Volume 20, Issue 6, June 2020, Page 25-27.

Volume 20, Issue 7, July 2020, Page 133-135.

Volume 20, Issue 3, March 2020, Page 1-5.

Background: While employers are increasingly considering and implementing COVID-19 vaccination requirements, little is known about the reasons offered by employees seeking religious exemptions.Methods: We conducted a mixed methods analysis of all the requests for religious exemptions submitted during the initial implementation of a COVID-19 vaccination requirement at a single academic medical center in the United States.Results: Five hundred sixty-five (3.4%) employees requested religious exemptions. At least 305 (54.0%) requesters had job titles suggesting that they had direct patient contact. Four hundred (...) ninety-nine (88.3%) of requesters self-identified as Christian, of whom 120 (21.2%) identified as Roman Catholic. Requesters offered 0 to 8 (mean 2.7) categories of reasons for their request. The most frequently stated reasons pertained to the use of fetal cell lines in vaccine development and manufacturing (382, 67.6%), interest in maintaining purity (221, 39.1%), or belief in divine healing (172, 30.4%). Some requesters also volunteered evidence of the sincerity of their beliefs including examples of their religious practices (116, 20.5%), other practices (66, 11.7%), and emotional states (32, 5.7%). One hundred fifty-two applications (26.9%) contained text copied without attribution, primarily from sample religious exemption request letters available on the Internet.Conclusions: Most requesters focused on the use of fetal cell lines in the development or manufacturing of the vaccines as the justification for their request. The development of vaccines that are not reliant on fetal cell lines may increase vaccination rates. Understanding reasons for religious exemption requests may inform vaccine education and vaccination policies. (shrink)

The analysis of a dispute can focus on either interests, rights, or power. Commentators often frame the conflict over conscience in clinical practice as a dispute between a patient’s right to legally available medical treatment and a clinician’s right to refuse to provide interventions the clinician finds morally objectionable. Multiple sources of unresolvable moral disagreement make resolution in these terms unlikely. One should instead focus on the parties’ interests and the different ways in which the health care delivery system can (...) accommodate them. In the specific case of pharmacists refusing to dispense emergency contraception, alternative systems such as advanced prescription, pharmacist provision, and over-the-counter sales may better reconcile the client’s interest in preventing unintended pregnancy and the pharmacist’s interest in not contravening his or her conscience. Within such an analysis, the ethicist’s role becomes identifying and clarifying the parties’ morally relevant interests. (shrink)

Critical reflection on clinical ethics consultation is essential to the field. Johnson and colleagues (2015) have helpfully summarized the consultation experience of a children's specialty hospital...

Nonpharmaceutical interventions to minimize the transmission of the severe acute respiratory syndrome coronavirus 2 are necessary because we currently lack a vaccine or specific treatments. Healthcare facilities have adopted visitor restrictions and masking requirements. These interventions should be evaluated as public health measures, focusing on their efficacy, the availability of less-restrictive alternatives, and the minimization of the burdens and their balance with the benefits. These interventions, as well as exceptions, can be justified by the same analysis. For example, visitor restrictions (...) are sound, as are exceptions for women in labor, adults with disabilities, minor children, and individuals who are dying. In implementing these policies, specific rules are preferable to general principles because they are more efficient and reduce possible bias. There should, however, be appeal mechanisms and retrospective review processes. Evaluating requests for medical exemptions to masking requirements is particularly difficult, given the prevalence of nonmedical objections, false claims of medical exemptions, and a lack of objective medical criteria. Requiring written statements by licensed healthcare providers that undergo subsequent substantive review may therefore be justified. (shrink)

The American Society for Bioethics and Humanities debated for several years about whether it should adopt positions and, if so, on what range of issues. The membership recently approved an amendment to its bylaws permitting the Society to adopt positions on matters related to academic freedom and professionalism but not on substantive moral and policy issues. This resolution is problematic for a number of reasons, including the lack of a categorical difference between these types of claims and the Society's inability (...) to speak on behalf of patients and research subjects. The implementation of the amendment also raises several issues. The Society will need to refrain from speaking too specifically and to articulate the responsibilities of its members. If the Society fails to address these concerns, it runs the risk of denigrating its public image and that of the profession. (shrink)

The American Journal of Bioethics, Volume 12, Issue 8, Page 11-13, August 2012.

Of the different features of this case, I focus on the pediatric endocrinologist's refusal to treat the patient. Providers generally have wide latitude in accepting or refusing patients. Appropriat...

Bioethicists have scrupulously defended patients’ privacy and autonomy in medical care settings; they have not always taken the same care in their own work.

In Disability's Challenge to Theology: Genes, Eugenics, and the Metaphysics of Modern Medicine (Notre Dame Press, 2022), Devan Stahl establishes an ambitious goal: develop a Christian bioethics that is metaphysically grounded, informed by the experience of disability, and culturally compelling. She argues that personhood is not the possession of certain abilities; all humans are worthy of dignity and respect because they are created by God in God's image. According to Stahl, persons should be valued for who they are and treated (...) with radical acceptance. Interventions on the body should be judged on whether they promote flourishing, and such judgments should be informed by the experience of disability and made in community. These arguments will be of interest to Christian bioethics, disability scholars, and those interested in the capability approach, but clinical ethicists may find Stahl's book less compelling. (shrink)

To the Editor: In the November–December 2010 issue, the Seattle Growth Attenuation and Ethics Working Group (“Navigating Growth Attenuation in Children with Profound Disabilities”) analyzed the arguments for and against growth attenuation in children with permanent, profound intellectual disabilities and identified conditions under which its use may be ethically acceptable. The working group’s conclusion is based on a particular construction of the issue that is not always justified. It focuses on the possibility that growth attenuation will increase children’s involvement in (...) family social and recreational activities. The critique of the biomedical model of disability, however, highlights the potential gap between .. (shrink)

In an article in this issue of the Hastings Center Report, Aaron Wightman and his coauthors attempt to address health care providers’ moral distress about acceding to parents’ requests to provide life‐sustaining medical treatment to children who have profound cognitive disabilities. They propose combining John Arras's relational potential standard and care ethics, and they argue that the capacity for caring relationships can provide an independent moral justification for honoring such requests. This combination is, however, unstable. Wightman et al.'s language of (...) potential and capacity opens the possibility of substantial misinterpretation. They rely on epistemological and prognostic uncertainty to argue that reciprocity and participation may be present in the parent‐child relationship even when the child's engagement cannot be observed. The terminology suggests that these are characteristics that can be gained or lost rather than characteristics of being born within certain social practices. In contrast, Eva Feder Kittay illuminates family membership as an important social relation. Her articulation of the independent moral value of parenting stands on its own without being conjoined to Arras's position. (shrink)

Amy E. Caruso Brown (2022) considers situations in which a minor child’s parent or legal guardian (the “marginalized decision-maker (MDM)”) defers to another individual (the “primary decision-maker...

In this case, an adolescent with a life-threatening immune disease experiences increased social complexity, child welfare involvement, and placement into foster care, which could disrupt a medical...

Objectives To characterize the prevalence and content of pediatric triage policies.Methods We surveyed and solicited policies from U.S. hospitals with pediatric intensive care units. Policies were analyzed using qualitative methods and coded by 2 investigators.Results Thirty-four of 120 institutions (28%) responded. Twenty-five (74%) were freestanding children’s hospitals and 9 (26%) were hospitals within a hospital. Nine (26%) had approved policies, 9 (26%) had draft policies, 5 (14%) were developing policies, and 7 (20%) did not have policies. Nineteen (68%) institutions shared (...) their approved or draft policy. Eight (42%) of those policies included neonates. The polices identified 0 to 5 (median 2) factors to prioritize patients. The most common factors were short- (17, 90%) and long- (14, 74%) term predicted mortality. Pediatric scoring systems included Pediatric Logistic Organ Dysfunction-2 (12, 63%) and Score for Neonatal Acute Physiology and Perinatal Extensions-II (4, 21%). Thirteen (68%) policies described a formal algorithm. The most common tiebreakers were random/lottery (10, 71%) and life cycles (9, 64%). The majority (15, 79%) of policies specified the roles of triage team members and 13 (68%) precluded those participating in patient care from making triage decisions.Conclusions While many institutions still do not have pediatric triage policies, there appears to be a trend among those with policies to utilize a formal algorithm that focuses on short- and long-term predicted mortality and that incorporates age-appropriate scoring systems. Additional work is needed to expand access to pediatric-specific policies, to validate scoring systems, and to address health disparities. (shrink)

International child rights law has the potential to change the way children are viewed and engaged by all social actors. It provides a child-centered perspective on all areas of children’s lives, including research with neonates. It differs from some bioethical perspectives by clearly articulating affirmative obligations owed to children and requiring rigorous monitoring mechanisms. The CRC’s focus on affirmative obligations and establishment of monitoring mechanisms provide additional useful elements that are not present in the dominant form of American pediatric bioethics.An (...) in-depth introduction to child rights and the U.N. Convention on the Rights of the Child is presented by Lansdown.. (shrink)