Table of Contents
International Journal of Family Medicine
Volume 2013 (2013), Article ID 587541, 18 pages
http://dx.doi.org/10.1155/2013/587541
Review Article

Ethical Diversity and the Role of Conscience in Clinical Medicine

1University of Alberta, 2935-66 Street, Edmonton, AB, Canada T6K 4C1
2University of British Columbia, 2329 W Mall, Vancouver, BC, Canada V6T 1Z4

Received 14 May 2013; Accepted 9 October 2013

Academic Editor: J. P. Sturmberg

Copyright © 2013 Stephen J. Genuis and Chris Lipp. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Linked References

  1. D. P. Sulmasy, “What is conscience and why is respect for it so important?” Theoretical Medicine and Bioethics, vol. 29, no. 3, pp. 135–149, 2008. View at Publisher · View at Google Scholar · View at Scopus
  2. L. R. Kass, “Regarding the end of medicine and the pursuit of health,” The Public Interest, vol. 40, pp. 11–42, 1975. View at Google Scholar · View at Scopus
  3. D. Harper, “Conscience,” Online Etymology Dictionary, 2001, http://www.etymonline.com/index.php?term=conscience&allowed_in_frame=0.
  4. Oxford University Press, “Conscience,” Oxford Dictionaries, 2013, http://oxforddictionaries.com/definition/english/conscience?q=conscience.
  5. F. A. Curlin, R. E. Lawrence, M. H. Chin, and J. D. Lantos, “Religion, conscience, and controversial clinical practices,” The New England Journal of Medicine, vol. 356, no. 6, pp. 593–600, 2007. View at Publisher · View at Google Scholar · View at Scopus
  6. M. P. Combs, R. M. Antiel, J. C. Tilburt, P. S. Mueller, and F. A. Curlin, “Conscientious refusals to refer: findings from a national physician survey,” Journal of Medical Ethics, vol. 37, no. 7, pp. 397–401, 2011. View at Publisher · View at Google Scholar · View at Scopus
  7. R. E. Lawrence and F. A. Curlin, “Physicians' beliefs about conscience in medicine: a national survey,” Academic Medicine, vol. 84, no. 9, pp. 1276–1282, 2009. View at Publisher · View at Google Scholar · View at Scopus
  8. P. Fuss, “Conscience part I,” in Conscience, J. Donnelly and L. Lyons, Eds., pp. 35–50, Alba House, New York, NY, USA, 1973. View at Google Scholar
  9. S. A. Hurst, S. C. Hull, G. DuVal, and M. Danis, “How physicians face ethical difficulties: a qualitative analysis,” Journal of Medical Ethics, vol. 31, no. 1, pp. 7–14, 2005. View at Publisher · View at Google Scholar · View at Scopus
  10. G. Birchley, “A clear case for conscience in healthcare practice,” Journal of Medical Ethics, vol. 38, no. 1, pp. 13–17, 2012. View at Publisher · View at Google Scholar · View at Scopus
  11. S. Murphy, “Notes toward an understanding of freedom of conscience,” 2012, http://www.consciencelaws.org/issues-ethical/ethical134.html.
  12. S. Murphy and S. J. Genuis, “Freedom of conscience in health care: distinctions and limits,” Journal of Bioethical Inquiry, vol. 10, no. 3, pp. 347–354, 2013. View at Publisher · View at Google Scholar
  13. L. Kruse, A. Iqbal, A. Aziz, I. J. Kodner, and J. D. Keune, “A surgeon coerced under the Taliban: an ethical dilemma,” Surgery, vol. 149, no. 6, pp. 825–829, 2011. View at Publisher · View at Google Scholar · View at Scopus
  14. P. G. Brindley, “Cardiopulmonary resuscitation, societal expectations, and the importance of saying, ‘No’,” Canadian Journal of General Internal Medicine, vol. 5, pp. 62–63, 2010. View at Google Scholar
  15. S. J. Genuis, “Medical practice and community health care in the 21st Century: a time of change,” Public Health, vol. 122, no. 7, pp. 671–680, 2008. View at Publisher · View at Google Scholar · View at Scopus
  16. S. J. Genuis, “Diaspora of clinical medicine: exploring the rift between conventional and alternative health care,” Canadian Family Physician, vol. 59, pp. 628–632, 2013. View at Google Scholar
  17. G. Cohen, “Circumvention tourism,” Cornell Law Review, vol. 97, no. 6, pp. 1309–1398, 2012. View at Google Scholar
  18. D. C. Wertz, J. M. Rosenfield, S. R. Janes, and R. W. Erbe, “Attitudes toward abortion among parents of children with cystic fibrosis,” The American Journal of Public Health, vol. 81, no. 8, pp. 992–996, 1991. View at Google Scholar · View at Scopus
  19. J. Liljestrand and D. Shaw, “Sex selection, gender-based violence and human rights abuse,” Acta Obstetricia et Gynecologica Scandinavica, vol. 87, no. 4, pp. 482–483, 2008. View at Publisher · View at Google Scholar · View at Scopus
  20. R. D. Macleod, D. M. Wilson, and P. Malpas, “Assisted or hastened death: the healthcare practitioner's dilemma,” Global Journal of Health Science, vol. 4, article 87, 2012. View at Google Scholar
  21. M. Gusmano, “End-of-life care for patients with dementia in the United States: institutional realities,” Health Economics, Policy and Law, vol. 7, no. 4, pp. 485–498, 2012. View at Google Scholar
  22. S. J. Genuis, “Dismembering the ethical physician,” Postgraduate Medical Journal, vol. 82, no. 966, pp. 233–238, 2006. View at Publisher · View at Google Scholar · View at Scopus
  23. K. Blanton, “Female genital cutting and the health care provider's dilemma: a case study,” Clinical Scholars Review, vol. 4, article 119, 2011. View at Google Scholar
  24. R. J. Cook and B. M. Dickens, “Special commentary on the issue of reinfibulation,” International Journal of Gynecology and Obstetrics, vol. 109, no. 2, pp. 97–99, 2010. View at Publisher · View at Google Scholar · View at Scopus
  25. H. V. Kunins, T. A. Farley, and D. Dowell, “Guidelines for opioid prescription: why emergency physicians need support,” Annals of Internal Medicine, vol. 158, no. 11, pp. 841–842, 2013. View at Google Scholar
  26. M. J. Desborough and M. F. Murphy, “Legal and ethical issues in blood transfusion,” The British Journal of Hospital Medicine, vol. 74, no. 1, pp. 2–4, 2013. View at Google Scholar
  27. R. Alta Charo, “The celestial fire of conscience—refusing to deliver medical care,” The New England Journal of Medicine, vol. 352, no. 24, pp. 2471–2473, 2005. View at Publisher · View at Google Scholar · View at Scopus
  28. K. Gray, R. Erb, and Detroit Free Press, “Moral objection' bill would allow health care providers to refuse service,” 2012, http://www.freep.com/article/20121207/NEWS06/312070093/-Moral-objection-bill-would-allow-health-care-providers-refuse-service.
  29. D. Walton and The Globe and Mail, “Conscience rights issue continues to dog Alberta election,” 2012, http://www.theglobeandmail.com/news/politics/conscience-rights-issue-continues-to-dog-alberta-election/article4099283/.
  30. K. Lützén, A. Cronqvist, A. Magnusson, L. Andersson, and Institutionen för vårdvetenskap, Ersta Sköndal högskola, “Moral stress: synthesis of a concept,” Nursing Ethics, vol. 10, pp. 312–322, 2003. View at Google Scholar
  31. K. Weaver, “Ethical sensitivity: state of knowledge and needs for further research,” Nursing Ethics, vol. 14, no. 2, pp. 141–155, 2007. View at Publisher · View at Google Scholar · View at Scopus
  32. A. Glasberg, S. Eriksson, V. Dahlqvist et al., “Development and initial validation of the stress of conscience questionnaire,” Nursing Ethics, vol. 13, no. 6, pp. 633–648, 2006. View at Publisher · View at Google Scholar · View at Scopus
  33. J. Åhlin, E. Ericson-Lidman, A. Norberg, and G. Strandberg, “Revalidation of the perceptions of conscience questionnaire (PCQ) and the stress of conscience questionnaire (SCQ),” Nursing Ethics, vol. 19, no. 2, pp. 220–232, 2012. View at Publisher · View at Google Scholar · View at Scopus
  34. A. L. Glasberg, S. Eriksson, and A. Norberg, “Burnout and “stress of conscience” among healthcare personnel,” Journal of Advanced Nursing, vol. 57, no. 4, pp. 392–403, 2007. View at Publisher · View at Google Scholar · View at Scopus
  35. A. Glasberg, S. Eriksson, and A. Norberg, “Factors associated with “stress of conscience” in healthcare,” Scandinavian Journal of Caring Sciences, vol. 22, no. 2, pp. 249–258, 2008. View at Publisher · View at Google Scholar · View at Scopus
  36. V. Dahlqvist, A. SÖderberg, and A. Norberg, “Facing inadequacy and being good enough: psychiatric care providers' narratives about experiencing and coping with troubled conscience,” Journal of Psychiatric and Mental Health Nursing, vol. 16, no. 3, pp. 242–247, 2009. View at Publisher · View at Google Scholar · View at Scopus
  37. H. Tuvesson, M. Eklund, and C. Wann-Hansson, “Stress of conscience among psychiatric nursing staff in relation to environmental and individual factors,” Nursing Ethics, vol. 19, no. 2, pp. 208–219, 2012. View at Publisher · View at Google Scholar · View at Scopus
  38. E. Ericson-Lidman, A. Norberg, B. Persson, and G. Strandberg, “Healthcare personnel's experiences of situations in municipal elderly care that generate troubled conscience,” Scandinavian Journal of Caring Science, vol. 27, no. 2, pp. 215–223, 2013. View at Publisher · View at Google Scholar
  39. C. Juthberg, S. Eriksson, A. Norberg, and K. Sundin, “Stress of conscience and perceptions of conscience in relation to burnout among care-providers in older people,” Journal of Clinical Nursing, vol. 17, no. 14, pp. 1897–1906, 2008. View at Publisher · View at Google Scholar · View at Scopus
  40. C. Juthberg, S. Eriksson, A. Norberg, and K. Sundin, “Perceptions of conscience, stress of conscience and burnout among nursing staff in residential elder care,” Journal of Advanced Nursing, vol. 66, no. 8, pp. 1708–1718, 2010. View at Publisher · View at Google Scholar · View at Scopus
  41. R. Saarnio, A. Sarvimäki, H. Laukkala, and A. Isola, “Stress of conscience among staff caring for older persons in Finland,” Nursing Ethics, vol. 19, no. 1, pp. 104–115, 2012. View at Publisher · View at Google Scholar · View at Scopus
  42. V. J. Kain, “Moral distress and providing care to dying babies in neonatal nursing,” International Journal of Palliative Nursing, vol. 13, no. 5, pp. 243–248, 2007. View at Google Scholar · View at Scopus
  43. A. Catlin, C. Armigo, D. Volat et al., “Conscientious objection: a potential neonatal nursing response to care orders that cause suffering at the end of life? Study of a concept,” Neonatal Network, vol. 27, no. 2, pp. 101–108, 2008. View at Google Scholar · View at Scopus
  44. E. G. Epstein, “End-of-life experiences of nurses and physicians in the newborn intensive care unit,” Journal of Perinatology, vol. 28, no. 11, pp. 771–778, 2008. View at Publisher · View at Google Scholar · View at Scopus
  45. M. N. K. Karanikola, E. D. E. Papathanassoglou, M. Kalafati, H. Stathopoulou, M. Mpouzika, and C. G. Goutsikas, “Exploration of the association between professional interactions and emotional distress of intensive care unit nursing personnel,” Dimensions of Critical Care Nursing, vol. 31, no. 1, pp. 37–45, 2012. View at Publisher · View at Google Scholar · View at Scopus
  46. G. Gustafsson, S. Eriksson, G. Strandberg, and A. Norberg, “Burnout and perceptions of conscience among health care personnel: a pilot study,” Nursing Ethics, vol. 17, no. 1, pp. 23–38, 2010. View at Publisher · View at Google Scholar · View at Scopus
  47. C. E. C. F. Grönlund, V. Dahlqvist, and A. I. S. Söderberg, “Feeling trapped and being torn: physicians' narratives about ethical dilemmas in hemodialysis care that evoke a troubled conscience,” BMC Medical Ethics, vol. 12, no. 1, article 8, 2011. View at Publisher · View at Google Scholar · View at Scopus
  48. M. E. L. Iglesias, R. B. de Bengoa Vallejo, P. S. Fuentes, and M. J. Trepal, “Comparative analysis of moral distress and values of the work organization between American and Spanish podiatric physicians,” The Journal of the American Podiatric Medical Association, vol. 102, no. 1, pp. 57–63, 2012. View at Google Scholar · View at Scopus
  49. R. Førde and O. G. Aasland, “Moral distress among Norwegian doctors,” Journal of Medical Ethics, vol. 34, no. 7, pp. 521–525, 2008. View at Publisher · View at Google Scholar · View at Scopus
  50. E. D. Papathanassoglou, M. N. Karanikola, M. Kalafati, M. Giannakopoulou, C. Lemonidou, and J. W. Albarran, “Professional autonomy, collaboration with physicians, and moral distress among European intensive care nurses,” The American Journal of Critical Care, vol. 21, no. 2, pp. e41–e52, 2012. View at Publisher · View at Google Scholar
  51. R. D. Piers, E. Azoulay, B. Ricou et al., “Perceptions of appropriateness of care among European and Israeli intensive care unit nurses and physicians,” The Journal of the American Medical Association, vol. 306, no. 24, pp. 2694–2703, 2011. View at Publisher · View at Google Scholar · View at Scopus
  52. R. I. Hilliard, C. Harrison, and S. Madden, “Ethical conflicts and moral distress experienced by paediatric residents during their training,” Paediatrics and Child Health, vol. 12, no. 1, pp. 29–35, 2007. View at Google Scholar · View at Scopus
  53. K. D. Lomis, R. O. Carpenter, and B. M. Miller, “Moral distress in the third year of medical school; a descriptive review of student case reflections,” The American Journal of Surgery, vol. 197, no. 1, pp. 107–112, 2009. View at Publisher · View at Google Scholar · View at Scopus
  54. C. Wiggleton, E. Petrusa, K. Loomis et al., “Medical students' experiences of moral distress: development of a web-based survey,” Academic Medicine, vol. 85, no. 1, pp. 111–117, 2010. View at Publisher · View at Google Scholar · View at Scopus
  55. R. F. Card, “Conscientious objection and emergency contraception,” The American Journal of Bioethics, vol. 7, no. 6, pp. 8–14, 2007. View at Publisher · View at Google Scholar · View at Scopus
  56. R. F. Card, “Is there no alternative? Conscientious objection by medical students,” Journal of Medical Ethics, vol. 38, article 602, 2012. View at Publisher · View at Google Scholar · View at Scopus
  57. J. Savulescu, “Conscientious objection in medicine,” The British Medical Journal, vol. 332, no. 7536, pp. 294–297, 2006. View at Publisher · View at Google Scholar · View at Scopus
  58. College of Physicians and Surgeons of Ontario (CPSO), “Physicians and the Ontario human rights code,” 2008, http://www.cpso.on.ca/uploadedFiles/downloads/cpsodocuments/policies/policies/human_rights.pdf.
  59. “Murphy S. Philippines RH Act: Rx for controversy: the RH Act of 2012: limited or worthless exemptions,” 2012, http://www.consciencelaws.org/law/commentary/legal055-001.aspx.
  60. B. A. Parco, “RH Law allows private health workers to deny some services,” 2013, http://www.sunstar.com.ph/cebu/local-news/2013/03/07/rh-law-allows-private-health-workers-deny-some-services-271621.
  61. The Protection of Conscience Project, “Controversial HHS regulation published: no change,” 2012, http://consciencelaws.org/blog/?p=1544.
  62. J. M. Brown, “Conscience: the professional and the personal,” Journal of Nursing Management, vol. 4, no. 3, pp. 171–177, 1996. View at Google Scholar · View at Scopus
  63. T. Goffin, “The physician's right to conscientious objection: an evolving recognition in Europe,” Medicine and Law, vol. 29, no. 2, pp. 227–237, 2010. View at Google Scholar · View at Scopus
  64. T. May, “Rights of conscience in health care,” Social Theory and Practice, vol. 27, no. 1, pp. 111–128, 2001. View at Google Scholar · View at Scopus
  65. S. L. M. Strickland, “Conscientious objection in medical students: a questionnaire survey,” Journal of Medical Ethics, vol. 38, no. 1, pp. 22–25, 2012. View at Publisher · View at Google Scholar · View at Scopus
  66. A. Jensen and E. Lidell, “The influence of conscience in nursing,” Nursing Ethics, vol. 16, no. 1, pp. 31–42, 2009. View at Google Scholar · View at Scopus
  67. S. Devi, “Obama rescinds “overly broad” Bush-era conscience rule,” The Lancet, vol. 377, no. 9770, p. 981, 2011. View at Publisher · View at Google Scholar · View at Scopus
  68. R. J. Lifton, “Doctors and torture,” The New England Journal of Medicine, vol. 351, no. 5, pp. 415–416, 2004. View at Publisher · View at Google Scholar · View at Scopus
  69. R. Card, “Federal provider conscience regulation: unconscionable,” Journal of Medical Ethics, vol. 35, no. 8, pp. 471–472, 2009. View at Publisher · View at Google Scholar · View at Scopus
  70. R. F. Card, “Conscientious objection, emergency contraception, and public policy,” Journal of Medicine and Philosophy, vol. 36, no. 1, pp. 53–68, 2011. View at Publisher · View at Google Scholar · View at Scopus
  71. J. D. Cantor, “Conscientious objection gone awry—restoring selfless professionalism in medicine,” The New England Journal of Medicine, vol. 360, no. 15, pp. 1484–1485, 2009. View at Publisher · View at Google Scholar · View at Scopus
  72. R. J. Cook, M. A. Olaya, and B. M. Dickens, “Healthcare responsibilities and conscientious objection,” International Journal of Gynecology and Obstetrics, vol. 104, no. 3, pp. 249–252, 2009. View at Publisher · View at Google Scholar · View at Scopus
  73. J. K. Davis, “Conscientious refusal and a doctors's right to quit,” Journal of Medicine and Philosophy, vol. 29, no. 1, pp. 75–91, 2004. View at Publisher · View at Google Scholar · View at Scopus
  74. B. M. Dickens and R. J. Cook, “The scope and limits of conscientious objection,” International Journal of Gynecology and Obstetrics, vol. 71, no. 1, pp. 71–77, 2000. View at Publisher · View at Google Scholar · View at Scopus
  75. B. M. Dickens, “Legal protection and limits of conscientious objection: when conscientious objection is unethical,” Medicine and Law, vol. 28, no. 2, pp. 337–347, 2009. View at Google Scholar · View at Scopus
  76. S. Edwards, “Editorial comment. Conscientious objection,” Nursing Ethics, vol. 17, no. 4, pp. 421–423, 2010. View at Google Scholar
  77. S. Rodgers and J. Downie, “Abortion: ensuring access,” Canadian Medical Association Journal, vol. 175, no. 1, pp. 9–11, 2006. View at Publisher · View at Google Scholar · View at Scopus
  78. J. B. Dossetor, Beyond the Hippocratic Oath: A Memoir on the Rise of Modern Medical Ethics, University of Alberta Press, Edmonton, Canada, 2005.
  79. I. Kant, Groundwork of the Metaphysic of Morals, translated by H. J. Paton, Harper and Row, New York, NY, USA, 1964.
  80. J. Savulescu, “Two worlds apart: religion and ethics,” Journal of Medical Ethics, vol. 24, no. 6, pp. 382–384, 1998. View at Google Scholar · View at Scopus
  81. “Submission of the Ontario human rights commission to the college of physicians and surgeons of Ontario—regarding the draft policy,” Physicians and the Ontario Human Rights Code, 2008.
  82. American College of Obstetrics and Gynecology (ACOG) official committee recommendation—the limits of conscientious refusal in reproductive medicine, 2007.
  83. R. J. Cook and B. M. Dickens, “In response,” Journal of Obstetrics and Gynaecology of Canada, vol. 26, no. 2, p. 112, 2004. View at Google Scholar
  84. J. D. Lantos and F. A. Curlin, “Religion, conscience and clinical decisions,” Acta Paediatrica, vol. 97, no. 3, pp. 265–266, 2008. View at Publisher · View at Google Scholar · View at Scopus
  85. J. J. Hardt, “The necessity of conscience and the unspoken ends of medicine,” The American Journal of Bioethics, vol. 7, no. 6, pp. 18–19, 2007. View at Publisher · View at Google Scholar · View at Scopus
  86. F. A. Curlin, “Caution: conscience is the limb on which medical ethics sits,” The American Journal of Bioethics, vol. 7, no. 6, pp. 30–32, 2007. View at Publisher · View at Google Scholar · View at Scopus
  87. J. W. Gerrard, “Is it ethical for a general practitioner to claim a conscientious objection when asked to refer for abortion?” Journal of Medical Ethics, vol. 35, no. 10, pp. 599–602, 2009. View at Publisher · View at Google Scholar · View at Scopus
  88. A. MacIntyre, After Virtue: A Study in Moral Theory, University of Notre Dame Press, Notre Dame, Ind, USA, 2nd edition, 1984.
  89. CBC News, “Alberta doctors bullied by bosses, panel finds,” 2012, http://www.cbc.ca/news/canada/edmonton/story/2012/02/22/edmonton-health-quality-council-report.html.
  90. CBC News, “Cancer rates downstream from oilsands to be probed,” 2011, http://www.cbc.ca/news/canada/edmonton/story/2011/08/19/edm-cancer-oilsands-fort-chipewyan-study.html.
  91. L. S. Rubenstein and G. J. Annas, “Medical ethics at Guantanamo Bay detention centre and in the US military: a time for reform,” The Lancet, vol. 374, no. 9686, pp. 353–355, 2009. View at Publisher · View at Google Scholar · View at Scopus
  92. S. Doherty, “History of evidence-based medicine. Oranges, chloride of lime and leeches: barriers to teaching old dogs new tricks,” Emergency Medicine Australasia, vol. 17, no. 4, pp. 314–321, 2005. View at Google Scholar · View at Scopus
  93. S. K. Genuis and S. J. Genuis, “Exploring the continuum: medical information to effective clinical practice. Paper I: the translation of knowledge into clinical practice,” Journal of Evaluation in Clinical Practice, vol. 12, no. 1, pp. 49–62, 2006. View at Publisher · View at Google Scholar · View at Scopus
  94. R. Grol and J. Grimshaw, “From best evidence to best practice: effective implementation of change in patients' care,” The Lancet, vol. 362, no. 9391, pp. 1225–1230, 2003. View at Publisher · View at Google Scholar · View at Scopus
  95. C. Duncan, S. Langlais, J. Danyluk-Hall, and K. Simonson, “Knowledge translation: empowering health professionals to take the lead,” Journal of Continuing Education in the Health Professions, vol. 28, no. 4, pp. 282–283, 2008. View at Publisher · View at Google Scholar · View at Scopus
  96. S. J. Genuis, “The proliferation of clinical practice guidelines: professional development or medicine-by-numbers?” Journal of the American Board of Family Practice, vol. 18, no. 5, pp. 419–425, 2005. View at Google Scholar · View at Scopus
  97. J. L. Heilbron, Dilemmas of an Upright Man: Max Planck and the Fortunes of German Science, University of California Press, Berkeley, Calif, USA, 1986.
  98. A. de Valk, Morality and Law in Canadian Politics: The Abortion Controversy, Palm Publishers, Dorval, Canada, 1974.
  99. D. Bell and H. Cunningham, Journal and Proceedings from the Northern Ireland Forum for Ethics in Medicine and Healthcare, 2009, http://www.qub.ac.uk/methics/journal.html.
  100. Calgary Herald, “If doctors who won't kill are “wicked,” the world is sick,” 2009, http://www.canada.com/calgaryherald/news/story.html?id=83835868-7f89-40bd-b16e-8bc961d41b39.
  101. Canadian Medical Association (CMA), “Code of ethics,” 2004, http://www.cma.ca/code-of-ethics.
  102. World Medical Association (WMA), “WMA code of ethics,” 2013, http://www.wma.net/en/30publications/10policies/c8/index.html.
  103. B. M. Dickens and R. J. Cook, “Conscientious commitment to women's health,” International Journal of Gynaecology and Obstetrics, vol. 113, no. 2, pp. 163–166, 2011. View at Google Scholar
  104. H. Brody, H. A. Squier, and J. P. Foglio, “Commentary: moral growth in medical students,” Theoretical Medicine, vol. 16, no. 3, pp. 281–289, 1995. View at Publisher · View at Google Scholar · View at Scopus
  105. G. Webster, “Moral residue,” in Margin of Error: The Ethics of Mistakes in the Practice of Medicine, S. B. Rubin and L. Zoloth, Eds., pp. 217–232, University Publishing Group, Hagerstown, Md, USA, 2000. View at Google Scholar
  106. S. Maguen and B. T. Litz, “Moral injury inveterans of war,” PTSD Research Quarterly, vol. 23, pp. 1–6, 2012. View at Google Scholar
  107. B. T. Litz, N. Stein, E. Delaney et al., “Moral injury and moral repair in war veterans: a preliminary model and intervention strategy,” Clinical Psychology Review, vol. 29, no. 8, pp. 695–706, 2009. View at Publisher · View at Google Scholar · View at Scopus
  108. C. M. Sinclair and Provincial Court of Manitoba, “The report of the Manitoba pediatric cardiac surgery inquest: an inquiry into twelve deaths at the Winnipeg Health Sciences Centre,” 2000, http://www.pediatriccardiacinquest.mb.ca/.
  109. C. Varcoe, B. Pauly, J. Storch, L. Newton, and K. Makaroff, “Nurses' perceptions of and responses to morally distressing situations,” Nursing Ethics, vol. 19, pp. 488–500, 2012. View at Google Scholar
  110. C. Rushton, A. W. Kaszniak, and J. Halifax, “A framework for understanding moral distress among palliative care clinicians,” Journal of Palliative Medicine, vol. 16, no. 9, pp. 1074–1079, 2013. View at Publisher · View at Google Scholar
  111. T. A. Cavaliere, B. Daly, D. Dowling, and K. Montgomery, “Moral distress in neonatal intensive care unit RNs,” Advances in Neonatal Care, vol. 10, no. 3, pp. 145–156, 2010. View at Google Scholar · View at Scopus
  112. C. Mitton, S. Peacock, J. Storch, N. Smith, and E. Cornelissen, “Moral distress among healthcare managers: conditions, consequences and potential responses,” Healthcare Policy, vol. 6, no. 2, pp. 99–112, 2010. View at Google Scholar · View at Scopus
  113. D. Silove, “Doctors and the state: lessons from the Biko case,” Social Science and Medicine, vol. 30, no. 4, pp. 417–429, 1990. View at Publisher · View at Google Scholar · View at Scopus
  114. G. Higgins, “We are not respected for our real value,” Alberta Doctors' Digest, vol. 29, pp. 2–4, 2004. View at Google Scholar
  115. H. Fernandez-Lynch, Conflicts of Conscience in Health Care: An Institutional Compromise, The MIT Press, Cambridge, Mass, USA, 2008.
  116. Constitution Act, “Canadian charter of rights and freedoms,” 1982, http://laws-lois.justice.gc.ca/eng/Const/page-15.html.
  117. Supreme Court Judgments, “R. v. Big M Drug Mart Ltd,” Section 7, Article #95, 1985, http://scc.lexum.org/decisia-scc-csc/scc-csc/scc-csc/en/item/43/index.do.
  118. United Nations (UN), “Universal declaration of human rights,” 1948, http://www.un.org/en/documents/udhr/.
  119. D. Foggo and A. Taher, “Muslim medical students get picky,” The Times Online, 2007, http://www.timesonline.co.uk/tol/news/uk/health/article2603966.ece.
  120. A. Jameton, “Dilemmas of moral distress: moral responsibility and nursing practice,” Clinical Issues in Perinatal and Women's Health Nursing, vol. 4, no. 4, pp. 542–551, 1993. View at Google Scholar · View at Scopus
  121. M. Angell, The Truth about the Drug Companies: How They Deceive Us and What to Do About It, Random House, New York, NY, USA, 2004.
  122. M. Angell, “Is academic medicine for sale?” The New England Journal of Medicine, vol. 342, no. 20, pp. 1516–1518, 2000. View at Publisher · View at Google Scholar · View at Scopus
  123. R. Moynihan, “Who pays for the pizza? Redefining the relationships between doctors and drug companies. 2: disentanglement,” The British Medical Journal, vol. 326, no. 7400, pp. 1193–1196, 2003. View at Google Scholar · View at Scopus
  124. K. Outterson, “Punishing health care fraud—is the GSK settlement sufficient?” The New England Journal of Medicine, vol. 367, pp. 1082–1085, 2012. View at Publisher · View at Google Scholar
  125. V. Cogliano, Y. Grosse, R. Baan et al., “Carcinogenicity of combined oestrogen-progestagen contraceptives and menopausal treatment,” The Lancet Oncology, vol. 6, no. 8, pp. 552–553, 2005. View at Publisher · View at Google Scholar · View at Scopus
  126. C. Kahlenborn, F. Modugno, D. M. Potter, and W. B. Severs, “Oral contraceptive use as a risk factor for premenopausal breast cancer: a meta-analysis,” Mayo Clinic Proceedings, vol. 81, no. 10, pp. 1290–1302, 2006. View at Publisher · View at Google Scholar · View at Scopus
  127. V. Moreno, F. X. Bosch, N. Muñoz et al., “Effect of oral contraceptives on risk of cervical cancer in women with human papillomavirus infection: the IARC multicentric case-control study,” The Lancet, vol. 359, no. 9312, pp. 1085–1092, 2002. View at Publisher · View at Google Scholar · View at Scopus
  128. D. Margel and N. E. Fleshner, “Oral contraceptive use is associated with prostate cancer: an ecological study,” BMJ Open, vol. 1, no. 2, Article ID e000311, 2011. View at Publisher · View at Google Scholar · View at Scopus
  129. H. K. Weir, L. D. Marrett, N. Kreiger, G. A. Darlington, and L. Sugar, “Pre-natal and peri-natal exposures and risk of testicular germ-cell cancer,” International Journal of Cancer, vol. 87, pp. 438–443, 2000. View at Publisher · View at Google Scholar
  130. J. Baillargeon, D. K. McClish, P. A. Essah, and J. E. Nestler, “Association between the current use of low-dose oral contraceptives and cardiovascular arterial disease: a meta-analysis,” Journal of Clinical Endocrinology and Metabolism, vol. 90, no. 7, pp. 3863–3870, 2005. View at Publisher · View at Google Scholar · View at Scopus
  131. J. P. Forman, M. J. Stampfer, and G. C. Curhan, “Diet and lifestyle risk factors associated with incident hypertension in women,” The Journal of the American Medical Association, vol. 302, no. 4, pp. 401–411, 2009. View at Publisher · View at Google Scholar · View at Scopus
  132. C. Le-Ha, L. J. Beilin, S. Burrows et al., “Oral contraceptive use in girls and alcohol consumption in boys are associated with increased blood pressure in late adolescence,” European Journal of Preventive Cardiology, vol. 20, no. 6, pp. 947–955, 2013. View at Publisher · View at Google Scholar
  133. M. Etminan, B. Takkouche, F. C. Isorna, and A. Samii, “Risk of ischaemic stroke in people with migraine: systematic review and meta-analysis of observational studies,” The British Medical Journal, vol. 330, no. 7482, pp. 63–65, 2005. View at Publisher · View at Google Scholar · View at Scopus
  134. C. Panzer, S. Wise, G. Fantini et al., “Impact of oral contraceptives on sex hormone-binding globulin and androgen levels: a retrospective study in women with sexual dysfunction,” Journal of Sexual Medicine, vol. 3, no. 1, pp. 104–113, 2006. View at Publisher · View at Google Scholar · View at Scopus
  135. C. W. Wallwiener, L. Wallwiener, H. Seeger, A. O. Mück, J. Bitzer, and M. Wallwiener, “Prevalence of sexual dysfunction and impact of contraception in female German medical students,” Journal of Sexual Medicine, vol. 7, no. 6, pp. 2139–2148, 2010. View at Publisher · View at Google Scholar · View at Scopus
  136. A. Borgström, V. Odlind, L. Ekselius, and I. Sundström-Poromaa, “Adverse mood effects of combined oral contraceptives in relation to personality traits,” European Journal of Obstetrics Gynecology and Reproductive Biology, vol. 141, no. 2, pp. 127–130, 2008. View at Publisher · View at Google Scholar · View at Scopus
  137. M. Gingnell, J. Engman, A. Frick et al., “Oral contraceptive use changes brain activity and mood in women with previous negative affect on the pill—a double-blinded, placebo-controlled randomized trial of a levonorgestrel-containing combined oral contraceptive,” Psychoneuroendocrinology, vol. 38, no. 7, pp. 1133–1144, 2013. View at Publisher · View at Google Scholar
  138. T. A. Ternes, P. Kreckel, and J. Mueller, “Behaviour and occurrence of estrogens in municipal sewage treatment plants—II: aerobic batch experiments with activated sludge,” Science of the Total Environment, vol. 225, no. 1-2, pp. 91–99, 1999. View at Publisher · View at Google Scholar · View at Scopus
  139. S. Kim, “Birth control, water, and women,” Huffington Post, 2009, http://www.huffingtonpost.com/susan-kim/birth-control-water-and-w_b_385532.html.
  140. X. K. Chen, S. W. Wen, L. M. Sun, Q. Yang, M. C. Walker, and D. Krewski, “Recent oral contraceptive use and adverse birth outcomes,” European Journal of Obstetrics Gynecology and Reproductive Biology, vol. 144, no. 1, pp. 40–43, 2009. View at Publisher · View at Google Scholar · View at Scopus
  141. L. Keski-Nisula, J. Pekkanen, B. Xu, T. Putus, and P. Koskela, “Does the pill make a difference? Previous maternal use of contraceptive pills and allergic diseases among offspring,” Allergy, vol. 61, no. 12, pp. 1467–1472, 2006. View at Publisher · View at Google Scholar · View at Scopus
  142. T. P. Bouchard and S. J. Genuis, “Personal fertility monitors for contraception,” Canadian Medical Association Journal, vol. 183, no. 1, pp. 73–76, 2011. View at Publisher · View at Google Scholar · View at Scopus
  143. S. J. Genuis and T. P. Bouchard, “High-tech family planning: reproductive regulation through computerized fertility monitoring,” European Journal of Obstetrics Gynecology and Reproductive Biology, vol. 153, no. 2, pp. 124–130, 2010. View at Publisher · View at Google Scholar · View at Scopus
  144. J. Wingrove, “Alberta tories label Wildrose position on conscience rights “frightening”,” 2013, http://www.theglobeandmail.com/news/politics/alberta-tories-label-wildrose-position-on-conscience-rights-frightening/article1370953/.
  145. U.K. General Medical Council, “Good medical practice,” 2013, http://www.gmc-uk.org/guidance/news_consultation/20477.asp.
  146. B. Starfield, “Is US health really the best in the world?” The Journal of the American Medical Association, vol. 284, no. 4, pp. 483–485, 2000. View at Google Scholar · View at Scopus
  147. G. R. Baker, P. G. Norton, V. Flintoft et al., “The Canadian adverse events study: the incidence of adverse events among hospital patients in Canada,” Canadian Medical Association Journal, vol. 170, no. 11, pp. 1678–1686, 2004. View at Publisher · View at Google Scholar · View at Scopus
  148. Institute of Medicine, To Err Is Human: Building a Safer Health System, National Academy Press, Washington, DC, USA, 2000.
  149. C. P. Landrigan, G. J. Parry, C. B. Bones, A. D. Hackbarth, D. A. Goldmann, and P. J. Sharek, “Temporal trends in rates of patient harm resulting from medical care,” The New England Journal of Medicine, vol. 363, no. 22, pp. 2124–2134, 2010. View at Publisher · View at Google Scholar · View at Scopus
  150. H. McGavock, “Prescription-related illness—a scandalous pandemic,” Journal of Evaluation in Clinical Practice, vol. 10, no. 4, pp. 491–497, 2004. View at Publisher · View at Google Scholar · View at Scopus
  151. T. A. Brennan, L. L. Leape, N. M. Laird et al., “Incidence of adverse event and negligence in hospitalized patients. Results of the Harvard medical practice study I,” The New England Journal of Medicine, vol. 324, no. 6, pp. 370–376, 1991. View at Google Scholar · View at Scopus
  152. D. L. Kunac, J. Kennedy, N. Austin, and D. Reith, “Incidence, preventability, and impact of Adverse Drug Events (ADEs) and potential ADEs in hospitalized children in New Zealand: a prospective observational cohort study,” Paediatric Drugs, vol. 11, no. 2, pp. 153–160, 2009. View at Google Scholar
  153. S. J. Genuis and S. K. Genuis, “Resisting cookbook medicine,” British Medical Journal, vol. 329, article 179, 2004. View at Google Scholar
  154. N. K. Choudhry, H. T. Stelfox, and A. S. Detsky, “Relationships between authors of clinical practice guidelines and the pharmaceutical industry,” The Journal of the American Medical Association, vol. 287, no. 5, pp. 612–617, 2002. View at Google Scholar · View at Scopus
  155. D. Healy, Pharmageddon, University of California Press, Los Angeles, Calif, USA, 2012.
  156. F. Dostoyevsky, The Brothers Karamazov, translation: The Grand Inquisitor, R. Pevear and L. Volokhonsky, Farrar, Straus and Giroux, New York, NY, USA, 1990.
  157. N. F. K. Gemes and S. May, Eds., Nietzsche on Freedom and Autonomy, Oxford University Press, New York, NY, USA, 2009.
  158. Canadian Medical Foundation, “Physician health and well-being,” 2009, http://www.medicalfoundation.ca/en/physician-health-and-well-being/.