://www.consciencelaws.org/Proposed-Conscience-Laws/International/Intl01.html 124 slovenskou-republikou-a-svatou-stolicou http://www.culture.gov.sk/cirkev-nabozenske-spolocnosti/legislatva/zkony/zakladna-zmluva-medzi- 123 Slovak Republic Article 3 of the Draft Treaty between the Slovak Republic and the Holy See on the Right to Objection Analysis of the Draft Treaty between the Slovak Republic and the Holy See on the Right to Objection of of Conscience: Objection to Right the on Holy See the and Republic Slovak the between Treaty Draft Basic Treaty between the Holy See and the Slovak Republic, Article 7, to be seen at: Basic Treaty between the Holy See and the Slovak Republic No. 326/2001 Coll. to be seen at: 123 in 2001 which contains the general in conscientious contains the general provision 2001 which on the http://www.consciencelaws.org/Proposed-Conscience- 126 First of all, it regulated the right to use the conscientious 125 that aimed to specify the extent and conditions on the 37 127 and despite the fact that the religious “The SlovakRepublicrecognizes . 124 The CEU eTD Collection 130 129 128 which and inaccordingworkers to theorganisationsservices professional health objectionconscientious is embodied inAnnex 4 to Actthe healthcare on providers, health care health areaof In the objection. contentious to respect with exist legal regulations Fourthly,in aswasmentioned above, legal the of Slovakthe order no Republic, compact abuse.unfounded or beas could ‘labeled’ his this objection treaty, to referring uses objection person another when then and objection the use could church Catholic the of members are who persons interpretingcourts provision this in future would the come tothe conclusion onlythat the of Church. based only Catholic principles the the on be can objection such however objection conscientious use can persons other all also notjust thedraft, provision According drafttreaty couldthis create. but to of Catholics Thirdly, another pointof criticism expressedby analysisthis wasthe situation which the support sexual the or treatments regardingeducation reproductive and the rights similar. by basisthey would refusalthatto state the tothe of paying are used taxes refuse onthe teachers the when even situations the causing any thus itsituation could apply to areas his conscience. with things contradicting perform to which refuse could everybody to according freedom of conscience, on the based objection the as treaty in thedraft defined was objection contentious the Secondly, areas to which the objection could apply could which objection the areas to Ibid, Article 3(4) Ibid, Article 4 Ibid, Article 2 128 129 The draft treaty demonstratively describes the 38 , however, as it is not the exhaustive list of 130 Thus, it Thus,could happenthatthe CEU eTD Collection constitutional rights greater and freedoms.”guarantee agreements and treaties international the that provided laws national over precedence take rights and freedoms ratified by Slovakthe Republic andpromulgated understatutory requirements shall 132 http://jaspi.justice.gov.sk/jaspiw1/htm_zak/jaspiw_maxi_zak_fr0.htm regulations, Appendix 4- Code of ofEthics Medical the worker,by clause later 3 to be amended as seen at: laws, certain supplementing and amending and service, health the in organisations 131 beforeRepublic Actsof the priority Parliament it have would Slovak of the legal order in the Treaty, Rights Human form International of in the health.lifeto or is a threat there in placewhen are limitations available at: orhealth have doctor tobeanother will care provider resolved. to patients affected issue of of referral aswell object exactly conscientiously can extent various religious groups thepressureof rights, reproductive their thereof and available, services reproductive in the country will multiply of people of awareness with growing later,the or sooner that, beexpected itcan care but and the issue of who heath inand present causing significantproblems is vague. not very It contrary general and to what butdetailed on the is not this regulation health inobjection care. However, areaof the Thus, the Slovak Republic is another example of the countries that regulate conscientious inbe just of regulated to conscience matters form.a general Treaty neverfound be way its to enacted in through Slovakthe Republicleavingthe Constitution of the Slovak Republic (Act No. 460/1992 Coll. Of September 1 Act No.578/2004Coll. of 21 October2004 on healthcare providers, workershealth and professional http://www-8.vlada.gov.sk/index.php?ID=1376 39 stating: “International instruments on human 132 131 . Consequently, this Draft Once it would be Once ratified itwould st , 1992),Article 11, CEU eTD Collection use of conscientious objections in health care should be illegal because doctors bare because a illegal doctors be careshould objections inhealth use conscientious of is no place for them. According to the renowned medical ethicist, Julian Savulescu, the that there others in health place care, have their objections these Some of claim that them vary. care health field of in objection the conscientious of ontheacceptability The views 3.1. Acceptability ofconscientious objection andvariety of opinions person. affected the and Professional care heatlh the of rights conflicting the between balance best the provides regulation that objection appropriate conscientious the presentingof most the model a objection and offer acceptability of to the conscientious opinionsrespect with is various introduce chapter to 2.The aimof this in Chapter can beseenin analysis the objection. Opinionsrely such on to professionals health care for is itappropriate that claim however, vary and thus also theOthers, profession. the have a of not exercise the does in objection place conscientious regulation of the factthat the conscientiousto attention call them of Some opinions. contradictory numerous objectionbecontroversial. allowedshould or ofwhetherit not causes The question as is very health care in of sphere objection the conscientious of acceptability The issueof Acceptability, limitation andthe best model of regulation objection ofconscientious CHAPTER III 40 CEU eTD Collection 16, 2010 at: 134 133 patients. strong professional towards duty invoking but the grounds other objection such personal as forself-preservation when for ground asthe is accepted onehandreligion inconsistency becauseon the significant creates belief. This isinvoking religious objection the for common the reason reasons, conscientious entitled. legally are they which to treatment objection lackingpatients abouttheir willnotreceivecould knowledge rights the happen also that is consideredisit entitled. which Thus, the patient careserviceto health of cause indelivery delays to bereiterates based thaton if thedoctors Fifthly, procedure. further provide Savulescu treatment or be to requested willing religious, refusewould who ones non-objecting those evendoctors the between find to topatients for referbe difficult a moralpatient to anotheroritcan is that equitable. Thereason not and inefficient becomes health care system the of ethical professional, also thus and practice care health in used are objections conscientious when thisunavailable can interest, nottheirown.” idiosyncratic, bigoted,discriminatory medicine. Publicservants must actinthepublic Pandora’s boxof isadoorto her patient.Thedoorto“value-driven-medicine” to hisor theindividualdoctoroffers care an shouldinfluence …[T]hey not private life. that: he reiterates Thirdly, profession should patients getbeall as able legally or procedures. to available treatments choose this not should conscience their itcontradicts because treatment available legally refusing aparticular thatdoctors he stipulates conscience. Secondly, doctors’ the patients, not legallybe to provided areto procedures treatment or what stipulates Ibid., p.297 J. Savulescu, “ http://www.bmj.com/cgi/content/full/332/7536/294?ijkey=6NtRebQvp8GVGYn&keytype=ref Conscientious objection in medicine”, BMJ 134 “… [V]alues and conscience have different rolesinpublicand havedifferent “… [V]aluesandconscience Fourthly, he emphasizes that service actually becomes actually he service that Fourthly, emphasizes 41 133 First, he argues that it isit he thelawthat that First, argues Sixthly, as he mentions even though the though even mentions he as Sixthly, 2006, 332, 294-297, last accessedMarchon CEU eTD Collection 16, 2010 at: 2010 at: New England Journal of Medicine, Volume 360: 1484-1485, 2009; Number 15,last accessedMarch on18, 136 135 and profession their freely choose care workers health has justification, its objection where conscientious thatunlikein - service conscription the states Hereshe service. and conscription the care health differentiating by care health in place a have not do objections conscientious why sheexplains Afterwards, health care worker. of the self-interest from the freed in health care, of sphere the of professionalism requirement the she emphasizes by administration. Bush’s in2008 December, enacted andServices Human of Health Department the of regulation federal new the to asaresponse Cantor by Julie madealso havecare was aplaceinhealth not does objection conscientious that The fact specialization. a different should then ifit so, and they choose care services recognized health does not hinder theservices quality legally patients the ina does and accessibility way of that offer the can they whether in advance consider should and therefore such profession their brings it profession the with alreadypatients towards their for preparation during that the responsibility of areaware care professionals heath that he reiterates addition, professionals who care ashealth should careworkers health other or of doctors status question the into calls also accept that theSavulescu beliefs. others to compare status superior such beliefs religious gave the interestwhat of their patients could askwhoand one Thus, discriminatory. is hisown health considered about concern should come first.the of because disease infectious with the patient the treat refuses to doctor the example In J. D. Cantor, “Conscientious objection gone awry – restoring selfless professionalism in medicine”, The medicine”, in professionalism selfless – restoring awry gone objection “Conscientious D. Cantor, J. J. Savulescu, “ http://content.nejm.org/cgi/content/extract/360/15/1484 http://www.bmj.com/cgi/content/full/332/7536/294?ijkey=6NtRebQvp8GVGYn&keytype=ref 135 Conscientious objection in medicine”, BMJ “[a]s the gatekeepers to medicine, physicians tomedicine, thegatekeepers “[a]s 42 2006, 332, 294-297, last accessedMarchon and otherhealthcare 136 Initially, CEU eTD Collection assn.org/2009/09/jdsc1-0909.html “Conscientious Objection: A Medical Student Perspective” 67 obtaining/providing/acting on genetic information”. 140 139 138 137 to claim such objection be for unjustis them they andexplains it such a system easier thatcan decide to consider as well in order to careget service or treatmentmust perform these ridservices in the place of those who object.of He excessive health any provision of to the not object whodo doctors that also out workload points John Wyatt laid on them arevery selfish. claims objection conscientious any that claim thus and patients their than position a better in be to doctors consider rightly They patients. their of fiduciaries the as society in enjoy doctors that and priviliges many status high the out point Frader andBosk critics - In other addition, unavailable. service health care controversial to making the access thus treatment different services theyunstable andif have placethey inhealth care, thepatientsbe can notsure of what can in fact get. There them“ can be differentproviders haveanobligation tochoose professionals objecting towards 2009, Volume 11, Number 9:686-689,p. 687, accessed on March 16, 2010 at: have toshoulder“ Frader J, Bosk. CL, Ibid Ibid Ibid in 137 . Then, she also compares conscience to a burdern which 139 138 “The personal is political, the professional isnot: Conscientious objection to . Moreover, her ctiticism relates to the fact that objections are very are objections factthat the to relates her ctiticism . Moreover, 140 specialties thatarespecialties notmoralminefields for Am J Med Genet Part C Semin Med Genet 151C:62- 43 , by A. Williams, Virtual Mentor http://virtualmentor.ama- “patients shouldnot , September CEU eTD Collection 145 144 143 2009, Vol. 25,No. 12, p. 133-144, p. 135 http://admin.cmf.org.uk/pdf/cmffiles/39_doctors_conscience.pdf Medical Ethics Advisor,“ 142 141 also onthe patient approach andmoralityto the Thus, the believe, doctor. the I of not only buthealth health the care ontheskilfulness professionals,care depends of the of quality the And beings. human also but professionals just not are however, Doctors, judgment.” clinical discernmentor exercising ofphysicians and necessaryconsequence both.” wayhave to no theirpatients.There’s best for thinkare not dothingsthattheydon’t what’sabout toit,unless their patientsandbeingcommitted them to bestfor you allow following reasons:inform to apatientwhoapproached them.he his offers and refer supporting argument In First of all, according havea duty still professionals health care that he emphasizes sametime atthe However, to him, conscience. totheir is which opposed treatment the refuse to care professionals for thehealth isit correct that believe who A. Curlin, such as Farr alsothose, are there care, health in objection conscientious the of application the to opponents the Besides abusefor of the conscience. way the creates This patient. the treat to refusal doctors’ objecting other the of because to doingwhat patientswant …” Ibid Ibid Ibid Curlin, FA, et al. “ J. Wyatt, 143 Furthermore he reiterates that: “Doctor’s conscience” 145 Religion, Conscience and Controversial Clinical Practices Should 141 health care providers have the rightof conscientious refusal , CMF Files CMF 144 And he also considers conscience to be , Number39, 2009, p. 1-2, access onMarch 22, 2009 at: 44 “… medical decisionscannotbereduced “… youcan’t have doctors thinking .” NEJM . 356;6:593-600 “… alogical ?”, December ?”, 142 in CEU eTD Collection objections. the allow to not reason no is there then time appropriate in available and quality bea good of would that services care health safeguard reproductive these manage to canstill if states Thus, objections. invoke all doctors not the is that services care health in objection fact acceptability another supportsthe that of conscientious the Furthermore, care towhich they themselves.devoted integrity,butalso patient the resultin or professionals good leaving the fieldmedical of inactjustagainst harming resultnot couldCompelling herto herpersonal herconscience one. butthis her patients high to quality of a treatments and careservices health available perform abortion.the Still, doctorcould this bea greatprofessional, offering all the to rely to andmuch, refuse objection the expected on canbereasonably she desiresso bear child the able to not is miscarriages multiple whoafter female doctor the example, his later practice. perception inthroughout objection For can develop doctor’s the conscientiously is object justified, can one not avoid situations where such conscientious not do they which to services care health comprising specialization the choose should for practice inawaythatthey their specialization preparation during already future their about think to medicine of students the on demand the though even Moreover, quality of the service they would be compelled to perform. the beliefs couldaffect conscientious act to contrary to their deep doctors requiring the 45 CEU eTD Collection http://www.bmj.com/cgi/content/full/332/7536/294?ijkey=6NtRebQvp8GVGYn&keytype=ref March 16, 2010 at: research onthe thisthroughout gained information the of topicbasis the on and section next in the I willTherefore, introduce what kind of limitations should be application. placed on the objection, is regulation this the door ambiguity verygeneral, to opening inits future to life or health threat entails the that aswell objection conscientious the regulates Slovakia though even of the professional conscientious and objector individual as requesting the treatment. patient as between health care the reasonablebalance the moving towards professional thus the limitationguidanceorder objecting that toinform doctor patientthe and another refer him to for the invocation of conscientious 149 148 147 146 conscientious objections andlimitations. While Mississippi has andalmost absolute unlimited clause onthe use of conscientious objections varies from state to state. They differ in the scope of regulation the USA, UK and Slovakia in Chapter 2 of this paper, it is clear that the regulation of the conscientious objection in the regulate already Many countries theopened. been already boxhas Pandora the However, field of health care. As can beidiosyncratic, bigoted,discriminatorydoor toaPandora’s medicine.” boxof seen from the example of that: Hestates inmedicine. and conscience Here, Iwould like returnto to the statement of Julian Savulescu about the place valuesof See Chapter 2.3. See Chapter 2.2. See Chapter 2.1. J. Savulescu, “ 149 Conscientious objection in medicine”, BMJ 147 , the UK provides certain limitation in its legislation and legislation its in limitation certain provides UK the , 46 “The door to‘value-driven-medicine’ isa 2006, 332, 294-297, p.297, lastaccessed on : 148 And 146 CEU eTD Collection conscience and its manifestation is fundamental human freedom and legal personalities legal and freedom human fundamental is manifestation its and conscience of Freedom it. invoke can institutions care health or hospitals whole as such personalities legal should invoke safeguardthat no it. can It objection individuals only that the conscientious of national in its regulation make it shouldclear of state all, First the astherightofindividual A. objection Conscientious conditions: following fulfils that way a in legislation national its in it regulate itshould inmedicine, objections usageof allows the conscientious for If state the reach above balance. mentioned the conscientious objection in health care comprising thelimitations it placed inon to order the two competingbetween balance reach a to in order do to of what think should one useand its extensive interests. dangerof the show clauses of conscientious regulations Various in sphere. this certainty In legal reach thus and services care access health thisto right andpatient’s of conscience right section care professional’s health between cause can which it conflict the resolve to necessary I will offerAs conscientious isobjection already applied inby practice health care professionals,is it the model of regulationregulation Limitation of conscientious objection and the 3.2. best model for its of best model for its regulation. be the would what thus and practice care health in objection conscientious of application 47 CEU eTD Collection objection “ againstwithoutreligiouscertainbelieve those beliefs. such groups HereI religious that objectorsaffiliated to favorthose religious would unjustifiably only grounds ground to limit To beliefs. ethical and moral of basis the on also but beliefs religious of basis Thirdly, the invocation of the conscientious objection should not be allowed conscientious objection only on the fortheinvocationof ofgrounds specification C. Non-discriminatory conscientious objection or its abuse. of excessive use prevent and professionals care ashealth aswell for patients preserve thelegalcertainty in to beinvoked order objection can conscientious treatments whichhealth specify or care services clearly Secondly,should regulation towards invoked canbe conscientious objection which towards care services ofhealth B. Clearspecification in this ‘objecting’ hospital able to perform the particular health care service or procedure. doctor single benot a would There restricted. much be very would services health care to if hospital the could claimconscientious objection asitinis the possible USA claim conscientious objection, it would go against the basis of this objection. Moreover, 151 150 a conscience. have not do that beings human not are See Chapter 2.1. Thought and Religion of Conscience, Freedom onthe I – Chapter See should be whatbased onadeeply held objectionto thepatientisasking 48 150 Thus, ifhospital would beable to 151 , access CEU eTD Collection 153 http://archive.student.bmj.com/issues/08/07/life/264.php Student BMJ, Volume 16,July 2642008, – 265, to be found at: 152 whatdoctor to do,not thepatienthas done orhow the patientlives” case which was resolved in UK wasresolved case which that of the administrativefor example suchas service health care in objected the participation indirect clear that workers typing Fourthly,legislation should specify directwhat constitutes participation.letters should It make of referral insuchservice directly participate for service or theobjected perform thatdirectly care professionals abortion procedures onlywithrespecttohealth objection D. Invocationofconscientious – a Charles Williams. discriminatorybe would approach Opposite characteristics. orother racial group or status marital hispatientbecauseorientation, sexual itselfto of objects service the andnot objector to conscientious when the approach non-discriminatory This shouldtreatment. safeguard constituting the particular but towards groupof patients or theparticular patient towards directed be not can objection conscientious the that stipulate should legislation the Fifthly, invoking objection conscientious objectorwhen patientsby towards approach E. Prohibitionofdiscriminatory abuse of objectionconscientious and toperform refusing task. the conscience andbe cannot construed used invokingabortion procedures as for the a basis daily cleancare of whounderwentabortiona woman or theinstrumentsused inthe and allowing the health care Janaway Salford v. Heatlh Authority C. Williams, “ Conscientious objection” 153 , [1989], A.C. 537 (House of Lords) orthe examples when nurses take the would refuseto , discussion of doctors’ right to stand by their moral convictions, moral by their stand to right of doctors’ discussion , 49 152 as stated by CEU eTD Collection the next point was recognized in the UK where the General Medical Council as Council General the Medical inwas recognized UK where nextpoint the the earlierin understood paper,thisduty withthis together duty the in referral of described contrary,the must duty this be by objector.As be conscientious observed the could diagnosis,state, prognosis and possibilitiesthe offurther legally On available treatment. information his health on the from withhold to patient health care professional objecting the allow not does invoked objection the that be emphasized should it Seventhly, offurthertreatment andpossibilities his diagnosis,prognosis tohealthstateofthepatient, relating G. Disclosureoftheinformation see another specialist. hewillhave to of such service need future in caseof takethe arisk that with and thus one this contract he will whether or doctor non-objecting another with contract will he whether on decision independent maketo made by This apatient allow will patient. futurethe request of offeritin case withconcluding him a contract which the treatmenthe about to objectsandthuscannot before patientinform health future potential objects, the should care professionals which normally would includethe which of performance services to professionalthe practice having aprivate it. In care professionals about case of health inform patient the should objection conscientious the invokes who professional care health the Sixthly, objects objector conscientious which towards F. Disclosureofprocedures life. of way disapproval one’s of itselfbecause of but because procedure the not refuse thetreatment professionals to 50 CEU eTD Collection patient, thedoctor originally relyobjecting cannot objection on this deliverand has to or necessary service or perform requested the to patient for the in accessible iscare provider health noanother there emergencywhen cases in that casescodify should objection whenconscientious the of regulation therethe Ninthly, is a risk to life objection ofconscientious I. Limitation ontheinvocation or health of the but legalrender objectionable services health otherwise unavailable.care itwould lapse. to Otherwise not service such a of performance the to time reserved the professional, this must be within the patient’s proximity and timely accessible in order for 156 http://aappolicy.aappublications.org/cgi/reprint/pediatrics;124/6/1689.pdf Number6,December 2009, p.1689-1693, 1689 and 1691, last accessedMarch on 15,2010 at: 155 154 Pediatrics. of Academy American the of Statement Policy and Council Medical General UK Asprocedure. mentioned abovein point F, referral was already in recognized of guidance requested thatcould perform a non-objecting professional refer to apatient to has aduty Eighthly, once a conscientious objection is invoked by the health care professional he still professional healthcare non-objecting H. Duty to referthe patienttoa inforpatients be them order decide ableto to autonomously. Pediatrics who stipulated that it is the health professional’s duty to provide information to Academy of American of the in mentioned Policy Statement the duties werealso laidin body regulatory its guidance. thison duty them doctors of Provide Information or Treatment onthe Basis of Claims of Conscience” See point F, Chapter 3.2. American Academy of Pediatrics, Committee of Bioethics, “ See Chapter 2.2. 156 Of course, in case when the patient is referred to another health care 51 Policy Statement – Physician Refusal to 155 , PEDIATRICS 154 Furthermore, these Furthermore, Volume 124, CEU eTD Collection at: 159 http://jaspi.justice.gov.sk/jaspiw1/htm_zak/jaspiw_maxi_zak_fr0.htmat: be seen to 3, clause worker, Medical ofthe ofEthics - Code 4 Appendix regulations, by later amended as laws, certain supplementing and amending and service, health the in organisations 158 http://www.statutelaw.gov.uk/documents/1967/87/ukpga 157 Worker. Health of Code of Ethics 1967 Act Abortion in UK’s wererecognized the life of patients andhealth the to cases of threat in limitation 2 paper,this of inthis As Chapter discussed procedure. or treatmentthe conscientious objection. conscientious remedies thatcould be sought by affected the persons with respect toinvocation of In addition, regulation of the conscientious objections should also provide for the remedies K. Legally available would have to bear a duty to perform services to which others object himself. particularas insuch he notcases treatment objecting towards careworker singlehealth such treatment. Suchpersonnel set upshould avoid situations when wouldthere be a to access have effective to patient the for in order treatment certain of provision against hospitals number shouldhealth who careworkers safeguard appropriate do notobject of services, health care legally available to access safeguard aneffective to Moreover, professionals healthcare ofnon-objecting number J. Securinganappropriate but also to health care institutions for refusal of offering even the emergency treatment. just health care professionals not immunities gives which conscience, on act Mississippi Mississippi Health Care Rights of Conscience Act 2004,section 3(2), last accessed onMarch 13, 2010 Act No.578/2004Coll. of 21 October2004 on healthcare providers, workershealth and professional Abortion Act 1967, Section 4(2), last accessed onMarch 20, 2010 at: http://billstatus.ls.state.ms.us/documents/2004/html/SB/2600-2699/SB2619SG.htm 157 as well as in the Slovak clauseon conscientiousthe included objection inthe 158 Such a limitation does not exist in the analyzed in the exist not does limitation a Such 52 159 CEU eTD Collection beingin invoked practice and patients are thosewho canbeby affected adversely the andindividual’sto accesshealthprocedure care.As objections right are conscientious professional invoking conscientious objection with respect to particular treatment or health between care the interest in of can a conflict result that services planning family other or sterilization voluntary procedure, abortion example for as such – services reproductive to related those some, especially are there However, care professionals. thehealth between controversies notcause conscientious do careservices health Many of humanity. treatment and they want tofeel they are cared forproperly, with the professional care and tend to look up at the doctors as those who are there for them,help to them, provide them life people of the time aneed.Atsuch cancausesuch diseases other flue or average also but accidents, serious of aresult as life in their later or surroundings medical in the place takes usually in modern that thebirth societies immediately after the Either health care. At some point in their life all people happen to be in a need of medical treatment and of terms and boundaries can help avoid to many controversies in arising practice. basicfor certain explanation standards, providing health such regulation, Ibelieve care, of inthepractice objection conscientious of application the -relating to future arise inthe can -that situations cover all possible the not can regulation legislative the Even though Conclusion 53 CEU eTD Collection general andvaguefuture for controversies. thus Consequently,forth openingin thedoor chapter the limitations on conscientious invocation the objection life– such as to threat and health,itis too certain despite that showed regulation Slovak the of analysis addition, In guidance. professional narrowlyinterpreted is procedure controversial the in participation the where and objection conscientious of duties of objection UK’s limitationUK the on on afine regulation conscientious usage provides that proved health care by being protected objection conscientious clause. Unlike the analyzed USA, the regulation in the professionals thus inbe procedure range a to considered broad of participation activities and well institutions as to inform as ofhealth care professionals all kinds covering in excessive regulation USAistoo the the that and refershowed It major differences. also are there similarities some are even there though that out pointed the patientperspective the existing regulation of conscientious objections in the USA, the UK and Slovakia andpreserved in comparative the analyzed thesis the of chapter second the Afterwards, access health care. to right patient’s and byconscience his to according act to right professional’s care health the namely Patient, and care professional health the between service health care controversial inthe arising interests of conflict of sources identified thesis of the chapter first the to this, With respect legislations. wouldbe the best appropriate model of conscientious objections’ regulation in the states’ national tosuggestwhatinKingdom order Slovak Republic, United UnitedAmerica,of the and the States of legalthe the systems respectto with services care health sphereof inreproductive objection the The aim of this thesis was to analyze the appropriateness of the regulation of conscientious interests. twoconflicting bestbetween balance providesthese way the for possible that in considereda andregulated must becarefully or procedure, objections these treatment ornecessary reproductive perform requested the to not decision health care professional’s 54 CEU eTD Collection must be also in place in order to enforce rights. to the in be in must also place order remedies legal and applies rule Non-discrimination anyway. service the perform to has objecting one the available, careprofessional health non-objecting another nois if there or is threatened such cases the duties informto and refer a patient must be observed and if in the person’seven life or healthHowever, treatment. controversial in the participation or performance direct the cover only At it same it beinvoked. time the whichshould health can careservices specify exactly towards conscientious objection is the right of individual,not institutions and that its regulation should forbest model regulation objection conscientious of This model that was presented. suggested presented and finally,based on knowledgethe through researchanddone the gained analysis, the carewere in objection health conscientious of on acceptability the various opinion of thesis the 55 CEU eTD Collection Bibliography: ------International Covenant on Civil - and Political Rights, Office of the United Nations at: High Commissioner for Human Rights, entry into force 23 March, 1976, available Physician Refusal to Provide Information or Treatment on the Basis of Claims of American Academy of Pediatrics, Committee of Bioethics, Policy Statement – http://jaspi.justice.gov.sk/jaspiw1/htm_zak/jaspiw_maxi_zak_fr0.htm supplementing certain laws, as amended by later regulations, available at: andworkers professional in organisations healththe service, and amending and ActNo. 578/2004Coll. 2004 of 21October healthcareon providers, health http://www.statutelaw.gov.uk/documents/1967/87/ukpga Abortion Act1967, available at: http://moment.ref.megaloman.sk/2001-08/index01-s.html Abortion – where yes, where no, http://virtualmentor.ama-assn.org/2006/05/hlaw1-0605.html Association, May 2006, Volume 8,Numberp327 5:327-331, available at: Medical American of Ethics the Journal Virtual Mentor, Law andMedicine, A. 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