The legitimacy of the refusal of South Australian nurses to care for second trimester abortion patients on grounds of conscience is examined as a test case for a theory of permissible limits on the autonomy of health care professionals. In cases of health care professional (HCP) conscientious refusal, it is argued that a balance be struck between the HCPs' claims to autonomous action and the consequences to them of having their autonomous action restricted, and the entitlement of patients to care (...) and the consequences for them of being refused such care. Conscientious action that results in the disruption or termination of health care services, however, is always impermissible on two grounds. Firstly, because it is at this point that the action '... invades a patient's autonomy, puts a patient at serious risk ... [and] treats a patient unjustly' (1) Secondly, because the consequences of such refusals turn them into political acts--acts of civil disobedience. It is arguable that in order for acts of civil disobedience to be legitimate, certain obligations are required of the dissenter by the community. It is concluded that the actions of the South Australian nurses, which have over the last few years both terminated and disrupted second trimester services, are morally impermissible. (shrink)

Rilke's remark conjures up an officious array of well-meaning persons bent on completing our orderly passage from cradle to grave. They tidy our files cosily about us, inject us with extreme unction and slide us into the warm embrace of the undertaker. At the forefront of the array stands the doctor, part mechanic and part priest. His main task is to repair the living with resources whose effective and impartial allocation is a chief topic of medical ethics. But his role (...) is not that of an impartial allocator: his patients want his partisan support. This builds a moral tension into a role played out where system meets patient, and one made instructively plain in the care of the dying. The system no doubt prefers death to be cheap and orderly but this thought may not move someone like Rilke wanting a death of his own. The doctor is then caught between his general duty to patients at large and his particular duty to the patient in front of him, a tension tautened for a Hippocratic promoter of health and life by a patient in search of an exit. (shrink)