Referral Archives - Page 8 of 8 - Protection of Conscience Project Library

The Limits of Conscientious Objection to Abortion in the Developing World

Louis-Jacques Van Bogaert

Abstract
The South African Choice on Termination of Pregnancy Act 92 of 1996 gives women the right to voluntary abortion on request. The reality factor, however, is that five years later there are still more ‘technically illegal’ abortions than legal ones. Amongst other factors, one of the main obstacles to access to this constitutionally enshrined human right is the right to conscientious objection/refusal. Although the right to conscientious objection is also a basic human right, the case of refusal to provide abortion services on conscientious objection grounds should not be seen as absolute and inalienable, at least in the developing world. In the developed world, where referral to another service provider is for the most part accessible, a conscientious objector to abortion does not really put the abortion seeker’s life at risk. The same cannot be said in developing countries even when abortion is decriminalised. This is because referral procedures are fraught with major obstacles. Therefore, it is argued that the right to conscientious objection to abortion should be limited by the circumstances in which the request for abortion arises.

Bogaert L-JV. The Limits of Conscientious Objection to Abortion in the Developing World. Dev World Bioeth. 2002;2(2):131-143.

Doing what the Patient Orders: Maintaining Integrity in the Doctor-Patient Relationship

Jeffrey Blustein

Extract
Conclusion
Physicians’ appeals to conscience, understood as fear of loss of integrity, should not be taken lightly. Integrity provides the basis for a unified, whole, and unalienated life, and its moral value, while dependent on the presence of other good traits in the agent, is not reducible to them. . . a physician can consistently be concerned about his or her own integrity without claiming to know better than the patient what is in the patient’s best interests. . . . The conception of integrity I have proposed . . . allows for the possibility of integrity-preserving compromise. . . . I have also considered the common practice of patient referral from the standpoint of physician integrity, and asked whether a physician who refuses to treat a patient as a matter of conscience can consistently refer the patient to another physician for the same treatment. . . in a dispute between physicians and their patients, there may be other values and principles at stake than the ones expressed in their conflicting positions, and a physician might well decide that referral in such a case is an appropriate response to a morally complex situation.

Blustein J. Doing what the Patient Orders: Maintaining Integrity in the Doctor-Patient Relationship. Bioethics. 1993;7(4):289-314.

(Correspondence) Readers Advocate Pro-conscience, Not Pro-Choice (Invited response)

Susan Wysocki

Extract
A nurse practitioner’s personal position on this issue is irrelevant in tem1s of the provision of patient care. Our responsibility as nurse practitioners is to provide our patients with information that helps them to make their own decisions based on the constructs of their own beliefs and needs. This does not mean that nurse practitioners who find a patient’s reproductive-health decisions to be in conflict with their own morals and beliefs should be forced to counsel on those choices. Instead, they have a responsibility to ensure that the patient has her needs met with another provider.

Wysocki S. (Correspondence) Readers Advocate Pro-conscience, Not Pro-Choice (Invited response). Nurse Pract. 1992 Oct;17(10):8-9

(Correspondence) The Code of ethcs: abortion referral

Paul Cameron, May Cohen, Linda Rapson, Wendell W Watters (Doctors for the Repeal of the Abortion Law)

Canadian Medical Association Journal, CMAJ — Canadian Medical Association Journal

Extract
Mr. Geekie explains that the ethics committee changed the code to prevent patients from being “abandoned – a result that was not in keeping with the tenets of the profession.” . . . If the profession follows Mr. Geekie’s guidelines the new code will result in a lower level of care for Canadian women faced with unwanted pregnancies. Antiabortion physicians now have an ethical green light to send such women on an endless round of pointless, time-consuming referrals until it may be too late to interrupt the pregnancy. . . .If ambiguity exists in the present code of ethics it should be eliminated, if necessary by return to the old code, which allowed women to find their own way to help without this form of “assistance”.

Cameron P, Cohen M, Rapson L, Watters WW. (Correspondence) The Code of ethcs: abortion referral. Can Med Assoc J. 1978 Apr 22;118(8):890, 895.

(Correspondence) The Code of ethics: abortion referral

John B Shea

Extract
The CMA has the audacity to “place responsibility” on the physician who acts in accordance with his intelligence and informed conscientious judgement in the matter. It is not true to state that a physician abandons a patient if he informs her that his moral principles preclude his becoming involved in referring her for an abortion. No patient has the right to anything other than what a physician can in his conscience do. To ask for more is to ask for his cooperation in performing an act that he deems an act of killing an innocent human being. The CMA, in supporting this type of request, is bringing pressure to bear on the physician to cooperate. By including it in the code of ethics the CMA has also put the physician who does not publicly object in the position of appearing to agree with the CMA. His intellectual and moral integrity are challenged by this action. . . .If the government were to make abortion on demand legal, I have no doubt the CMA would make another change in the code that would “place responsibility” on the physician to cooperate in this also. I find it intolerable that the CMA is telling me I may not follow my conscience in this most serious matter.

Shea JB. (Correspondence) The Code of ethics: abortion referral. Can Med Assoc J. 1978 Apr 22;118(8):890.

(Correspondence) The Code of ethics: abortion referral

RG Wilson(CMA Secretary General)

Extract
.. . . the wording in the pertinent paragraph of the code of ethics represents an amendment to the recommendation of the committee on ethics, moved from the floor of General Council and subsequently passed. In discussing this paragraph the mover of the motion stated that the medical profession must stand by its ethics and, in so doing, has a responsibility to patients, who should not be abandoned in any regard. He went on to state that the medical profession is based on compassion and help and that every physician has a responsibility to a patient, even when he does not agree with a particular form of therapy. . . In suggesting changes in the code of ethics the CMA’s committee on ethics attempted to underline the right of the patient to have other opinions, and the responsibility of the physician to indicate to the patient that she has that right. General Council, in its wisdom, strengthened the recommendation and indicated that, in its view, the physician has a broader responsibility not to abandon the patient or impede her from obtaining help from other sources of assistance.

Wilson RG. (Correspondence) The Code of ethics: abortion referral. Can Med Assoc J. 1978 Apr 22;118(8):895-896.

(Correspondence) The Code of ethics: abortion referral

CA Johnson

Extract
Mr. Geekie’s interpretation of this section is most disturbing in that some of the phrases he uses suggest a derogatory attitude to physicians engaged in abortion referral. . . . It seems to me clearly unethical for a physician with moral conflicts of interest to refer a patient who consults him about an abortion to a clergyman. . . .It seems that what appeared to be a step forward in ensuring that patients receive unbiased professional judgement in each individual case has become just the opposite.

Johnson CA. (Correspondence) The Code of ethics: abortion referral. Can Med Assoc J. 1978 Apr 22;118(8):888, 890.

(Correspondence) The Code of ethics: abortion referral

MA Baltzan

Extract
The code means that a physician who has a conflict of interest between duty to a patient and personal belief shall refer the patient to someone who is not burdened by this conflict of interest, but the code states that a physician who has a conflict of interest between duty to a patient and personal belief shall refer the patient to someone who will provide the treatment the patient desires.

Baltzan MA. (Correspondence) The Code of ethics: abortion referral. Can Med Assoc J. 1978;118(8):895.