Abortion Archives - Page 9 of 51 - Protection of Conscience Project Library

Obstetrician-gynecologists’ opinions about conscientious refusal of a request for abortion: results from a national vignette experiment

Kenneth A Rasinski, John D Yoon, Youssef G Kalad, Farr A Curlin

Abstract
Background and objectives: Conscientious refusal of abortion has been discussed widely by medical ethicists but little information on practitioners’ opinions exists. The American College of Obstetricians and Gynecologists (ACOG) issued recommendations about conscientious refusal. We used a vignette experiment to examine obstetrician-gynecologists’ (OB/GYN) support for the recommendations.

Design: A national survey of OB/GYN physicians contained a vignette experiment in which an OB/GYN doctor refused a requested elective abortion. The vignette varied two issues recently addressed by the ACOG ethics committee–whether the doctor referred and whether the doctor disclosed their objection to the abortion.

Participants and setting: 1800 OB/GYN randomly selected physicians were asked to complete a mail survey containing the vignette. The response rate was 66% (n=1154) after excluding 40 ineligible cases.

Measurement: Physicians indicated their approval for the vignette doctor’s decision.

Main results: Overall, 43% of OB/GYN physicians responded that the conscientious refusal exercised by the vignette physician was appropriate. 70% rated the vignette doctor as acting appropriately when a referral was made. This dropped to 51% when the doctor disclosed objections to the patient, and to 12% when the doctor disclosed objections and refused to make a referral. Consistent with previous research, males were more likely to support disclosure and refusal to refer. Highly religious physicians supported non-referral but not disclosure.

Conclusion: OB/GYN physicians are less likely to support conscientious refusal of abortion if physicians disclose their objections to patients. This is at odds with ACOG recommendations and with some models of the doctor-patient relationship.

Rasinski KA, Yoon JD, Kalad YG, Curlin FA. Obstetrician-gynecologists’ opinions about conscientious refusal of a request for abortion: results from a national vignette experiment. J Med Ethics. 2011;37(12):711-714.

Conscientious commitment to women’s health

Bernard M Dickens, Rebecca J Cook

International Journal of Gynecology & Obstetrics

Abstract
Conscientious commitment, the reverse of conscientious objection, inspires healthcare providers to overcome barriers to delivery of reproductive services to protect and advance women’s health. History shows social reformers experiencing religious condemnation and imprisonment for promoting means of birth control, until access became popularly accepted. Voluntary sterilization generally followed this pattern to acceptance, but overcoming resistance to voluntary abortion calls for courage and remains challenging. The challenge is aggravated by religious doctrines that view treatment of ectopic pregnancy, spontaneous abortion, and emergency contraception not by reference to women’s healthcare needs, but through the lens of abortion. However, modern legal systems increasingly reject this myopic approach. Providers’ conscientious commitment is to deliver treatments directed to women’s healthcare needs, giving priority to patient care over adherence to conservative religious doctrines or religious self-interest. The development of in vitro fertilization to address childlessness further illustrates the inspiration of conscientious commitment over conservative objections.

Dickens BM, Cook RJ. Conscientious commitment to women’s health. Int J Gyn Ob. 2011;113(2):163-166.

Professional Right of Conscience

Margaret W Beal, Joyce Cappiello

Journal of Midwifery & Women's Health — Journal of Midwifery & Women’s Health

Abstract
In recent years there have been numerous media reports of professionals attempting to expand the right of conscience and deny health care services requested by consumers. While the media has focused the most attention on pharmacists’ right to refuse access to contraception, this trend is an expansion of the right originally established to protect professionals from being required to perform abortions or to provide direct assistance with abortions. State legislatures have addressed this issue, in some cases by overtly protecting consumers’ rights and in other cases by broadening professional right of conscience. In this article, the literature on provider right of conscience is reviewed, and approaches advised by professional organizations are discussed.

Beal MW, Cappiello J. Professional Right of Conscience. J. Midwifery Womens Health. 2008;53(5):406-412.

Alternative Burdens on Freedom of Conscience

Adam J. Kolber

Abstract
Suppose a pharmacist refuses to dispense pills that induce abortion claiming that dispensing such pills runs counter to principles he holds dear. Indeed, the pharmacist claims that forcing him to dispense the pills would violate his freedom of conscience. He even claims that he would not have become a pharmacist had he foreseen an obligation to dispense such pills at the time he entered his profession. Should the pharmacist’s job be protected if he is making a bona fide claim of conscience? And does it matter whether the pharmacist’s objection to dispensing the pills is rooted in religious or nonreligious reasons?

Kolber AJ. Alternative Burdens on Freedom of Conscience, 47 San Diego L. Rev. 919 (2010).

Obstacles and challenges following the partial decriminalisation of abortion in Colombia

Eduardo Díaz Amado, Maria Cristina Calderón García, Katherine Romero Cristancho, Elena Prada Salas, Eliane Barreto Hauzeur

Abstract
During a highly contested process, abortion was partially decriminalised in Colombia in 2006 by the Constitutional Court: when the pregnancy threatens a woman’s life or health, in cases of severe fetal malformations incompatible with life, and in cases of rape, incest or unwanted insemination. However, Colombian women still face obstacles to accessing abortion services. This is illustrated by 36 cases of women who in 2006-08 were denied the right to a lawful termination of pregnancy, or had unjustified obstacles put in their path which delayed the termination, which are analysed in this article. We argue that the obstacles resulted from fundamental disagreements about abortion and misunderstandings regarding the ethical, legal and medical requirements arising from the Court’s decision. In order to avoid obstacles such as demands for a judge’s authorisation, institutional claims of conscientious objection, rejection of a claim of rape, or refusal of health insurance coverage for a legal termination, which constitute discrimination against women, three main strategies are suggested: public ownership of the Court’s decision by all Colombian citizens, a professional approach by those involved in the provision of services in line with the law, and monitoring of its implementation by governmental and non-governmental organisations.

Amado ED, García MCC, Cristancho KR, Salas EP, Hauzeur EB. Obstacles and challenges following the partial decriminalisation of abortion in Colombia. Reprod Health Matters. 2010;118-126.

Abortion and human rights

Dorothy Shaw

Best Practice and Research Clinical Obstetrics & Gynaecology

Abstract
Abortion has been a reality in women’s lives since the beginning of recorded history, typically with a high risk of fatal consequences, until the last century when evolutions in the field of medicine, including techniques of safe abortion and effective methods of family planning, could have ended the need to seek unsafe abortion. The context of women’s lives globally is an important but often ignored variable, increasingly recognised in evolving human rights especially related to gender and reproduction. International and regional human rights instruments are being invoked where national laws result in violations of human rights such as health and life. The individual right to conscientious objection must be respected and better understood, and is not absolute. Health professional organisations have a role to play in clarifying responsibilities consistent with national laws and respecting reproductive rights. Seeking common ground using evidence rather than polarised opinion can assist the future focus.

Shaw D. Abortion and human rights. Best Practice and Research Clin Ob Gyn. 2010;24(5):633-646.

A Most Fundamental Freedom of Choice: An International Review of Conscientious Objection to Elective Abortion

Erin Whitcomb

St. John's Journal of Legal Commentary — St. John’s Journal of Legal Commentary

Abstract
Conclusion
American President Thomas Jefferson once explained, “[t]he price of freedom is eternal vigilance.”210 He also warned, “It behooves every man who values liberty of conscience for himself, to resist invasions of it in the case of others.”211 As this Note demonstrates, even in constitutional democracies that have provided their people with broad, enumerated individual liberties, the threat of erosion of rights is ever-present. No rights, even those that seem most fundamental—like freedom of conscience—are immune. They must be avidly protected and defended. The individual choice guaranteed by statutory conscience protection demonstrates respect for the autonomy of health care providers, promotes the integrity of the medical profession,212 and protects the rights of healthcare professionals without compromising those of patients. Failure to protect individual conscience rights will be devastating to any democratic society.213

The absence of a statute compelling health care professionals’ participation in abortion is irrelevant to those in functionally equivalent circumstances, just as the cases of registered nurse Sister Charles in South Africa, American nurse Catherina Cenzon-DeCarlo, and the unnamed Canadian medical student remind us. Health care professionals who are discriminated against on the basis of their conscientious unwillingness to participate in elective abortion procedures must not be left without a remedy. South Africa and Canada should enact statutory conscience protection measures without delay. Similarly, the statutory and regulatory conscience protection established thus far in the United States must be vigilantly protected from erosion.

A matter of choice for one person should not result in a matter of compulsion for another, particularly where the matter is one of such significant moral or religious import. The “freedom to choose” so often associated with elective abortion must be extended to medical professionals who would choose to follow the dictates of their own consciences in abstaining from a practice, which, in their view, is hostile to the ethical obligations of the practice of medicine and violates the profound and inherent dignity of the human person.

Whitcomb E. A Most Fundamental Freedom of Choice: An International Review of Conscientious Objection to Elective Abortion. St. John’s J Legal Com. 2010;24(4):771-809.

Making Rules and Unmaking Choice: Federal Conscience Clauses, the Provider Conscience Regulation, and the War on Reproductive Freedom

Rachel White-Domain

Extract
Conclusion
This Comment analyzes the PCR, which is currently under review by the Obama Administration. As currently written, the PCR promises to have devastating effects on the healthcare system. . .

Commenters have predicted that the PCR will be used to discriminate against patients based on their sexual orientation. 196 And because reproductive healthcare remains so controversial in this country, women will be disproportionately disadvantaged by the PCR, which now allows almost all employees-not only the doctor, but potentially the nurse, the pharmacist, the pharmacist’s assistant, the receptionist, the ambulance driver, and the janitor-to have a say in whether she can access her chosen healthcare without interference.

The PCR brought the ongoing debate over conscience clauses into the national spotlight. . . .this Comment argues that any analysis of conscience clauses must recognize that what is at stake is access to healthcare services, and that reduction of healthcare access can be accomplished not only explicitly, for example through the explicit redefining of the term “abortion,” but also through “strategic ambiguity.” . . .

White-Domain R. Making Rules and Unmaking Choice: Federal Conscience Clauses, the Provider Conscience Regulation, and the War on Reproductive Freedom. DePaul Law Rev. 2010 Summer;59(4):1249-1281.

Religion and conscientious objection: a survey of pharmacists’ willingness to dispense medications

Laura A.Davidson, Clare T.Pettis, Amber J.Joiner, Daniel M.Cook, Craig M.Klugmand

Abstract
Some US states allow pharmacists to refuse to dispense medications to which they have moral objections, and federal rules for all health care providers are in development. This study examines whether demographics such as age, religion, gender influence 668 Nevada pharmacists’ willingness to dispense or transfer five potentially controversial medications to patients 18 years and older: emergency contraception, medical abortifacients, erectile dysfunction medications, oral contraceptives, and infertility medications. Almost 6% of pharmacists indicated that they would refuse to dispense and refuse to transfer at least one of these medications. Religious affiliation significantly predicted pharmacists’ willingness to dispense emergency contraception and medical abortifacients, while age significantly predicted pharmacists’ willingness to distribute infertility medications. Evangelical Protestants, Catholics and other-religious pharmacists were significantly more likely to refuse to dispense at least one medication in comparison to non-religious pharmacists in multinomial logistic regression analyses. Awareness of the influence of religion in the provision of pharmacy services should inform health care policies that appropriately balance the rights of patients, physicians, and pharmacists alike. The results from Nevada pharmacists may suggest similar tendencies among other health care workers, who may be given latitude to consider morality and value systems when making clinical decisions about care.

Davidson LA, Pettis CT, Joiner AJ, Cook DM, Klugman CM. Religion and conscientious objection: a survey of pharmacists’ willingness to dispense medications. Soc Sci Med. 2010 Jul;71(1):161-5. Epub 2010 Apr 13. PubMed PMID: 20447746

Maryland’s conscience clause: leaving a woman’s right to a health care provider’s choice

Maria Cirincione

Extract
Conclusion
. . . Currently, ambiguities in the Maryland statute allow too much flexibility for providers in emergency rooms to refuse to provide or even inform patients about emergency contraception. This kind of state sanctioned refusal serves as the kind of government obstacle the Supreme Court has forbidden in upholding a woman’s right to bodily privacy. The Maryland legislature should act to eliminate the ambiguities in Maryland’s conscience legislation and explicitly protect a woman’s right to access emergency contraception in Maryland emergency rooms. In order to do so, the Maryland legislature should adopt the medical community’s definition for abortion that excludes emergency contraception. The new Maryland conscience statute should also provide explicit protections to patients receiving emergency room care. Physicians should be required to inform patients of emergency contraception if treatment in each particular case is medically indicated. Finally, physicians should be required to treat patients that request access to emergency contraception or to refer them to another provider who is willing to administer treatment within the effective time period of emergency contraception. . .

Cirincione M. Maryland’s conscience clause: leaving a woman’s right to a health care provider’s choice. J Health Care Law & Pol. 2010;13(1):171-202.