Abstract Although for centuries conscientious objection was primarily claimed by those who for religious or ethical reasons refused to join the ranks of the military (whether out of a general principle or in response to a particular violent conflict), in recent decades a significant broadening of the concept can be seen. In Thailand, for example, doctors recently refused medical attention to injured policemen suspected of having violently repressed a demonstration. In Argentina a few public defenders have rejected for conscientious reasons to represent individuals accused of massive human rights violations. In different countries all over the world there are doctors who refuse to perform euthanasia, schoolteachers who reject to teach the theory of evolution, and students who refuse to attend biology classes where frogs are dissected.
Extract Conclusion The constitutional jurisprudence surrounding assisted conception is only beginning to take shape . . . . When conception occurs naturally, both positive and negative rights surrounding procreation are fairly clear, but grow murky as the reproductive process invites third parties to assist. As methods of assisted conception show increasing technological promise for those whose physical characteristics, social status, or both require they look to ART for family formation, worrisome trends suggest that third party actors are quietly mounting status-based barriers to fertility treatment. Barriers to ART are taking shape on the basis of patient characteristics including wealth, race, ethnicity, sexual orientation, and marital status, all under the guise of preventing harm to offspring and society at large. However, judgments by ART providers and public lawmakers that certain individuals will be unfit parents, veer dangerously close to the coercive eugenics practices of early twentieth century America, practices whose only positive legacy is the extreme caution with which we now approach state-sponsored limitations on reproduction.
Like a pentimento, ART barriers are only beginning to come into view from the experiences of an increasingly diverse and nontraditional reproductive medicine patient population. As each barrier emerges-whether it be a provider refusing treatment to a single or gay or lesbian prospective parent, or a lawmaker attempting to limit the availability of a reproductive technology for reasons unrelated to human health-it is essential to evaluate these actions by the same standards we would evaluate barriers to natural conception. . . . State-sponsored or state-approved limitations on any individual’s right to procreate simply cannot stand in a society that acknowledges the preeminence of reproductive freedom. Justice Douglas’ selfevident observation that reproduction is a basic human right is as durable and universal as the human race-it simply must be nurtured in order to continue to thrive.
American College of Obstetricians and Gynecologists
American College of Obstetricians & Gynecologists
Abstract Health care providers occasionally may find that providing indicated, even standard, care would present for them a personal moral problem-a conflict of conscience particularly in the field of reproductive medicine. Although respect for conscience is important, conscientious refusals should be limited if they constitute an imposition of religious or moral beliefs on patients, negatively affect a patient’s health, are based on scientific misinformation, or create or reinforce racial or socioeconomic inequalities. Conscientious refusals that conflict with patient well-being should be accommodated only if the primary duty to the patient can be fulfilled. All health care providers must provide accurate and unbiased information so that patients can make informed decisions. Where conscience implores physicians to deviate from standard practices, they must provide potential patients with accurate and prior notice of their personal moral commitments. Physicians and other health care providers have the duty to refer patients in a timely manner to other providers if they do not feel that they can in conscience provide the standard reproductive services that patients request. In resource-poor areas, access to safe and legal reproductive services should be maintained. Providers with moral or religious objections should either practice in proximity to individuals who do not share their views or ensure that referral processes are in place. In an emergency in which referral is not possible or might negatively have an impact on a patient’s physical or mental health, providers have an obligation to provide medically indicated and requested care.
Abstract Rather than putting the onus on women to have children at times that suit societal rather than women’s individual interests, we could provide technical alternatives to gestation and childbirth so that women are no longer unjustly obliged to be the sole risk takers in reproductive enterprises. In short, what is required is ectogenesis: the development of artificial wombs that can sustain fetuses to term without the need for women’s bodies. Only by thus remedying the natural or physical injustices involved in the unequal gender roles of reproduction can we alleviate the social injustices that arise from them.
Extract Conscience is a tricky business. Some interpret its personal beacon as the guide to universal truth and undoubtedly many of the health care providers who refuse to treat or refer or inform their patients do so in the sincere belief that it is in the patients’ own interests, regardless of how those patients might view the matter themselves. But the assumption that one’s own conscience is the conscience of the world is fraught with dangers. As C.S. Lewis wrote, “of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience.”
Abstract The pharmacist who wants her integrity and self-conception to be respected must accord respect to the woman whose views about sex, life processes, and parenthood differ from her own by courteously offering her own rationale and a referral.
Extract This symposium issue explores several continuing controversies at the intersection of Law, Ethics, Healthcare, Politics, Health Policy and Religion: abortion, contraception, the status of embryos, stem cell research, IVF, personal and professional autonomy, end- of-life decisions, and religiously based health care systems. The multiple values associated with each of these topics strain and threaten to usurp the effectiveness of our legal system to regulate them.
Extract We are entering an era where medicine is becoming more like engineering. The distinction between “treatment” and “enhancement” blurs as we are ever better at tinkering with the body. . .
Medical scientists will be able to modify and control an ever-expanding range of human bodily functions, from drugs that slow down aging to drugs that alter basic aspects of mood, anxiety, and cognition. Someday soon, the conflict between a physician’s idea of how people ought to live and how those people want to live will occur in fields far removed from reproductive technology. . .
Extract an egalitarian justice argument, he mentions only briefly as more promising than the former: refusing to provide reproductive assistance to homosexual parents while making it available to heterosexual parents constitutes unjust discrimination against the former. Appel does not develop this suggestion at all, but I want to say a word about an issue on which it hinges, namely, the moral standing that reproductive assistance has in a just health care system.
Best Practice and Research Clinical Obstetrics & Gynaecology
Abstract Women’s sexual and reproductive rights are an integral part of daily practice for obstetricians/gynaecologists and the key to the survival and health of women around the world. Women’s sexual and reproductive health is often compromised because of infringements of their basic human rights, not the lack of medical knowledge. Understanding the relevance of respecting and promoting sexual and reproductive rights is critical for providing current standards of care, and includes access to information and care, confidentiality, informed consent and evidence-based practice. The violation of women’s rights in their daily lives through common problems such as gender-based violence and discrimination results in serious consequences for their health. Obstetricians/gynaecologists are natural advocates for women’s health, yet may be lacking in their understanding of relevant laws or the limits of conscientious objection. This chapter outlines the framework for sexual and reproductive rights, and explores its relevance to the practising clinician.
