Conscientious Objection

Essay #2

This essay assignment offers you the opportunity to write about the resonance and dissonance between (a) healthcare providers’ ethical obligations to their patients (as explored in our reading and discussion of Yeo et al., 2010 thus far) and (b) providers’ right to practice with integrity and use conscientious objection to support that right (as discussed in Yeo et al. and the AAP Committee on Bioethics, 2009).  There are two versions of the assignment.  You are asked to choose one of the two.

This essay goes through a recommended draft process, explained in the writing guidelines and syllabus.  Due dates are as follows:

(1)  If you elect to engage the draft process, the draft of the essay, which will be graded and returned with feedback, is due by 8:00 am Friday, 4 December.  The final version of the essay will subsequently be due by 8:00 am Monday, 14 December.

(2)  If you elect to not engage the draft process, the first and final version of the essay is due by 8:00 am on Wednesday, 9 December.

Version 1

Consider the following case example.

Ms. R is an 18 year-old high school graduate who is about to leave for college.  She tells you that she would like to begin taking daily hormonal contraception, as she anticipates becoming sexually active. She understands that she should use condoms to lower the risk of contracting an STI, but wishes to go on the pill as an added measure to prevent pregnancy.

You are the only physician assistant in a busy, two-physician women’s health practice in a small town in northwest Virginia.  You are opposed, on religious grounds, to individuals having sexual intercourse outside of marriage.  Thus far, your attending physicians have respected your position and have, themselves, provided counseling and prescriptions for birth control for patients who are not married.  However, one of the two physicians has gone out on medical leave, and things have become too busy for the remaining physician to assume all of the counseling and prescription duties for non- married patients. (Most of the practice’s patients, it seems, are not married but sexually active.)

The physician sits down with you and explains that, while she understands and respects your moral position on extra-marital sex, it is no longer feasible to honor your objection to counseling and prescribing birth control for unmarried patients.  She asks that you agree to engage these tasks for all patients (married or otherwise), at least until the second physician returns from medical leave.

Drawing on our reading of Yeo et al. (2010) and the AAP Committee on Bioethics (2009), please write a 4-page (1320 word) letter to your attending physicians making the strongest possible case justifying your request to continue to refuse to counsel and prescribe birth control for unmarried patients, based on your right to conscientious objection as explained in these sources.  Your letter should:

(a)   explain the conditions/criteria associated with ethically acceptable conscientious objection as recommended by the AAP Committee on Bioethics;

(b)  explain how your request satisfies those conditions/criteria;

(c)   explain the ethical obligations you have to unmarried patients seeking counsel and prescriptions related to sexual intercourse and birth control, as discussed in our reading of Yeo et al. so far this semester; and

(d)  explain how your refusal to provide these services for such patients does not violate those obligations (or, if you prefer, how your right to conscientious objection outweighs the violation of those obligations).

As with all of our writing in this course, your submission should be (a) well-documented; (b) double-spaced, 12-point Times New Roman font, with one-inch margins on all sides, and (c) within the assigned word limit (<1320 words).

Please do not turn in an essay without documentation.

Version 2

Consider the following case example.

Ms. R is an 18 year-old high school graduate who is about to leave for college.  She tells your physician assistant colleague that she would like to begin taking daily hormonal contraception, as she anticipates becoming sexually active. She understands that she should use condoms to lower the risk of contracting an STI, but wishes to go on the pill as an added measure to prevent pregnancy.

You have two physicians and one physician assistant in your busy women’s health practice in a small town in northwest Virginia.  Your physician assistant is opposed, on religious grounds, to individuals having sexual intercourse outside of marriage.  Thus far, you or your physician partner have respected the PA’s position and have, yourselves, provided counseling and prescriptions for birth control for patients who are not married. However, the other physician in the practice has gone out on medical leave, and things have become too busy for you to assume all of the counseling and prescription duties for non-married patients. (Most of the practice’s patients, it seems, are not married but sexually active.)

When she comes and requests that you provide counseling and a prescription for this 18 year-old patient, you sit down with the PA and explain that, while you understand and respect her moral position on extra-marital sex, it is no longer feasible to honor her objection to counseling and prescribing birth control for unmarried patients.  You ask her to agree to engage these tasks for all patients (married or otherwise), at least until the second physician returns from medical leave.  You agree to follow up with a letter explaining why, at least temporarily, you will not be able to honor her refusal based on conscientious objection.

Drawing on our reading of Yeo et al. (2010) and the AAP Committee on Bioethics (2009), please write a 4-page (1320 word) letter to your physician assistant making the strongest possible case refusing her request to refuse to counsel and prescribe hormonal birth control on the grounds of conscientious objection.  Your letter should:

(a)   explain the conditions/criteria associated with ethically acceptable conscientious objection as recommended by the AAP;

(b)  explain how her request fails to satisfy those conditions/criteria;

(c)   explain the ethical obligations she has to this patient, as discussed in our reading of Yeo et al. so far this semester; and

(d)  explain how her refusal to counsel and prescribe violates those obligations in a manner that outweighs her rights of conscience.

As with all of our writing in this course, your submission should be (a) well-documented; (b) double-spaced, 12-point Times New Roman font, with one-inch margins on all sides, and (c) within the assigned word limit (<1320 words).

Please do not turn in an essay without documentation.

Grading Rubric, Version 1

Grading Rubric, Version 2