Extract “Do doctors have the right to refuse certain treatments on the grounds of personal conscience?” Is the question asking about Conway’s point about what the doctor sincerely, on medical grounds, considers to be in the patient’s best interests, or is the question asking about a doctor’s refusal to attend to a patient on the basis of some irrational prejudice? Horses of quite different colours — racing in different races.
Abstract The practice of conscientious objection often arises in the area of individuals refusing to fulfil compulsory military service requirements and is based on the right to freedom of thought, conscience and religion as protected by national, international and regional human rights law. The practice of conscientious objection also arises in the field of health care, when individual health care providers or institutions refuse to provide certain health services based on religious, moral or philosophical objections. The use of conscientious objection by health care providers to reproductive health care services, including abortion, contraceptive prescriptions, and prenatal tests, among other services is a growing phenomena throughout Europe. However, despite recent progress from the European Court of Human Rights on this issue (RR v. Poland, 2011), countries and international and regional bodies generally have failed to comprehensively and effectively regulate this practice, denying many women reproductive health care services they are legally entitled to receive. The Italian Ministry of Health reported that in 2008 nearly 70% of gynaecologists in Italy refuse to perform abortions on moral grounds. It found that between 2003 and 2007 the number of gynaecologists invoking conscientious objection in their refusal to perform an abortion rose from 58.7 percent to 69.2 percent. Italy is not alone in Europe, for example, the practice is prevalent in Poland, Slovakia, and is growing in the United Kingdom. This article outlines the international and regional human rights obligations and medical standards on this issue, and highlights some of the main gaps in these standards. It illustrates how European countries regulate or fail to regulate conscientious objection and how these regulations are working in practice, including examples of jurisprudence from national level courts and cases before the European Court of Human Rights. Finally, the article will provide recommendations to national governments as well as to international and regional bodies on how to regulate conscientious objection so as to both respect the practice of conscientious objection while protecting individual’s right to reproductive health care.
Grace S Chung, Ryan E Lawrence, Kenneth A Rasinski, John D Yoon, Farr A Curlin
American Journal of Obstetrics & Gynecology
Abstract Objective: The purpose of this study was to assess obstetrician- gynecologists’ regarding their beliefs about when pregnancy begins and to measure characteristics that are associated with believing that pregnancy begins at implantation rather than at conception.
Study Design: We mailed a questionnaire to a stratified, random sample of 1800 practicing obstetrician-gynecologists in the United States. The outcome of interest was obstetrician-gynecologists’ views of when pregnancy begins. Response options were (1) at conception, (2) at implantation of the embryo, and (3) not sure. Primary predictors were religious affiliation, the importance of religion, and a moral objection to abortion.
Results: The response rate was 66% (1154/1760 physicians). One-half of US obstetrician-gynecologists (57%) believe pregnancy begins at conception. Fewer (28%) believe it begins at implantation, and 16% are not sure. In multivariable analysis, the consideration that religion is the most important thing in one’s life (odds ratio, 0.5; 95% confidence interval, 0.20.9) and an objection to abortion (odds ratio, 0.4; 95% confidence interval, 0.20.9) were associated independently and inversely with believing that pregnancy begins at implantation.
Conclusion: Obstetrician-gynecologists’ beliefs about when pregnancy begins appear to be shaped significantly by whether they object to abortion and by the importance of religion in their lives.
Lisa H Harris, Alexandra Cooper, Kenneth A Rasinski, Farr A Curlin, Anne Drapkin Lyerly
Obstetrics & Gynecology
Abstract Objective: To describe obstetrician-gynecologists’ (ob-gyns’) views and willingness to help women seeking abortion in a variety of clinical scenarios.
Methods: We conducted a mailed survey of 1,800 U.S. ob-gyns. We presented seven scenarios in which patients sought abortions. For each, respondents indicated if they morally objected to abortion and if they would help patients obtain an abortion. We analyzed predictors of objection and assistance.
Results: The response rate was 66%. Objection to abortion ranged from 16% (cardiopulmonary disease) to 82% (sex selection); willingness to assist ranged from 64% (sex selection) to 93% (cardiopulmonary disease). Excluding sex selection, objection was less likely among ob-gyns who were female (odds ratio [OR] 0.5, 95% confidence interval [CI] 0.4-0.8), urban (OR 0.3, 95% CI 0.1-0.7), or Jewish (OR 0.3, 95% CI 0.1-0.7) compared with male, rural, or religiously unaffiliated ob-gyns. Objection was more likely among ob-gyns from the South (OR 1.9, 95% CI 1.2-3.0) or Midwest (OR 1.9, 95% CI 1.2-3.1), and among Catholic, Evangelical Protestant, or Muslim ob-gyns, or those for whom religion was most important, compared with reference. Among ob-gyns who objected to abortion in a given case, approximately two-thirds would help patients obtain an abortion. Excluding sex selection, assistance despite objection was more likely among female (OR 1.8, 95% CI 1.1-2.9) and United States-born ob-gyns (OR 2.2, 95% CI 1.1-4.7) and less likely among southern ob-gyns (OR 0.3, 95% CI 0.2-0.6) or those for whom religion was most important (OR 0.3, 95% CI 0.1-0.7).
Conclusion: Most ob-gyns help patients obtain an abortion even when they morally object to abortion in that case. Willingness to assist varies by clinical context and physician characteristics.
Abstract Objective: To explore attitudes towards conscientious objections among medical students in the UK.
Methods: Medical students at St George’s University of London, Cardiff University, King’s College London and Leeds University were emailed a link to an anonymous online questionnaire, hosted by an online survey company. The questionnaire contained nine questions. A total of 733 medical students responded.
Results: Nearly half of the students in this survey stated that they believed in the right of doctors to conscientiously object to any procedure. Demand for the right to conscientiously object is greater in Muslim medical students when compared with other groups of religious medical students.
Discussion: Abortion continues to be a contentious issue among medical students and this may contribute to the looming crisis in abortion services over the coming years. This project sheds some light on how future doctors view some of their ethical rights and obligations. Using empirical evidence, it reveals that conscientious objection is an issue in the UK medical student body today. These data could help anticipate problems that may arise when these medical students qualify and practise medicine in the community.
Conclusion: Clearer guidance is needed for medical students about the issue of conscientious objection at medical school.
Abstract Abortion is the central issue in the conscientious objection debate. In this article I demonstrate why this is so for two philosophical viewpoints prominent in American culture. One, represented by Patrick Lee and Robert P. George, holds that the fundamental moral value of being human can be found in bare life and the other, represented by Tom Beauchamp and James Childress, holds that this fundamental value is found in the life that can choose and determine itself. First, I articulate Lee and George’s philosophical theory and demonstrate how the fundamental moral value of their theory, personhood, is represented in the issue of abortion. Second, I examine Beauchamp and Childress’ theoretical vision and demonstrate how their fundamental moral value, the right to autonomous selfdetermination, is represented in abortion. Third, I sketch the theoretical and practical dynamics of the conscientious objection debate as well as each author’s understanding of conscience. Fourth, I demonstrate how abortion, which represents their respective fundamental value, shapes each perspectives’ approach to the conscientious objection debate. I conclude that because each theory finds its fundamental value represented in the issue of abortion, each perspective is bound to engage the conscientious objection debate in a way that centers on the issue of abortion.
Extract Beware of arguments that appear to accept that CO is just about our ‘personal values’; it isn’t. Beware of relying on our fallen consciences rather than on God’s Word. Beware of resorting to the safety of guidelines and laws which may be changed. By God’s grace, we have the right to CO made explicit in our professional guidance, given concrete examples in the law, supported by a European assembly. We can argue from history or personal example in favour of it. But in the end, we need to be prepared to stand for Christ, and the experience of those before us suggests that this will be costly.
Extract Conclusion It is undeniable that Catholic hospitals play a pivotal role in the administration of health care in America. The requirement that they follow both federal law and canon law can, however, create conflicting obligations. If FOCA were to pass, Catholic hospitals would be required under federal law to provide abortions and other reproductive services in direct conflict with Catholic teachings. At the same time, because the Catholic Church would view FOCA as an unjust law operating against human good and divine good, Catholic hospitals would also have a moral obligation under church teachings to disobey the provisions of FOCA.
Unable to sell because of their inability to cooperate in an evil act, Catholic hospitals would likely engage in civil disobedi ence. And yet, such tactics would only work for so long. Suits would be brought and courts would almost certainly uphold FOCA as a valid and neutral law that is generally applicable. Despite what many would like to believe, FOCA poses a very real and imminent threat to the existence of Catholic hospitals. And the effect least talked about and yet most important is not what effect such closing would have on the Church itself, but what effect it would have on the 92 million patients that Catholic hospitals treat annually. The effects of FOCA passing and Catholic hospitals closing would be much more than a victory for the pro- choice advocates; it would be a loss to every person who has ever received treatment at a Catholic hospital and to all those who would be denied such services in the future. Perhaps we should take a cue from the medical profession itself and remember above all else: first, do no harm
Kenneth A Rasinski, John D Yoon, Youssef G Kalad, Farr A Curlin
Journal of Medical Ethics
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.
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.
