Abortion Archives - Page 4 of 51 - Protection of Conscience Project Library

Referrals for Services Prohibited In Catholic Health Care Facilities

Debra B. Stulberg, Rebecca A. Jackson, Lori R. Freedman

Perspectives on Sexual and Reproductive Health

Abstract
Context: Catholic hospitals control a growing share of health care in the United States and prohibit many common reproductive services, including ones related to sterilization, contraception, abortion and fertility. Professional ethics guidelines recommend that clinicians who deny patients reproductive services for moral or religious reasons provide a timely referral to prevent patient harm. Referral practices in Catholic hospitals, however, have not been explored.

Methods: Twenty-seven obstetrician-gynecologists who were currently working or had worked in Catholic facilities participated in semistructured interviews in 2011–2012. Interviews explored their experiences with and perspectives on referral practices at Catholic hospitals. The sample was religiously and geographically diverse. Referral-related themes were identified in interview transcripts using qualitative analysis.

Results: Obstetrician-gynecologists reported a range of practices and attitudes in regard to referrals for prohibited services. In some Catholic hospitals, physicians reported that administrators and ethicists encouraged or tolerated the provision of referrals. In others, hospital authorities actively discouraged referrals, or physicians kept referrals hidden. Patients in need of referrals for abortion were given less support than those seeking referrals for other prohibited services. Physicians received mixed messages when hospital leaders wished to retain services for financial reasons, rather than have staff refer patients elsewhere. Respondents felt referrals were not always sufficient to meet the needs of low-income patients or those with urgent medical conditions.

Conclusions: Some Catholic hospitals make it difficult for obstetrician-gynecologists to provide referrals for comprehensive reproductive services.

Stulberg DB, Jackson RA, Freedman LR. Referrals for Services Prohibited In Catholic Health Care Facilities. Perspect Sex Repro H, 48:111–117. doi:10.1363/48e10216

Conscientious Objection in Healthcare Provision: A New Dimension

Peter West-Oram, Alena Buyx

Abstract
The right to conscientious objection in the provision of healthcare is the subject of a lengthy, heated and controversial debate. Recently, a new dimension was added to this debate by the US Supreme Court’s decision in Burwell vs. Hobby Lobby et al. which effectively granted rights to freedom of conscience to private, for-profit corporations. In light of this paradigm shift, we examine one of the most contentious points within this debate, the impact of granting conscience exemptions to healthcare providers on the ability of women to enjoy their rights to reproductive autonomy. We argue that the exemptions demanded by objecting healthcare providers cannot be justified on the liberal, pluralist grounds on which they are based, and impose unjustifiable costs on both individual persons, and society as a whole. In doing so, we draw attention to a worrying trend in healthcare policy in Europe and the United States to undermine women’s rights to reproductive autonomy by prioritizing the rights of ideologically motivated service providers to an unjustifiably broad form of freedom of conscience.

West-Oram P, Buyx A. Conscientious Objection in Healthcare Provision: A New Dimension. Bioethics. 2016 Jun;30(5):336-343.

From women’s ‘irresponsibility’ to foetal ‘patienthood’: Obstetricians-gynaecologists’ perspectives on abortion and its stigmatisation in Italy and Cataluña

Silvia De Zordo

Abstract
This article explores obstetricians-gynaecologists’ experiences and attitudes towards abortion, based on two mixed-methods studies respectively undertaken in Italy in 2011–2012, and in Spain (Cataluña) in 2013–2015. Short questionnaires and in-depth interviews were conducted with 54 obstetricians-gynaecologists at 4 hospitals providing abortion care in Rome and Milan, and with 23 obstetricians-gynaecologists at 2 hospitals and one clinic providing abortion care in Barcelona. A medical/moral classification of abortions, from those considered ‘more acceptable’, both medically and morally – for severe foetal malformations – to the ‘least acceptable’ ones – repeated ‘voluntary abortions’, emerged in the discourse of most obstetricians-gynaecologists working in public hospitals, regardless of their religiosity. I argue that this is the result of the increasing medicalisation of contraception as well as of reproduction, which has reinforced the stigmatisation of ‘voluntary abortion’ (in case of unintended pregnancy) in a context of declining fertility rates. This contributes to explain why obstetricians-gynaecologists working in Catalan hospitals, which provide terminations only for medical reasons, unlike Italian hospitals, do not experience abortion stigma and do not object to abortion care as much as their Italian colleagues do.

Zordo SD. From women’s ‘irresponsibility’ to foetal ‘patienthood’: Obstetricians-gynaecologists’ perspectives on abortion and its stigmatisation in Italy and Cataluña. Glob Public Health. 2018 May 27;13(6).

Physician opinions concerning legal abortion in Bogotá, Colombia

Kaitlyn Stanhope, Roger Rochat, Lauren Fink, Kalie Richardson, Chelsey Brack, Dawn Comeau

Abstract
Since the decriminalisation of abortion in 2006, women in Colombia have continued to seek clandestine abortions, endangering their health and contributing to maternal mortality and morbidity. The goal of this study was to explore physicians’ opinions towards and knowledge about legal abortion in Bogotá, Colombia, and key barriers to the legal abortion access. We conducted 13 key informant interviews followed by a survey with a probability sample of 49 doctors working in public hospitals in Bogotá. Interview and survey data showed lack of technical experience in the provision of abortion and nuanced opinions towards its practice. Key informants described ignorance and lack of abortion training in medical schools as key barriers to provision. In the survey, 16/49 respondents had performed an abortion, 24/49 had referred a woman for an abortion and only 33/49 showed correct knowledge of the law.

Stanhope K, Rochat R, Fink L, Richardson K, Brack C, Comeau D. Physician opinions concerning legal abortion in Bogotá, Colombia. Culture, Health and Sexuality. 2017;19(8):873-887.

When Policy Produces Moral Distress: Reclaiming Conscience

Nancy Berlinger

Abstract
For too long, bioethics has followed law in reducing “conscience” to “conscientious objection,” in other words, to laws and policies permitting and protecting refusal. In “Reframing Conscientious Care: Providing Abortion Care When Law and Conscience Collide,” Mara Buchbinder and colleagues draw our attention to one dimension of the problem of reducing conscience to refusal to provide certain forms of medical care: what about the conscience problems experienced by the professionals who are attempting to provide safe, effective health care that includes services that others associate with conscientious objection? In seeking to disrupt a specific medical practice – one that is legal, desired by the patient, and conducted in accordance with medical standards – North Carolina House Bill 854, The Women’s Right to Know Act, and laws like it, appear to be designed to produce moral distress in physicians and other professionals involved in the provision of abortions. For abortion providers in North Carolina and other states, conscientious objection to the mandates of laws like HB 854 isn’t a realistic option. So what can bioethics offer to professionals bound by such laws? We can start by reclaiming the idea of “conscience” as something that can say “yes” to providing health care.

Berlinger, N. (2016), When Policy Produces Moral Distress: Reclaiming Conscience. Hastings Center Report, 46: 32–34. doi: 10.1002/hast.547

Conscience, Courage, and “Consent”

Mark A. Hall, Nancy M. P. King

Abstract
On September 8, 2015, the Department of Health and Human Services issued a Notice of Proposed Rule Making to revise the Federal Policy for the Protection of Human Subjects, widely known as the “Common Rule.” The NPRM proposes several changes to the current system, including a dramatic shift in the approach to secondary research using biospecimens and data. Under the current rules, it is relatively easy to use biospecimens and data for secondary research. This approach systematically facilitates secondary research with biospecimens and data, maximizing the capacity for substantial public benefit. However, it has been criticized as insufficiently protective of the privacy and autonomy interests of biospecimen and data sources. Thus, the NPRM proposes a more restrictive regime, although more so for biospecimens than data. Both the status quo and the NPRM’s proposal are critically flawed.

Hall, M. A. and King, N. M. P. (2016), Conscience, Courage, and “Consent”. Hastings Center Report, 46: 30–32. doi: 10.1002/hast.546

Reframing Conscientious Care: Providing Abortion Care When Law and Conscience Collide

Mara Buchbinder, Dragana Lassiter, Rebecca Mercier, Amy Bryant, Anne Drapkin Lyerly

Abstract
“It’s almost like putting salt in a wound, for this person who’s already made a very difficult decision,” suggested Meghan Patterson (an alias), a licensed obstetrician-gynecologist whom we interviewed in our qualitative study of the experiences of North Carolina abortion providers practicing under the state’s Woman’s Right to Know Act (House Bill 854; 2011). The act requires that women receive counseling with state-mandated information at least twenty-four hours prior to obtaining an abortion. After the law was passed, Patterson worked with clinic administrators, in consultation with a lawyer, to write a script to be used in the state-mandated counseling procedure. She and her colleagues took particular steps to mitigate the effects of what she described as HB 854’s “forced language” – such as referring to the “father of the child.” While HB 854 stipulated that patients must be informed of the medical risks associated with the particular abortion procedure as well as those of carrying the child to term, Patterson’s script made explicit the magnitude of comparative risks, emphasizing that the risks of carrying a pregnancy to term are substantially greater than the risks of an early-term abortion. She felt that these contextualization strategies helped to facilitate trust and rapport in a clinical care situation that proved relationally and morally challenging.

In this article, we take up and expand on this point by elucidating an empirically grounded approach to ethically justified care when health care providers face legal or institutional policy mandates that raise possible moral conflicts. Our approach builds on recent bioethics discourse addressing conscience in the practice of medicine. While the concept of conscience has broad philosophical underpinnings relating to moral judgment, agency, and discernments of right and wrong, debates in bioethics have tended to engage the concept primarily vis-à-vis rights of conscientious objection or refusal. Here, we suggest a broader frame for thinking about claims of conscience in health care. Our approach draws on the feminist bioethics and the ethics of care literatures to highlight how providers may be motivated by matters of conscience, including relational concerns, in the active provision of certain forms of care. What emerges are two possibilities: not only conscientious refusal to comply with a policy mandate but also conscientious compliance – working conscientiously within a mandate’s confines.

Buchbinder, M., Lassiter, D., Mercier, R., Bryant, A. and Lyerly, A. D. (2016), Reframing Conscientious Care: Providing Abortion Care When Law and Conscience Collide. Hast Cent Rep , 46: 22–30. doi: 10.1002/hast.545

“Conscientious Objection” in Reproductive Healthcare is Immoral and Should Be Abolished

Joyce H Arthur

Extract
The majority of so-called “conscientious objection” is exercised today in reproductive healthcare and is not really about protecting the right to conscience. It’s about a person in a privileged position of authority (there by choice) imposing their personal beliefs on a vulnerable other in a dependent position (not there by choice).

Arthur JH. “Conscientious Objection” in Reproductive Healthcare is Immoral and Should Be Abolished. Joyce Arthur Blog. 2015.

(Thesis) A Region at Odds: Abortion Politics in the Maritime Provinces, 1969-1988

Katrina Ackerman

Abstract
The inaccessibility of abortion services in the Maritime Provinces remains a constant topic in the media, and yet little research has been conducted to explain the barriers to the procedure in the region. Despite many excellent studies on the barriers enforced at a provincial level after the Supreme Court of Canada case R. v. Morgentaler (1988), which decriminalized abortion nationwide, few studies provide insight into to the reasoning for strong opposition to abortion access in the region. This dissertation endeavours to fill this gap in the scholarship through a historical analysis of abortion politics in the Maritime Provinces between 1969 and 1988. When the federal government liberalized the abortion law in 1969 at the behest of the women’s movement, Canadian Bar Association, and Canadian Medical Association, opposition to the medical procedure came to the forefront. Medical professionals, politicians, clergy, and citizens quickly united to form pro-life organizations and became a powerful countermovement in the region. Through an exploration of medical society, government, and social movement organization records in conjunction with interviews with residents, this dissertation offers insight into the effectiveness and longevity of pro-life activism in New Brunswick, Nova Scotia, and Prince Edward Island. Furthermore, it illuminates the financial, physical, and psychological costs of attempting to terminate pregnancies in the region.

Ackerman K. (Thesis) A Region at Odds: Abortion Politics in the Maritime Provinces, 1969-1988. 2015.

Fetal Tissue Fallout

R Alta Charo

New England Journal of Medicine, NEJM — New England Journal of Medicine

Abstract
The duty of care is a fundamental principle of medicine that should be at the heart of the debate surrounding Planned Parenthood and fetal tissue research. And that duty includes taking advantage of avenues of hope for current and future patients.

Charo RA. Fetal Tissue Fallout. N Engl J Med. 2015 Sep 03;373(10):890-891. Available from: