Extract Introduction: Recently, the discussion regarding the physicians’ “Right of Conscience” (ROC) has been on the rise. This issue is often confined to the “reproductive health” arena (abortions, birth control, morning-after pills, fertility treatments, etc.) within the political context. The recent dispute of the Bush-Obama administrations regarding the legal protections of health workers who refuse to provide care that violates their personal beliefs is an example of the political aspects of this dispute.
Extract The administration of former President George W. Bush and the subsequent revival of the abortion disputes in the United States have put the ethical challenges of conscientious objection in the spotlight in many international journals on bioethics in the last decade. . . . In the last few years some clear administrative guidelines have been drawn up, considering the institutional realities of developed countries, most of them with private healthcare systems. These include rules that the objection or refusal is an individual right and not an institutional right and healthcare providers have a duty to refer a woman to a similar health care service provider.
I would suggest that this is not the reality for many developing countries.
Abstract We provide comprehensive, practical guidance for physicians on when to offer, recommend, perform, and refer patients for induced abortion and feticide. We precisely define terminology and articulate an ethical framework based on respecting the autonomy of the pregnant woman, the fetus as a patient, and the individual conscience of the physician. We elucidate autonomy-based and beneficence-based obligations and distinguish professional conscience from individual conscience. The obstetrician’s role should be based primarily on professional conscience, which is shaped by autonomy-based and beneficence-based obligations of the obstetrician to the pregnant and fetal patients, with important but limited constraints originating in individual conscience.
Extract Conclusion The ethics of referral for abortion is autonomy based with a beneficence-based component, the clinician’s obligation to protect the woman’s health and life, similar to referral for cosmetic procedures. At a minimum, indirect referral— providing referral information but not ensuring that referral occurs—should be the clinical ethical standard of care. Direct referral for abortion is a matter of individual clinician discretion, not the clinical ethical standard of care. Conscience based objections to direct referral for termination of pregnancy have merit; conscience-based objections to indirect referral for termination of pregnancy do not.
Chervenak FA, McCullough LB. Ethical Distinction Between Direct and Indirect Referral for Abortion. The Female Patient. 2009 Dec;34:46-48
Abstract As Latin American countries seek to guarantee sexual and reproductive health and rights, opponents of women’s rights and reproductive choice have become more strident in their opposition, and are increasingly claiming conscientious objection to providing these services. Conscientious objection must be seen in the context of the rights and interests at stake, including women’s health needs and right to self-determination. An analysis of law and policy on conscientious objection in Peru, Mexico and Chile shows that it is being used to erode women’s rights, especially where it is construed to have no limits, as in Peru. Conscientious objection must be distinguished from politically-motivated attempts to undermine the law; otherwise, the still fragile re-democratisation processes underway in Latin America may be placed at risk. True conscientious objection requires that a balance be struck between the rights of the objector and the health rights of patients, in this case women. Health care providers are entitled to their beliefs and to have those beliefs accommodated, but it is neither viable nor ethically acceptable for conscientious objectors to exercise this right without regard for the right to health care of others, or for policy and services to be rendered ineffectual because of individual objectors.
Abstract Aims: To highlight the potential difficulties in the management of staff with a conscientious objection to abortion, in light of expanding role of nurses.
Background: Recent years have seen changes in the provision of abortion services. Medical procedures are now gaining popularity and some areas are seeing the integration of outpatient clinics into ward settings. This may involve nurses being required to provide care to women undergoing termination of pregnancy, which may not have previously been within their remit. This has implications for staff with a conscientious objection.
Methods: A review of the academic literature.
Results: The advent of medical abortion has led to changes in the way in which abortion services are provided which in turn has re-ignited the debate of the competing rights of nurses with a conscientious objection and those of the patient accessing abortion services.
Conclusions: This extended role of nurses creates challenges for staff working in clinical areas offering termination of pregnancy and these are further compounded when staff have expressed a conscientious objection to abortion.
Implications for Nursing Management: Managers face new challenges in achieving the fine balance between the rights of staff with a conscientious objection to abortion and women accessing abortion services.
Abstract PURPOSE: To explore physicians’ beliefs about whether physicians sometimes have a professional obligation to provide medical services even if doing so goes against their conscience, and to examine associations between physicians’ opinions and their religious and ethical commitments.
METHOD: A survey was mailed in 2007 to a stratified random sample of 1,000 U.S. primary care physicians, selected from the American Medical Association Physician Masterfile. . . .
RESULTS: The response rate was 51% (446/879 delivered questionnaires). Forty-two percent and 22% believed they are never and sometimes, respectively, obligated to do what they personally believe is wrong, and 36% agreed with both statements. Physicians who are more religious are more likely to believe that physicians are never obligated to do what they believe is wrong (58% and 31% of those with high and low intrinsic religiosity, respectively; multivariate odds ratio, 2.9; 95% CI, 1.2-7.2). Those with moral objections to any of three controversial practices were more likely to hold that physicians should never do what they believe is wrong.
CONCLUSION: A substantial minority of physicians do not believe there is ever a professional obligation to do something they personally believe is wrong.
Abstract Since the 1994 Cairo Conference on Population and Development, the human rights movement has embraced the concept of reproductive rights. These are often pursued, however, by means to which objection is taken. Some conservative political and religious forces continue to resist implementation of several means of protecting and advancing reproductive rights. Individuals’ rights to grant and to deny consent to medical procedures affecting their reproductive health and confidentiality have been progressively advanced. However, access to contraceptive services, while not necessarily opposed, is unjustifiably obstructed in some settings. Rights to lawful abortion have been considerably liberalized by legislative and judicial decisions, although resistance remains. Courts are increasingly requiring that lawful services be accommodated under transparent conditions of access and of legal protection. The conflict between rights of resort to lawful reproductive health services and to conscientious objection to participation is resolved by legal duties to refer patients to non-objecting providers.
Abstract Abortion is the most politically contested social issue in the United States, a debate that manifests itself in extensive regulation of abortion as a health care service. This study provides a brief history of the judicial acceptance of abortion regulation and an overview of the most common forms of abortion regulation affecting physicians in the United States. The article concludes with a discussion of pending threats to the legal right to abortion in the United States and recommended resources where physicians can find assistance to comply with existing laws.
Abstract Although for centuries conscientious objection was primarily claimed by those who for religious or ethical reasons refused to join the ranks of the military (whether out of a general principle or in response to a particular violent conflict), in recent decades a significant broadening of the concept can be seen. In Thailand, for example, doctors recently refused medical attention to injured policemen suspected of having violently repressed a demonstration. In Argentina a few public defenders have rejected for conscientious reasons to represent individuals accused of massive human rights violations. In different countries all over the world there are doctors who refuse to perform euthanasia, schoolteachers who reject to teach the theory of evolution, and students who refuse to attend biology classes where frogs are dissected.
