Abortion Archives - Page 11 of 48 - Protection of Conscience Project Library

(Correspondence) Incidence of induced abortions in Peru (Two of the authors respond)

Peter J White, Antonio Bernabé-Ortiz

Canadian Medical Association Journal, CMAJ — Canadian Medical Association Journal

Extract
The correct measure of the public health burden of a discrete event is its incidence: the annual per capita rate of occurrence of the event of interest in the relevant population group. As we reported, the incidence of induced abortion in Peru is as high as, or higher than, the incidence in Britain and the United States, but in Peru this practice is illegal, performed clandestinely and potentially unsafe. . . .he is probably correct in his assertion that the legal restrictions in Peru result in relatively fewer pregnancies being terminated in that country than in Britain or the United States; that is, there are more unwanted births in Peru. . . The high incidence of induced abortion clearly indicates a high incidence of unwanted pregnancy.

White B, Bernabé-Ortiz A. (Correspondence) Incidence of induced abortions in Peru (Two of the authors respond). Can Med Assoc J. 2009 May 26;180(11):1133.

Conscientious Objection: Resisting Ethical Aggression in Medicine

Sean Murphy

Responding to Cantor, Julie D., Conscientious Objection Gone Awry – Restoring Selfless Professionalism in Medicine. N Eng J Med 360;15, 9 April, 2009

Extract
Judging from the title of her article, Professor Julie D. Cantor believes that “selfless professionalism” in medicine is being destroyed by health care workers who will not do what they believe to be wrong.

She also implies that Americans have access to health care only because health care workers are compelled to provide services that they find morally repugnant. At least, that is the inference to be drawn from her warning that health care “could grind to a halt” if a federal protection of conscience regulation were “[t]aken to its logical extreme.”

Such anxiety is inconsistent with the fact that religious believers and organizations have been providing health care in the United States for generations. If anything, this demonstrates that health care is provided to many Americans – and many of the poorest Americans – because of the commitment of health care workers to their moral convictions, not in spite of them.

Murphy S. Conscientious Objection: Resisting Ethical Aggression in Medicine [Internet]. Protection of Conscience Project (2009 Apr 17).

Conscientious Objection Gone Awry-Restoring Selfless Professionalism in Medicine

Julie D Cantor

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

Extract
Health care providers already enjoy broad rights — perhaps too broad — to follow their guiding moral or religious tenets when it comes to sterilization and abortion. An expansion of those rights is unwarranted. . . .Physicians should support an ethic that allows for all legal options, even those they would not choose. Federal laws may make room for the rights of conscience, but health care providers — and all those whose jobs affect patient care — should cast off the cloak of conscience when patients’ needs demand it.

Cantor JD. Conscientious Objection Gone Awry-Restoring Selfless Professionalism in Medicine. N Engl J Med. 2009 Apr 09;360(15):1484-1485.

Healthcare responsibilities and conscientious objection

Rebecca J. Cook, Monica Arango Olaya, Bernard M. Dickens

International Journal of Gynecology & Obstetrics

Abstract
The Constitutional Court of Colombia has issued a decision of international significance clarifying legal duties of providers,hospitals, and healthcare systems when conscientious objection is made to conducting lawful abortion. The decision establishes objecting providers’duties to refer patients to non-objecting providers, and that hospitals,clinics, and other institutions have no rights of conscientious objection. Their professional and legal duties are to ensure that patients receive timely services. Hospitals and other administrators cannot object, because they do not participate in the procedures they are obliged to arrange. Objecting providers, and hospitals, must maintain knowledge of non-objecting providers to whom their patients must be referred. Accordingly, medical schools must adequately train, and licensing authorities approve, non-objecting providers. Where they are unavailable, midwives and perhaps nurse practitioners may be trained, equipped, and approved for appropriate service delivery. The Court’s decision has widespread implications for how healthcare systems must accommodate conscientious objection and patients’ legal rights.

Cook RJ, Olaya MA, Dickens BM. Healthcare responsibilities and conscientious objection. Int J Gynaecol Obstet. 2009 Mar;104(3):249-52. Epub 2008 Nov 29.

Transparency in the delivery of lawful abortion services

Rebecca J Cook

Abstract
• Laws limiting access to abortion services do not reduce the number of abortions, only their safety.

• Governments of countries are obligated to collect official statistics on the number of abortions and their health effects.

• Where statistics show deficiencies in the delivery of abortion services, governments are obligated to remedy the problem.

• Governments are obligated to ensure that women, irrespective of age or other socio-demographic factors, have transparent access to abortion counselling and services where they are legal.

Cook RJ. Transparency in the delivery of lawful abortion services. Can Med Assoc J. 2009 Feb 03;180(3):272-273.

Clandestine induced abortion: prevalence, incidence and risk factors among women in a Latin American country

Antonio Bernabé-Ortiz, Peter J White, Cesar P Carcamo, James P Hughes, Marco A Gonzales, Patricia J Garcia, Geoff P Garnett, King K Holmes

Abstract
Background: Clandestine induced abortions are a public health problem in many developing countries where access to abortion services is legally restricted. We estimated the prevalence and incidence of, and risk factors for, clandestine induced abortions in a Latin American country. Methods: We conducted a large population-based survey of women aged 18–29 years in 20 cities in Peru. We asked questions about their history of spontaneous and induced abortions, using techniques to encourage disclosure.Interpretation: The incidence of clandestine, potentially unsafe induced abortion in Peru is as high as or higher than the rates in many countries where induced abortion is legal and safe. The provision of contraception and safer- sex education to those who require it needs to be greatly improved and could potentially reduce the rate of induced abortion.

Keywords:

Bernabé-Ortiz A, White PJ, Carcamo CP, Hughes JP, Gonzales MA, Garcia PJ et al. Clandestine induced abortion: prevalence, incidence and risk factors among women in a Latin American country. Can Med Ass J. 2009;180(3):298-304.

Abortion and the politicisation of conscience

Megan-Jane Johnstone

Extract
In formulating a response to the abortion issue, the nursing profession needs to be careful not to lose sight of its moral obligation to ensure that women receive the care they require. Nurses also need to be wary of the politicisation of conscience and the corrupting influence this can have on authentic debate about complex moral issues.

Johnstone M-J. Abortion and the politicisation of conscience. Aust Nurs J. 2008 Dec;16(6):21.

Healthcare responsibilities and conscientious objection

Rebecca J Cook, Mónica Arango Olaya, Bernard M Dickens

Abstract
The Constitutional Court of Colombia has issued a decision of international significance clarifying legal duties of providers, hospitals, and healthcare systems when conscientious objection is made to conducting lawful abortion. The decision establishes objecting providers’ duties to refer patients to non-objecting providers, and that hospitals, clinics, and other institutions have no rights of conscientious objection. Their professional and legal duties are to ensure that patients receive timely services. Hospitals and other administrators cannot object, because they do not participate in the procedures they are obliged to arrange. Objecting providers, and hospitals, must maintain knowledge of non-objecting providers to whom their patients must be referred. Accordingly, medical schools must adequately train, and licensing authorities approve, non-objecting providers. Where they are unavailable, midwives and perhaps nurse practitioners may be trained, equipped, and approved for appropriate service delivery. The Court’s decision has widespread implications for how healthcare systems must accommodate conscientious objection and patients’ legal rights.

Cook RJ, Olaya MA, Dickens BM. Healthcare responsibilities and conscientious objection. Int J Gyn Ob. 2009 Nov 29;104(3):249-252.

The ethics of direct and indirect referral for termination of pregnancy

Frank A Chervenak, Laurence B McCullough

American Journal of Obstetrics & Gynecology

Abstract
Referral of pregnant patients for termination of pregnancy by physicians morally opposed to the procedure is ethically controversial, with polarized positions taken by physician organizations. Based on the ethical principles of beneficence and respect for autonomy, we establish the distinction between direct and indirect referral. Direct referral is beneficence based and requires the referring physician to ensure that the referral occurs. Indirect referral is autonomy based, with a beneficence-based component that requires that the physician provide information to the patient about health care organizations that will provide competent medical care. We show that only indirect referral is ethically required in healthy women for termination of an unwanted pregnancy or a pregnancy complicated by fetal anomalies because the indications for this procedure are solely autonomy based. Direct referral for termination of pregnancy is not ethically required but is permissible. Conscience-based objections to direct referral for termination of pregnancy have merit; conscience-based objections to indirect referral do not.

Chervenak FA, McCullough LB. The ethics of direct and indirect referral for termination of pregnancy. Am J Obstet Gynecol. 2008 Jul 30;199(3):232.e1-232.e3.

Moral Courage Through a Collective Voice

(Ethics and Rural Healthcare)

Julie Aultman

Extract
In posing the question of whether it is morally right for the only pharmacist in town to refuse healthcare services based on his or the community’s religious convictions, I could not help but think of “the conscience clause.” While many states across the United States support the conscience clause, which protects healthcare professionals from discrimination when refusing to dispense birth control pills or performing abortions and sterilizations, such clauses have different implications in the rural setting.When a physician or pharmacist refuses to prescribe or dispense birth control pills, the urban patient is able to acquire birth control from another healthcare provider with less difficulty than the rural patient. The rural patient may have to drive a great distance to acquire birth control even if it is needed for a medical condition rather than to prevent pregnancy.

Aultman J. Moral Courage Through a Collective Voice (Ethics and Rural Healthcare). Am J Bioeth. 2008;8(4):67-69.