Ethically challenging or controversial medical procedures have prompted increasing requests for the exercise of conscientious objection, and caused concerns about how and when it should be practised. This paper clarifies definitions, especially with regard to discrimination, and explores the restrictions, duties, and practical limitations, in order to suggest criteria for its practice. It also argues that a conscientious refusal to treat, where there is therapeutic doubt, is a valid form of conscientious objection. An email survey sent to General Practitioners (GPs), (...) explored the adherence to the suggested criteria, and assessed the outcomes, in terms of acceptability, impact, and difficulties experienced by the GPs, their colleagues and their patients. The results demonstrate high acceptability of conscientious objection, and better outcomes when the suggested criteria are adhered to. The GPs would support education to improve the practice of conscientious objection to a professional level, which could further improve outcomes and acceptability. (shrink)

This paper draws on research undertaken by the authors in community well woman clinics and hospital settings. Discussion focuses on issues around informed consent and participant observation. The authors are concerned to highlight the complexity of decision-making where researchers hold dual or multiple agendas, which are sometimes in conflict. Further situational factors which affect decision-making in research settings are explored. In particular, the complexity of gaining informed consent throughout the research process is addressed. The intention is not to point to (...) definitive resolutions to the problems posed, but rather to prompt debate about the often taken for granted meaning of 'informed' consent in relationship to participant observation. Cet article est basé sur les recherches que les auteurs avaient entrepris dans des polycliniques de santé de femmes et des hôpitaux. La discussion est concentré sur les thèmes du consentement informé et l'observation participante. Les auteurs sont inquiets de montrer la complexité du processus de se décider quant les chercheurs ont un rôle double ou multiple qui peut être en conflit. D'autres éléments qui influencent la prise de décisions dans des cadres de recherche sont aussi étudiés. En particulier, la compléxité de l'acquisition du consentement informé est adressée. L'intention n'est pas d'amener à une résolution définitive du problème posé, mais plutôt d'inviter á une discussion sur le sens (trop souvent pris pour réalité) du consentment 'informé' quant il s'agit de l'observation participante. Dieser Artikel stützt auf Forschungen, die die Autoren in Frauengesundheits-Kliniken und Spitälern unternommen hatten. Die Diskussion ist hier über die Themen Informierte Zustimmung und Mitteilende Beobachtung. Die Autoren befassen sich mit der Vielschichtigkeit der Entscheidungskräfte wenn die Forscher doppelte oder mehrfache Rollen haben, die manchmal im Konflikt sein können. Andere Faktoren, die die Entscheidungsmöglichkeit beeinflussen, sind auch untersucht. Besonders wird hier die Komplexität des erhalten von informierter Zustimmungung während des Forschungsprozesses angesprochen. Die Absicht ist nicht, eine definitive Lösung des Problems zu finden, sondern eher zu einer Debatte einzuladen über die zu oft als selbstverständlich betrachtete Bedeutung der 'informierten' Zustimmung auf der Ebene der mitteilenden Beobachtung. (shrink)

A response to Kavita Shah's article Selecting Barrenness.

The morning-after pill has been promoted as a solution to the growing teenage sexual health problem being witnessed in Scotland. The continuing increase in sexually transmitted infections (STIs), recorded in recent reports of the Scottish Centre for Infections and Environmental Health2, has come as a shock to members of the health profession across Scotland. Documenting a marked increase in teenage sexual activity, the report raises urgent questions about the impact of the “safe sex” message in our classrooms and the Scottish (...) Executive’s overall approach to teenage sexual health. One specific feature of this approach that has prompted concern from General Practitioners (GPs), parents and educators (and others) has been the official policy on the promotion of the morning-after pill as a method of contraception. When appropriately initiated within 72 hours of unprotected coitus, emergency contraception will prevent approximately 80% of pregnancies in teens and young women who are mid-cycle and, thus, at risk of pregnancy.3 But this policy has not been based on a clear and rigorous understanding of the properties, the function and the efficacy of the morning-after pill. Neither has there been adequate and in-depth research on the short and long-term safety implications of the morning-after pill. In light of proposals to increase the availability of the morning-after pill, the overall aim of this Briefing Paper is: 1. to provide specific answers to the questions raised above, based on research evidence; and 2. to provide an independent source of information on the most recent research on the morning-after pill and STIs, for parents, teachers, politicians, members of the health and legal professions and other interested parties. (shrink)