Abortion Archives - Page 6 of 51 - Protection of Conscience Project Library

Legal and ethical standards for protecting women’s human rights and the practice of conscientious objection in reproductive healthcare settings

Christina Zampas

International Journal of Gynecology & Obstetrics

Abstract
The practice of conscientious objection by healthcare workers is growing across the globe. It is most common in reproductive healthcare settings because of the religious or moral values placed on beliefs as to when life begins. It is often invoked in the context of abortion and contraceptive services, including the provision of information related to such services. Few states adequately regulate the practice, leading to denial of access to lawful reproductive healthcare services and violations of fundamental human rights. International ethical, health, and human rights standards have recently attempted to address these challenges by harmonizing the practice of conscientious objection with women’s right to sexual and reproductive health services. FIGO ethical standards have had an important role in influencing human rights development in this area. They consider regulation of the unfettered use of conscientious objection essential to the realization of sexual and reproductive rights. Under international human rights law, states have a positive obligation to act in this regard. While ethical and human rights standards regarding this issue are growing, they do not yet exhaustively cover all the situations in which women’s health and human rights are in jeopardy because of the practice. The present article sets forth existing ethical and human rights standards on the issue and illustrates the need for further development and clarity on balancing these rights and interests.

Zampas C. Legal and ethical standards for protecting women’s human rights and the practice of conscientious objection in reproductive healthcare settings. Int J Gyn Ob. 2013 Dec 10;123:S63-S65.

(Editorial) Conscientious objection to the provision of reproductive healthcare

Wendy Chavkin

Extract
Healthcare providers who cite conscientious objection as grounds for refusing to provide components of legal reproductive care highlight the tension between their right to exercise their conscience and women’s rights to receive needed care. There are also societal obligations and ramifications at stake, including the responsibility for negotiating balance between all of these competing interests. . .

. . . There are too many barriers to access to reproductive health- care. Conscience-based refusal of care may be one that we can successfully address.

Chavkin W. (Editorial) Conscientious objection to the provision of reproductive healthcare. Int J Gynec Obstet. 2013 Dec;123(SUPPL.3):s39-s40.

Conscientious objection and refusal to provide reproductive healthcare: A White Paper examining prevalence, health consequences, and policy responses

Wendy Chavkin, Liddy Leitman, Kate Polin, Global Doctors for Choice

Abstract
Background
Global Doctors for Choice—a transnational network of physician advocates for reproductive health and rights—began exploring the phenomenon of conscience-based refusal of reproductive healthcare as a result of increasing reports of harms worldwide. The present White Paper examines the prevalence and impact of such refusal and reviews policy efforts to balance individual conscience, autonomy in reproductive decision making, safeguards for health, and professional medical integrity.

Objectives and search strategy
The White Paper draws on medical, public health, legal, ethical, and social science literature published between 1998 and 2013 in English, French, German, Italian, Portuguese, and Spanish. Estimates of prevalence are difficult to obtain, as there is no consensus about criteria for refuser status and no standardized definition of the practice, and the studies have sampling and other methodologic limitations. The White Paper reviews these data and offers logical frameworks to represent the possible health and health system consequences of conscience-based refusal to provide abortion; assisted reproductive technologies; contraception; treatment in cases of maternal health risk and inevitable pregnancy loss; and prenatal diagnosis. It concludes by categorizing legal, regulatory, and other policy responses to the practice.

Conclusions
Empirical evidence is essential for varied political actors as they respond with policies or regulations to the competing concerns at stake. Further research and training in diverse geopolitical settings are required. With dual commitments toward their own conscience and their obligations to patients’ health and rights, providers and professional medical/public health societies must lead attempts to respond to conscience-based refusal and to safeguard reproductive health, medical integrity, and women’s lives.

Chavkin W, Leitman L, Polin K, for Choice GD. Conscientious objection and refusal to provide reproductive healthcare: A White Paper examining prevalence, health consequences, and policy responses. Int J Gynec Obstet. 2013 Dec 10;123(S41-S56.

Conscientious objection to the provision of legal abortion care

Brooke R Johnson, Eszter Kismödi, Monica V Dragoman, Marleen Temmerman

Abstract
Despite advances in scientific evidence, technologies, and human rights rationale for providing safe abortion, a broad range of cultural, regulatory, and health system barriers that deter access to abortion continues to exist in many countries. When conscientious objection to provision of abortion becomes one of these barriers, it can create risks to women’s health and the enjoyment of their human rights. To eliminate this barrier, states should implement regulations for healthcare providers on how to invoke conscientious objection without jeopardizing women’s access to safe, legal abortion services, especially with regard to timely referral for care and in emergency cases when referral is not possible. In addition, states should take all necessary measures to ensure that all women and adolescents have the means to prevent unintended pregnancies and to obtain safe abortion..

Johnson BR, Kismödi E, Dragoman MV, Temmerman M. Conscientious objection to the provision of legal abortion care. Int J Gyn Obstet. 2013;123(S60-S62).

Conscientious objection and induced abortion in Europe

Anna Heino, Mika Gissler, Dan Apter, Christian Fiala

The European Journal of Contraception & Reproductive Health Care

Abstract
The issue of conscientious objection (CO) arises in healthcare when doctors and nurses refuse to have any involvement in the provision of treatment of certain patients due to their religious or moral beliefs. Most commonly CO is invoked when it comes to induced abortion. Of the EU member states where induced abortion is legal, invoking CO is granted by law in 21 countries. The same applies to the non-EU countries Norway and Switzerland. CO is not legally granted in the EU member states Sweden, Finland, Bulgaria and the Czech Republic. The Icelandic legislation provides no right to CO either. European examples prove that the recommendation that CO should not prevent women from accessing services fails in a number of cases. CO puts women in an unequal position depending on their place of residence, socio-economic status and income. CO should not be presented as a question that relates only to health professionals and their rights. CO mainly concerns women as it has very real consequences for their reproductive health and rights. European countries should assess the laws governing CO and its effects on women ’ s rights. CO should not be used as a subtle method for limiting the legal right to healthcare.

Heino A, Gissler M, Apter D, Fiala C. Conscientious objection and induced abortion in Europe. European J Contraception and Reproductive Health Care, 2013; 18: 231–233

Termination of pregnancy as emergency obstetric care: the interpretation of Catholic health policy and the consequences for pregnant women

An analysis of the death of Savita Halappanavar in Ireland and similar cases

Marge Berer

Abstract
Issues arising from the death of Savita Halappanavar in Ireland in October 2012 include the question of whether it is unethical to refuse to terminate a non-viable pregnancy when the woman’s life may be at risk. In Catholic maternity services, this decision intersects with health professionals’ interpretation of Catholic health policy on treatment of miscarriage as well as the law on abortion. This paper explores how these issues came together around Savita’s death and the consequences for pregnant women and maternity services worldwide. It discusses cases not only in Ireland but also the Americas. Many of the events presented are recent, and most of the sources are media and individual reports. However, there is a very worrying common thread across countries and continents. If further research unearths more cases like Savita’s, any Catholic health professionals and/or hospitals refusing to terminate a pregnancy as emergency obstetric care should be stripped of their right to provide maternity services. In some countries these are the main or only existing maternity services. Even so, governments should refuse to fund these services, and either replace them with non-religious services or require that non-religious staff are available at all times specifically to take charge of such cases to prevent unnecessary deaths. At issue is whether a woman’s life comes first or not at all.

Berer M. Termination of pregnancy as emergency obstetric care: the interpretation of Catholic health policy and the consequences for pregnant women: An analysis of the death of Savita Halappanavar in Ireland and similar cases. Reproductive Health Matters 2013;21(41):9–17

Interrupción voluntaria del embarazo y objeción de conciencia en Uruguay

Francisco Cóppola

Abstract
Author Translation
In October 2012 Act 18.987 for the Voluntary Interruption of Pregnancy was passed in Uruguay. This law contemplates the right to conscientious objection, although it lacks conceptual clarity and there was no debate during the discussion of the bill. Thus, declarations by both congressmen and professionals reflect there is confusion regarding such objection. Conscientious objection implies an individual (in this case a health professional) refuses to act in a certain way, which action would be legally enforceable, on account of conscientious issues. Therefore, conscientious objection is an authorization, provided certain requirements and limitations are observed, to refrain from observing a law. This article explores the existence of degrees and nuances within conscientious objection, the importance of distinguishing objectors from pseudo-objectors, whether a previous declaration is necessary or not, its regulatory mechanisms and in particular, the extreme event in which it were necessary to “sacrifice” the freedom of conscience.

Keywords:

Cóppola F. Interrupción voluntaria del embarazo y objeción de conciencia en Uruguay. Revista médica del Uruguay. 2013 Mar;29(1):43-46.

Conscientious Refusals and Reason-Giving

Jason Marsh

Abstract
Some philosophers have argued for what I call the reason-giving requirement for conscientious refusal in reproductive healthcare. According to this requirement, healthcare practitioners who conscientiously object to administering standard forms of treatment must have arguments to back up their conscience, arguments that are purely public in character. I argue that such a requirement, though attractive in some ways, faces an overlooked epistemic problem: it is either too easy or too difficult to satisfy in standard cases. I close by briefly considering whether a version of the reason-giving requirement can be salvaged despite this important difficulty.

Marsh J. Conscientious Refusals and Reason-Giving. Bioethics. 2014;28(6):313-319.

Professional QOL of Japanese nurses/midwives providing abortion/childbirth care

M. Mizuno, E. Kinefuchi, R. Kimura

Abstract
This study explored the relationship between professional quality of life and emotion work and the major stress factors related to abortion care in Japanese obstetric and gynecological nurses and midwives. . . . Multiple regression analysis revealed that of all the evaluated variables, the Japanese version of the Frankfurt Emotional Work Scale score for negative emotions display was the most significant positive predictor of compassion fatigue and burnout. The stress factors “thinking that the aborted fetus deserved to live” and “difficulty in controlling emotions during abortion care” were associated with compassion fatigue. These findings indicate that providing abortion services is a highly distressing experience for nurses and midwives.

Mizuno M, Kinefuchi E, Kimura R. Professional QOL of Japanese nurses/midwives providing abortion/childbirth care. Nurs Ethics January 17, 2013 0969733012463723

Beyond abortion: Why the Personhood Movement Implicates Reproductive Choice

Jonathon F Will

Abstract
This paper describes the background of the Personhood Movement and its attempt to achieve legal protection of the preborn from the earliest moments of biological development. Following the late 2011 failure of the personhood measure in Mississippi, the language used within the Movement was dramatically changed in an attempt to address some of the concerns raised regarding implications for reproductive choice. Putting abortion to one side, this paper identifies why the personhood framework that is contemplated by the proposed changes does not eliminate the potential for restrictions on contraception and in vitro fertilization (IVF) that put the lives of these newly recognized persons at risk; nor should it if proponents intend to remain consistent with their position. The paper goes on to suggest what those restrictions might look like based on recent efforts being proposed at the state level and frameworks that have already been adopted in other countries.

Will JF. Beyond abortion: Why the Personhood Movement Implicates Reproductive Choice. Am J Law Med. 2013;39(573-616.