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      Women’s Reproductive Health Rights in Poland. Between a Druggists’ Conscience Clause and Their Legal Duty to Provide Contraceptives

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      ETHICS IN PROGRESS
      Adam Mickiewicz University Poznan

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          Abstract

          This article recommends the promotion of moral competence in the health and pharmacy professions to enable them to respect human and patient health rights with a focus on the provision of reproductive and sexual health care services. In certain cultures, health care and drug providers follow their conscientious objection (conscience clause) and decline to perform specific health services, including the provision of legal contraceptives in cases protected by legal and human rights. Such malpractices may violate patients’ and purchasers’ legitime rights. The article also presents findings obtained in Poland with N=121 women experimentally interviewed to examine their experiences as contraception purchasers, to assess their preference concerning facing human vs. robotic pharmacists, to manage the risk of refusal argued by the conscientious objection, and to score their moral competence with one of the dilemmas included in the MCT by G. Lind. This study demonstrated that purchasers with higher C-score (C for moral competence) would not just prefer a robotic pharmacist without a ‘conscience’ but, rather, a competent sales staff able to instruct the patient and advice her on any related queries. It further results that participants with higher moral competence are thus less likely to trust the medical expertise of artificial intelligence. We conclude that public institutions in pluralistic societies must manage normative reproductive health contexts more inclusively, and the election, education, and practice of health professionals in the public health care sector require the development of a normative mindset toward respecting the rights of all patients instead of respecting them selectively at the diktat of particularistic conscience.

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          Religion, conscience, and controversial clinical practices.

          There is a heated debate about whether health professionals may refuse to provide treatments to which they object on moral grounds. It is important to understand how physicians think about their ethical rights and obligations when such conflicts emerge in clinical practice. We conducted a cross-sectional survey of a stratified, random sample of 2000 practicing U.S. physicians from all specialties by mail. The primary criterion variables were physicians' judgments about their ethical rights and obligations when patients request a legal medical procedure to which the physician objects for religious or moral reasons. These procedures included administering terminal sedation in dying patients, providing abortion for failed contraception, and prescribing birth control to adolescents without parental approval. A total of 1144 of 1820 physicians (63%) responded to our survey. On the basis of our results, we estimate that most physicians believe that it is ethically permissible for doctors to explain their moral objections to patients (63%). Most also believe that physicians are obligated to present all options (86%) and to refer the patient to another clinician who does not object to the requested procedure (71%). Physicians who were male, those who were religious, and those who had personal objections to morally controversial clinical practices were less likely to report that doctors must disclose information about or refer patients for medical procedures to which the physician objected on moral grounds (multivariate odds ratios, 0.3 to 0.5). Many physicians do not consider themselves obligated to disclose information about or refer patients for legal but morally controversial medical procedures. Patients who want information about and access to such procedures may need to inquire proactively to determine whether their physicians would accommodate such requests. Copyright 2007 Massachusetts Medical Society.
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            Typical-use contraceptive failure rates in 43 countries with Demographic and Health Survey data: summary of a detailed report

            Background While most unintended pregnancies occur because couples do not use contraception, contraceptive failure is also an important underlying cause. However, few recent studies outside of the United States have estimated contraceptive failure rates, and most such studies have been restricted to married women, to a limited number of countries and to 12-month failure rate estimates. Methods Using self-reported data from 43 countries with Demographic and Health Survey data, we estimated typical-use contraceptive failure rates for seven contraceptive methods at 12, 24 and 36 months of use. We provide a median estimate for each method across 43 countries overall, in seven subregions and in individual countries. We assess differences by various demographic and socioeconomic characteristics. Estimates are not corrected for potential errors in retrospective reporting contraceptive use or potential underreporting of abortion, which may vary by country and subgroups within countries. Results Across all included countries, reported 12-month typical-use failure rates were lowest for users of longer-acting methods such as implants (0.6 failures per 100 episodes of use), intrauterine devices (1.4) and injectables (1.7); intermediate for users of short-term resupply methods such as oral contraceptive pills (5.5) and male condoms (5.4); and highest for users of traditional methods such as withdrawal (13.4) or periodic abstinence (13.9), a group largely using calendar rhythm. Conclusions Our findings help us to highlight those methods, subregions and population groups that may be in need of particular attention for improvements in policies and programs to address higher contraceptive failure rates.
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              Physicians, Not Conscripts — Conscientious Objection in Health Care

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                Author and article information

                Contributors
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                Journal
                ETHICS IN PROGRESS
                eip
                Adam Mickiewicz University Poznan
                2084-9257
                July 31 2023
                July 31 2023
                : 14
                : 1
                : 94-109
                Article
                10.14746/eip.2023.1.6
                82198d00-740f-45ba-9892-7cead6992991
                © 2023

                https://creativecommons.org/licenses/by-sa/4.0

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