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.
Extract While a fetus dies during an abortion, women also die when they don’t have access to proper reproductive services. People died in concentration camps and during civil rights protests. However, I would never compare reproductive issues to those historical events. . . . Regardless of which side we stand on in this debate, let’s not do an injustice to those who endured so much in WWII and in the United States during the 1950s and 1960s to allow us to have the freedom to have this debate. . . . Doing no harm may be impossible. Doing the lesser of harms is more achievable.
Extract In some regions of the world, hospital policy, negotiated with the health ministry and police, requires that a doctor who finds evidence of an unskilled abortion or abortion attempt should immediately inform police authorities and preserve the evidence. Elsewhere, religious leaders forbid male doctors from examining any part of a female patient’s body other than that being directly complained about. Can a doctor invoke a conscientious commitment to medically appropriate and timely diagnosis or care and refuse to comply with such directives?
Abstract Objective: Whether Canadian physicians can refuse to refer women for abortion and whether private clinics can charge for abortions are matters of controversy. We sought to identify barriers to access for women seeking therapeutic abortion and to have them identify what they considered to be most important about access to abortion services.
Methods: Women presenting for abortion over a two-month period at two free-standing abortion clinics, one publicly funded and the other private, were invited to participate in the study. Phase I of the study involved administration of a questionnaire seeking information about demographics, perceived barriers to access to abortion, and what the women wanted from abortion services. Phase II involved semi-structured interviews of a convenience sample of women to record their responses to questions about access. Responses from Phase I questionnaires were compared between the two clinics, and qualitative analysis was performed on the interview responses.
Results: Of 423 eligible women, 402 completed questionnaires, and of 45 women approached, 39 completed interviews satisfactorily. Women received information about abortion services from their physicians (60.0%), the Internet (14.8%), a telephone directory (7.8%), friends or family (5.3%), or other sources (12.3%). Many had negative experiences in gaining access. The most important issue regarding access was the long wait time; the second most important issue was difficulty in making appointments. In the private clinic, 85% of the women said they were willing to pay for shorter wait times, compared with 43.5% in the public clinic.
Conclusion: Physicians who failed to refer patients for abortion or provide information about obtaining an abortion caused distress and impeded access for a significant minority of women requesting an abortion. Management of abortion services should be prioritized to reflect what women want: particularly decreased wait times for abortion and greater ease and convenience in booking appointments. Since many women are willing to pay for services in order to have an abortion within one week, this option should be considered by policy makers.
Extract This report on the monitoring of reproductive rights in Poland was created in the framework of the project financed by the European Commission and realised by the Federation for Women and Family Planning, entitled Proactive monitoring of women’s reproductive rights as a part of human rights in Poland. The report provides a comprehensive overview of reproductive rights in Poland. It deals with the legal issues involved, and the analysis of the Polish legal regulations on reproductive rights (E. Zielińska) deserves special attention, as well as the review of court cases conducted in Poland and at the European Court of Human Rights regarding the lack of access to termination of pregnancy in Poland (A. Bodnar). The report shows the real effects of the current law and social policy with regard to termination of pregnancy, family planning and sexual education (W. Nowicka). Through the use of qualitative research, the report also presents the attitude of the health service to the issues mentioned above and the role of doctors in restricting access to services connected with reproductive health (A. Domaradzka). Moreover, the report publishes guidelines for Poland from international institutions, which aim to improve the respect for human rights regarding reproductive health issues
Extract 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.
Gary W Clark, Kelly Latimer, Richard W Sams II, Gordon Zubrod
Family Medicine
Extract Abortion training for residents is not simply a “politically charged” issue, as the authors assert. It is a moral or ethical issue. As faculty physicians in family medicine residency programs, we oppose the introduction of abortion training on moral, not political grounds. German physicians “politicized” euthanasia and ultimately killed 200,000 mentally ill and disabled persons from 1939–1945.
Extract As we gear up to provide the basket of services important to our patients in the Future of< Family Medicine, residencies need the information in these articles to be able to best design and implement abortion training. Residents with a strong experience in reproductive health, including abortion, will be best suited to meet the needs of the women they will meet in their future practices.
Journal of Family Planning and Reproductive Health Care
Abstract Background and methodology Community pharmacists’ role in the sale and supply of emergency hormonal contraception (EHC) represents an opportunity to increase EHC availability and utilise pharmacists’ expertise but little is known about pharmacists’ attendant ethical concerns. Semi-structured qualitative interviews were undertaken with 23 UK pharmacists to explore their views and ethical concerns about EHC.
Results Dispensing EHC was ethically acceptable for almost all pharmacists but beliefs about selling EHC revealed three categories: pharmacists who sold EHC, respected women’s autonomy and peers’ conscientious objection but feared the consequences of limited EHC availability; contingently selling pharmacists who believed doctors should be first choice for EHC supply but who occasionally supplied and were influenced by women’s ages, affluence and genuineness; non-selling pharmacists who believed EHC was abortion and who found selling EHC distressing and ethically problematic. Terminological/factual misunderstandings about EHC were common and discussing ethical issues was difficult for most pharmacists. Religion informed non-selling pharmacists’ ethical decisions but other pharmacists prioritised professional responsibilities over their religion.
Discussion and conclusions Pharmacists’ ethical views on EHC and the influence of religion varied and, together with some pharmacists’ reliance upon non-clinical factors, led to a potentially variable supply, which may threaten the prompt availability of EHC. Misunderstandings about EHC perpetuated lay beliefs and potentially threatened correct advice. The influence of subordination and non-selling pharmacists’ dispensing EHC may also lead to variable supply and confusion amongst women. Training is needed to address both factual/terminological misunderstandings about EHC and to develop pharmacists’ ethical understanding and responsibility.
Extract Physicians who fail to act in their patient’s interests breach the fundamental duty of care of a physician. It is negligent to deny a person who would benefit a blood transfusion, a vaccination, an abortion, intensive care or sedation at the end of their life. Physicians should not play God. If they morally disagree with some medical treatment, they can give their reasons to their patients and they can take that debate to the level of law and professional bodies. But in a liberal society they should not inflict their judgments on their patients. Physicians can disagree, but they should not dictate.
