Contraception Archives - Page 2 of 10 - Protection of Conscience Project Library

Conscientious Objection in Healthcare Provision: A New Dimension

Peter West-Oram, Alena Buyx

Abstract
The right to conscientious objection in the provision of healthcare is the subject of a lengthy, heated and controversial debate. Recently, a new dimension was added to this debate by the US Supreme Court’s decision in Burwell vs. Hobby Lobby et al. which effectively granted rights to freedom of conscience to private, for-profit corporations. In light of this paradigm shift, we examine one of the most contentious points within this debate, the impact of granting conscience exemptions to healthcare providers on the ability of women to enjoy their rights to reproductive autonomy. We argue that the exemptions demanded by objecting healthcare providers cannot be justified on the liberal, pluralist grounds on which they are based, and impose unjustifiable costs on both individual persons, and society as a whole. In doing so, we draw attention to a worrying trend in healthcare policy in Europe and the United States to undermine women’s rights to reproductive autonomy by prioritizing the rights of ideologically motivated service providers to an unjustifiably broad form of freedom of conscience.

West-Oram P, Buyx A. Conscientious Objection in Healthcare Provision: A New Dimension. Bioethics. 2016 Jun;30(5):336-343.

From women’s ‘irresponsibility’ to foetal ‘patienthood’: Obstetricians-gynaecologists’ perspectives on abortion and its stigmatisation in Italy and Cataluña

Silvia De Zordo

Abstract
This article explores obstetricians-gynaecologists’ experiences and attitudes towards abortion, based on two mixed-methods studies respectively undertaken in Italy in 2011–2012, and in Spain (Cataluña) in 2013–2015. Short questionnaires and in-depth interviews were conducted with 54 obstetricians-gynaecologists at 4 hospitals providing abortion care in Rome and Milan, and with 23 obstetricians-gynaecologists at 2 hospitals and one clinic providing abortion care in Barcelona. A medical/moral classification of abortions, from those considered ‘more acceptable’, both medically and morally – for severe foetal malformations – to the ‘least acceptable’ ones – repeated ‘voluntary abortions’, emerged in the discourse of most obstetricians-gynaecologists working in public hospitals, regardless of their religiosity. I argue that this is the result of the increasing medicalisation of contraception as well as of reproduction, which has reinforced the stigmatisation of ‘voluntary abortion’ (in case of unintended pregnancy) in a context of declining fertility rates. This contributes to explain why obstetricians-gynaecologists working in Catalan hospitals, which provide terminations only for medical reasons, unlike Italian hospitals, do not experience abortion stigma and do not object to abortion care as much as their Italian colleagues do.

Zordo SD. From women’s ‘irresponsibility’ to foetal ‘patienthood’: Obstetricians-gynaecologists’ perspectives on abortion and its stigmatisation in Italy and Cataluña. Glob Public Health. 2018 May 27;13(6).

“Conscientious Objection” in Reproductive Healthcare is Immoral and Should Be Abolished

Joyce H Arthur

Extract
The majority of so-called “conscientious objection” is exercised today in reproductive healthcare and is not really about protecting the right to conscience. It’s about a person in a privileged position of authority (there by choice) imposing their personal beliefs on a vulnerable other in a dependent position (not there by choice).

Arthur JH. “Conscientious Objection” in Reproductive Healthcare is Immoral and Should Be Abolished. Joyce Arthur Blog. 2015.

Conscience and Complicity: Assessing Pleas for Religious Exemptions in Hobby Lobby’s Wake

Amy J Sepinwall

Abstract
In the paradigmatic case of conscientious objection, the objector claims that his religion forbids him from actively participating in a wrong (for example, by fighting in a war). In the religious challenges to the Affordable Care Act’s employer mandate, on the other hand, employers claim that their religious convictions forbid them from merely subsidizing insurance through which their employees might commit a wrong (for example, by using contraception). The understanding of complicity underpinning these challenges is vastly more expansive than the standard that legal doctrine or moral theory contemplates. Courts routinely reject claims of conscientious objection to taxes that fund military initiatives or to university fees that support abortion services. In Hobby Lobby, however, the Supreme Court took the corporate owners at their word: the mere fact that Hobby Lobby believed that it would be complicit, no matter how idiosyncratic its belief, sufficed to qualify it for an exemption. In this way, the Court made elements of an employee’s health-care package the “boss’s business” (to borrow from the nickname of the Democrats’ proposed bill to overturn Hobby Lobby).

Much of the critical reaction to Hobby Lobby focuses on the issue of corporate rights of religious freedom. Yet this issue is a red herring. The deeper concerns that Hobby Lobby raises—about whether employers may now refuse, on religious grounds, to subsidize other forms of health coverage (for example, blood transfusions or vaccinations) or to serve customers whose lifestyles they deplore (for example, gays and lesbians)—do not turn on the organizational form that the employer has adopted. Instead, the more significant issue goes to our understanding of complicity: When is it reasonable for an employer (for-profit or nonprofit, corporate or individual) to think itself complicit in the conduct of its employees or customers? And when is a reasonable claim of complicity compelling enough to warrant an accommodation, especially when that accommodation would impose costs on third parties?

Sepinwall AJ. Conscience and Complicity: Assessing Pleas for Religious Exemptions in Hobby Lobby’s Wake. U Chicago Law Rev. 2015 Fall; 82:1897-1980.

Contraceptive Comstockery: Reasoning from Immorality to Illness in the Twenty-First Century

Priscilla J Smith

Abstract
This Article examines the use by anti-contraception advocates of the claims that “contraception harms women” and “contraception is abortion,” claims made most prominently in litigation challenging Obamacare’s contraceptive coverage requirement. See Burwell v. Hobby Lobby, 134 S. Ct. 2751 (2014). The Article uncovers the nineteenth-century roots of these arguments and the strategic reasoning behind their current revival, to reveal that these claims are part of a broad attack on contraception grounded in opposition to non-procreative sex. In Part II, the Article reviews nineteenth-century reasoning about contraceptives, and then in Part III, discusses the modern revival of this Comstock era mode of reasoning about contraception which connected immorality and illness. Today, however, considerable social acceptance of sex for pleasure (at least for some people in some circumstances) means that straightforward arguments against contraception based on its immorality do not resonate as successfully as they once did. Social conservatives have publicly acknowledged as much, expressing an anxiety about the position of religion as “belief” rather than “truth,” and about a rise in what they call “sexualityism.” As a result, modern opponents of contraception have intentionally attempted to mask outmoded and unpopular moral opposition to non-procreative sex by using scientific discourse, citing the best science “we can currently lay our hands on,” for support. The problem for anti-contraception advocates, as revealed in Parts IV and V, is that the appeal to science is a purely rhetorical move, and their claims are contradicted by the latest scientific evidence. The Article establishes the safety and benefits of hormonal contraceptives to women’s and children’s health. The Article also shows that the claim that five hormonal contraceptives are abortifacients is false. Four out of five do not interfere with implantation of a fertilized egg and so cannot be said to terminate a “pregnancy,” even as redefined by opponents as occurring upon fertilization. Opposition to these hormonal contraceptives is thus not truly based on the view that destruction of a fertilized egg is immoral and should be considered an abortion. Rather, the opposition goes much deeper, stemming from a general objection to all forms of contraception and the ability of women to have sex without accepting the possibility of pregnancy and motherhood. The Article concludes in Part VI with evidence of the benefits of increased access to the most effective forms of contraception. Anti-contraception advocates are deploying woman-protective health arguments to limit access to contraception using a strategy similar to that adopted to oppose abortion. Anti-contraception advocates have melded these arguments to contemporary anxieties about heterosexual women’s ability to survive on equal footing with men in today’s sexual and marital “marketplace” in order to stymie efforts to expand contraceptive access and to further restrict access where possible.

Smith PJ. Contraceptive Comstockery: Reasoning from Immorality to Illness in the Twenty-First Century. Conn Law Rev. 2015 May;47(4).

Striking a Balance: Conscientious Objection and Reproductive Health Care from the Colombian Perspective

Luisa Cabal, Monica Arango Olaya, Valentina Montoya Robledo

Abstract
Conscientious Objection or conscientious refusal (CO) in access to reproductive health care is at the center of current legal debates worldwide. In countries such as the US and the UK, constitutional dilemmas surrounding CO in the context of reproductive health services reveal inadequate policy frameworks for balancing CO rights with women’s rights to access contraception and abortion. The Colombian Constitutional Court’s holistic jurisprudence regarding CO standards has applied international human rights norms so as to not only protect women’s reproductive rights as fundamental rights, but to also introduce clear limits for the exercise of CO in health care settings. This paper reviews Latin American lines of regulation in Argentina, Uruguay, and Mexico City to argue that the Colombian Court’s jurisprudence offers a strong guidance for future comprehensive policy approaches that aim to effectively balance tensions between CO and women’s reproductive rights..

Cabal L, Olaya MA, Robledo VM. Striking a Balance: Conscientious Objection and Reproductive Health Care from the Colombian Perspective. Health Human Rights J. 2014;16(2):73-83.

(News) Controversy over doctors’ right to say “no”: The most controversial issues relate to abortion referrals or prescribing birth control

Wendy Glauser

Canadian Medical Association Journal, CMAJ — Canadian Medical Association Journal

Extract
Religious groups, doctor’s organizations, ethicists and abortion rights advocates are raising concerns around the review of an Ontario policy that outlines, among other things, physicians’ right to object to patients’ requests for services on moral grounds.

The College of Physicians and Surgeons of Ontario’s Physicians and Ontario Human Rights Code is up for its five-year review, with both public and expert opinion being sought. . .

Glauser W. Controversy over doctors’ right to say “no”: The most controversial issues relate to abortion referrals or prescribing birth control. CMAJ September 16, 2014 186:E483-E484; published ahead of print August 18, 2014

When Religious Freedom Clashes with Access to Care

I. Glenn Cohen, Holly Fernandez Lynch, Gregory D. Curfman

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

Extract
At the tail end of this year’s Supreme Court term, religious freedom came into sharp conflict with the government’s interest in providing affordable access to health care. In a consolidated opinion in Burwell v. Hobby Lobby Stores and Conestoga Wood Specialties Corp. v. Burwell (collectively known as Hobby Lobby) delivered on June 30, the Court sided with religious freedom, highlighting the limitations of our employment-based health insurance system.

Hobby Lobby centered on the contraceptives-coverage mandate, which derived from the Affordable Care Act (ACA) mandate that many employers offer insurance coverage of certain “essential” health benefits, including coverage of “preventive” services without patient copayments or deductibles.

Cohen IG, Lynch HF, Curfman GD. When Religious Freedom Clashes with Access to Care. N Engl J Med 2014; 371:596-599 August 14, 2014 DOI: 10.1056/NEJMp1407965

Reproductive Justice Begins with Contraceptive Access in the Philippines

Elisabeth S Smith

Abstract
Reproductive justice will exist in the Philippines when the lowest-income Filipino women have access to contraception. As long as women express a desire to use modern contraception but cannot access it, the Philippine government has not met its obligations. As the right to health is self-executing, Filipinos do not depend on the interest or goodwill of their government, but rather have enforceable claims to health care, including contraception. The government of Philippines should adhere to the Constitution, national laws, and ratified international agreements and fulfill the RH Act’s objectives to advance reproductive justice for all Filipinos.

Smith ES. Reproductive Justice Begins with Contraceptive Access in the Philippines. Pacific Rim Law Pol J. 2014;23(1):203-249.

Legal and ethical standards for protecting women’s human rights and the practice of conscientious objection in reproductive healthcare settings

Christina Zampas

International Journal of Gynecology & Obstetrics

Abstract
The practice of conscientious objection by healthcare workers is growing across the globe. It is most common in reproductive healthcare settings because of the religious or moral values placed on beliefs as to when life begins. It is often invoked in the context of abortion and contraceptive services, including the provision of information related to such services. Few states adequately regulate the practice, leading to denial of access to lawful reproductive healthcare services and violations of fundamental human rights. International ethical, health, and human rights standards have recently attempted to address these challenges by harmonizing the practice of conscientious objection with women’s right to sexual and reproductive health services. FIGO ethical standards have had an important role in influencing human rights development in this area. They consider regulation of the unfettered use of conscientious objection essential to the realization of sexual and reproductive rights. Under international human rights law, states have a positive obligation to act in this regard. While ethical and human rights standards regarding this issue are growing, they do not yet exhaustively cover all the situations in which women’s health and human rights are in jeopardy because of the practice. The present article sets forth existing ethical and human rights standards on the issue and illustrates the need for further development and clarity on balancing these rights and interests.

Zampas C. Legal and ethical standards for protecting women’s human rights and the practice of conscientious objection in reproductive healthcare settings. Int J Gyn Ob. 2013 Dec 10;123:S63-S65.