0 - 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.

The Physician as a Conscientious Objector

J David Bleich

Extract
Patient autonomy certainly deserves both moral respect and legal protection, but to demand of a physician that she act in a manner she deems to be morally unpalatable not only compromises the physician’s ethical integrity, but is also likely to have a corrosive effect upon the dedication and zeal with which she ministers to patients.

Bleich JD. The Physician as a Conscientious Objector. Fordham Urban Law J. 2002;30(1): 245-265 .

The Fallacies of Objections to Selective Conscientious Objection

Amir Paz-Fuchs, Michael Sfard

Abstract
This paper critically analyzes the theoretical and pragmatic arguments raised against the refusal of individuals to serve in a specific military campaign that they view as immoral. The Israeli Supreme Court case of Zonshein v Judge-Advocate General will serve as an axis of the discussion, as it combines two related facets: first, the Court’s decision touches upon most of the difficult issues in the field of conscientious objection. And second, the development leading up to the decision was accompanied by an exceptional clash of academics, each side summoning expert opinions in support of its claim.

Courts worldwide have accepted that a categorical distinction exists between universal and selective conscientious objection. The combination of the Zonshein decision and the accompanying academic debate presents the opportunity to reexamine the theoretical and pragmatic reasons that are offered as support for distinguishing the two ‘types’ of conscientious objection. Close scrutiny finds them wanting.

Paz-Fuchs A, Sfard M. The Fallacies of Objections to Selective Conscientious Objection. Israel Law Review, Special Issue: Refusals to Serve – Political Dissent in the Israel Defense Forces. 2002 Fall; 36(3);111 – 143. DOI: https://doi.org/10.1017/S0021223700017994.

(Thesis) Samvete och samvetsfrihet: En analys av samvetskonflikter i det svenska samhället och av begreppen samvete och samvetsfrihet

(Conscience and freedom of conscience: An analysis of conflicts of conscience in Swedish society and of the concepts of conscience)

Mats Alden

Abstract
This thesis has several aims which are related in various ways. The first task is to study conflicts of conscience in Swedish society. In this type of conflict, the terms conscience and freedom of conscience are central terms. Thus it is vital that they are understood and related to when analyzing the conflicts themselves. The second task is therefore to study and come to grips with the term conscience, suggest a definition, and then apply the various ways of understanding conscience to the conflicts of conscience in order to answer the question of whether or not an individual should follow his or her conscience. The third task is to study the term freedom of conscience and provide a definition. In addition, a typology is provided and applied to the conflicts of conscience studied in order to answer the question of whether or not there is ample freedom to follow one’s conscience. Finally, I take a stand for one of the types in the typology. The first task is undertaken in Chapter 2, the second task comprises Chapter 3 and the third task, Chapter 4.

Alden M. (Thesis) Samvete och samvetsfrihet: En analys av samvetskonflikter i det svenska samhället och av begreppen samvete och samvetsfrihet (Conscience and freedom of conscience: An analysis of conflicts of conscience in Swedish society and of the concepts of conscience. Lund University, Sweden. 2002;5-215.

Christian churches and euthanasia in the Low Countries: background, argumentation and commentary

Jans Jans

Extract
In this article, I will first describe the argumentative way in which the major Christian churches in the Netherlands and Belgium have dealt with what they considered the challenge of the demand to legalize euthanasia in their respective countries. Given the important differences between the courses of events in both countries, the part on the interventions in the Netherlands will be considerably longer than the one on Belgium. No doubt, the most important reason for this difference is the fact that the public discussion on euthanasia together with efforts to change the penal law prohibiting it, took shape in the Netherlands already from 1968 on. Next to this, the fact that the major Christian churches in the Netherlands were not in agreement on the proper approach also contributes to a more differentiated picture. In the third part of this article, I will present some comments and a moral theological evaluation of the core of the argumentation forwarded by the Christian churches.

Jans Jans. Christian churches and euthanasia in the Low Countries: background, argumentation and commentary. Ethical Perspect 2002;9(2-3) 119-33.

The injustice of unsafe motherhood

Rebecca J Cook, Bernard M Dickens

Abstract
This paper presents an overview of the dimensions of unsafe motherhood, contrasting data from economically developed countries with some from developing countries. It addresses many common factors that shape unsafe motherhood, identifying medical, health system and societal causes, including women’s powerlessness over their reproductive lives in particular as a feature of their dependent status in general. Drawing on perceptions of Jonathan Mann, it focuses on public health dimensions of maternity risks, and equates the role of bioethics in conscientious medical care to that of human rights in public health care. The microethics of medical care translate into the macroethics of public health, but the transition compels some compromise of personal autonomy, a key feature of Western bioethics, in favour of societal analysis. Religiously-based morality is seen to have shaped laws that contribute to unsafe motherhood. Now reformed in former colonizing countries of Europe, many such laws remain in effect in countries that emerged from colonial domination. UN conferences have defined the concept of ‘reproductive health’ as one that supports women’s reproductive self-determination, but restrictive abortion laws and practices epitomize the unjust constraints to which many women remain subject, resulting in their unsafe motherhood. Pregnant women can be legally compelled to give the resources of their bodies to the support of others, while fathers are not legally compellable to provide, for instance, bone-marrow or blood donations for their children’s survival. Women’s unjust legal, political, economic and social powerlessness explains much unsafe motherhood and maternal mortality and morbidity.

Cook RJ, Dickens BM. The injustice of unsafe motherhood. Dev World Bioeth. 2002 May;2(1):64-81

Effect of mifepristone and levonorgestrel on expression of steroid receptors in the human Fallopian tube

A Christow, X Sun, K Gemzell-Danielsson

Abstract
It is likely that mifepristone or levonorgestrel in the future will find extended use for contraceptive purposes. It is therefore essential to characterize the modes of action of these compounds. To assess the effect on the human Fallopian tube, 24 women with regular menstrual cycles and proven fertility, admitted to the hospital for voluntary sterilization by laparoscopic technique, were randomly allocated to a control or one of two treatment groups. Treatments were given with either a single dose of 200 mg mifepristone or 0.75 mg levonorgestrel in two doses 12 h apart, on day LH2. Surgery was performed on day LH4 to LH6. Steroid receptor expression was analysed by immunohistochemistry, Western blot and RT-PCR. In the controls, there was a higher concentration of progesterone receptors in the stromal cells in the isthmic region than in those in the ampullar region. Treatment with mifepristone increased the progesterone receptor concentration in epithelial and stromal cells and increased the estrogen receptor concentration in epithelial cells. No effect on steroid receptor concentration was found following levonorgestrel. The contraceptive effect of post-ovulatory mifepristone has previously been considered to be dependent on an effect on the endometrium. However an effect on the Fallopian tube could contribute to alter the peri-implantation milieu influencing fertilization and embryo development.

Christow A, Sun X, Gemzell-Danielsson K. Effect of mifepristone and levonorgestrel on expression of steroid receptors in the human Fallopian tube. Mol Hum Reprod. 2002 April 01;8(4):333-340.

A Group Practice Disagrees About Offering Contraception

Frank A Chervenak, Laurence McCullough

Extract
This case concerns the justification of moral constraints that a physician group decides to apply to itself in the provision of patient services. Family physicians confront this issue with regard to reproductive medical services and state laws such as those in Oregon regarding physician-assisted suicide. Whether such constraints are ethically justified depends on the distinction between professional medical ethics and individual conscience.

Chervenak FA, McCullough L. A Group Practice Disagrees About Offering Contraception. Am Fam Physician. 2002 Mar 15;65(6):1230-1233.

Mandatory Overtime: Conflicts of Conscience

Jennell Charles

JONA's Healthcare Law, Ethics and Regulation — JONA’s Healthcare Law, Ethics and Regulation

Extract
This article attempts to engage only in a discussion of the ethical dimensions of mandatory overtime; the economic and empirical discussions are left for others to explore. Using the framework of “conscience,” we can begin to see some of the dynamics underlying the almost visceral reaction of some nurses to the issue of mandatory overtime.

Charles J. Mandatory Overtime: Conflicts of Conscience. JONA’s Healthcare Law, Ethics Reg. 2002;4(1):10-12.

Palliative Care and Euthanasia: Belgian and Dutch Perspectives

Bert Broeckaert, Rien Janssens

Extract
In the first part of this article the input of palliative care organisations in the Dutch euthanasia debate is described and explained by situating it in its broader context. First opinions on euthanasia of a variety of palliative care organisations are described. Secondly the Dutch debate on palliative care and euthanasia is analysed and evaluated. In a second part of this article a brief introduction to Belgian palliative care is given. This introduction is followed by an overview of the way organised palliative care has been active in the Belgian euthanasia debate. Attention too is given to the Belgian discussion on palliative sedation, sedation being presented by some as the palliative alternative to euthanasia but seen by others as nothing but euthanasia in disguise

Broeckaert B, Janssens R. Palliative Care and Euthanasia: Belgian and Dutch Perspectives. Ethical Perspectives 9(2-3); 2002 Feb 01, 156-175