Rebecca J Cook Archives - Protection of Conscience Project Library

Conscientious commitment to women’s health

Bernard M Dickens, Rebecca J Cook

International Journal of Gynecology & Obstetrics

Abstract
Conscientious commitment, the reverse of conscientious objection, inspires healthcare providers to overcome barriers to delivery of reproductive services to protect and advance women’s health. History shows social reformers experiencing religious condemnation and imprisonment for promoting means of birth control, until access became popularly accepted. Voluntary sterilization generally followed this pattern to acceptance, but overcoming resistance to voluntary abortion calls for courage and remains challenging. The challenge is aggravated by religious doctrines that view treatment of ectopic pregnancy, spontaneous abortion, and emergency contraception not by reference to women’s healthcare needs, but through the lens of abortion. However, modern legal systems increasingly reject this myopic approach. Providers’ conscientious commitment is to deliver treatments directed to women’s healthcare needs, giving priority to patient care over adherence to conservative religious doctrines or religious self-interest. The development of in vitro fertilization to address childlessness further illustrates the inspiration of conscientious commitment over conservative objections.

Dickens BM, Cook RJ. Conscientious commitment to women’s health. Int J Gyn Ob. 2011;113(2):163-166.

From reproductive choice to reproductive justice

Rebecca J Cook, Bernard M Dickens

Abstract
Since the 1994 Cairo Conference on Population and Development, the human rights movement has embraced the concept of reproductive rights. These are often pursued, however, by means to which objection is taken. Some conservative political and religious forces continue to resist implementation of several means of protecting and advancing reproductive rights. Individuals’ rights to grant and to deny consent to medical procedures affecting their reproductive health and confidentiality have been progressively advanced. However, access to contraceptive services, while not necessarily opposed, is unjustifiably obstructed in some settings. Rights to lawful abortion have been considerably liberalized by legislative and judicial decisions, although resistance remains. Courts are increasingly requiring that lawful services be accommodated under transparent conditions of access and of legal protection. The conflict between rights of resort to lawful reproductive health services and to conscientious objection to participation is resolved by legal duties to refer patients to non-objecting providers.

Cook RJ, Dickens BM. From reproductive choice to reproductive justice. Int J Gyn Ob. 2009 Aug;106(2):106-109.

Healthcare responsibilities and conscientious objection

Rebecca J. Cook, Monica Arango Olaya, Bernard M. Dickens

Abstract
The Constitutional Court of Colombia has issued a decision of international significance clarifying legal duties of providers,hospitals, and healthcare systems when conscientious objection is made to conducting lawful abortion. The decision establishes objecting providers’duties to refer patients to non-objecting providers, and that hospitals,clinics, and other institutions have no rights of conscientious objection. Their professional and legal duties are to ensure that patients receive timely services. Hospitals and other administrators cannot object, because they do not participate in the procedures they are obliged to arrange. Objecting providers, and hospitals, must maintain knowledge of non-objecting providers to whom their patients must be referred. Accordingly, medical schools must adequately train, and licensing authorities approve, non-objecting providers. Where they are unavailable, midwives and perhaps nurse practitioners may be trained, equipped, and approved for appropriate service delivery. The Court’s decision has widespread implications for how healthcare systems must accommodate conscientious objection and patients’ legal rights.

Cook RJ, Olaya MA, Dickens BM. Healthcare responsibilities and conscientious objection. Int J Gynaecol Obstet. 2009 Mar;104(3):249-52. Epub 2008 Nov 29.

Transparency in the delivery of lawful abortion services

Rebecca J Cook

Canadian Medical Association Journal, CMAJ — Canadian Medical Association Journal

Abstract
• Laws limiting access to abortion services do not reduce the number of abortions, only their safety.

• Governments of countries are obligated to collect official statistics on the number of abortions and their health effects.

• Where statistics show deficiencies in the delivery of abortion services, governments are obligated to remedy the problem.

• Governments are obligated to ensure that women, irrespective of age or other socio-demographic factors, have transparent access to abortion counselling and services where they are legal.

Cook RJ. Transparency in the delivery of lawful abortion services. Can Med Assoc J. 2009 Feb 03;180(3):272-273.

Healthcare responsibilities and conscientious objection

Rebecca J Cook, Mónica Arango Olaya, Bernard M Dickens

Abstract
The Constitutional Court of Colombia has issued a decision of international significance clarifying legal duties of providers, hospitals, and healthcare systems when conscientious objection is made to conducting lawful abortion. The decision establishes objecting providers’ duties to refer patients to non-objecting providers, and that hospitals, clinics, and other institutions have no rights of conscientious objection. Their professional and legal duties are to ensure that patients receive timely services. Hospitals and other administrators cannot object, because they do not participate in the procedures they are obliged to arrange. Objecting providers, and hospitals, must maintain knowledge of non-objecting providers to whom their patients must be referred. Accordingly, medical schools must adequately train, and licensing authorities approve, non-objecting providers. Where they are unavailable, midwives and perhaps nurse practitioners may be trained, equipped, and approved for appropriate service delivery. The Court’s decision has widespread implications for how healthcare systems must accommodate conscientious objection and patients’ legal rights.

Cook RJ, Olaya MA, Dickens BM. Healthcare responsibilities and conscientious objection. Int J Gyn Ob. 2009 Nov 29;104(3):249-252.

Achieving Transparency In Implementing Abortion Laws

Rebecca J Cook, JN Erdman, Bernard M Dickens

Abstract
National and international courts and tribunals are increasingly ruling that although states may aim to deter unlawful abortion by criminal penalties, they bear a parallel duty to inform physicians and patients of when abortion is lawful. The fear is that women are unjustly denied safe medical procedures to which they are legally entitled, because without such information physicians are deterred from involvement. With particular attention to the European Court of Human Rights, the UN Human Rights Committee, the Constitutional Court of Colombia, the Northern Ireland Court of Appeal, and the US Supreme Court, decisions are explained that show the responsibility of states to make rights to legal abortion transparent. Litigants are persuading judges to apply rights to reproductive health and human rights to require states’ explanations of when abortion is lawful, and governments are increasingly inspired to publicize regulations or guidelines on when abortion will attract neither police nor prosecutors’ scrutiny.

Cook RJ, Erdman J, Dickens BM. Achieving Transparency In Implementing Abortion Laws. Int J Gyn Ob. 2007 Nov;99(2):157-161.

Achieving transparency in implementing abortion laws

Rebecca J. Cook, Joanna N. Erdman, Bernard M. Dickens

Cook RJ Erdman JN, Dickens BM. Achieving transparency in implementing abortion laws. Int J Gynaecol Obstet. (2007) 99, 157-161

The Growing Abuse of Conscientious Objection

Rebecca J Cook, Bernard M Dickens

American Medical Association Journal of Ethics

Extract
Religious initiatives to propose, legislate, and enforce laws that protect denial of care or assistance to patients, (almost invariably women in need), and bar their right of access to lawful health services, are abuses of conscientious objection clauses that aggravate public divisiveness and bring unjustified criticism toward more mainstream religious beliefs. Physicians who abuse the right to conscientious objection and fail to refer patients to nonobjecting colleagues are not fulfilling their profession’s covenant with society.

Cook RJ, Dickens BM. The Growing Abuse of Conscientious Objection. Am Med Ass J Ethics. 2006 May;8(5):337-340.

(Correspondence) Access to Emergency Contraception – In Response

Rebecca J Cook, Bernard M Dickens

Journal of Obstetrics and Gynaecology Canada

Extract
The CMA Code of Ethics begins with the principle that an ethical physician will consider first the well-being of the patient. Physicians who feel entitled to subordinate their patients’ desire for well-being to the service of their own personal morality or conscience should not practise clinical medicine.

Cook RJ, Dickens BM. (Correspondence) Access to Emergency Contraception – In Response. J. Obstet Gynaecol Can. 2004 Feb;112.

Access to emergency contraception

Rebecca J Cook, Bernard M Dickens

Abstract
The merits of non-prescription distribution of levonorgestrel as emergency contraception (EC), which is effective within 72 hours of unprotected intercourse, are contentious. The advantage of promptness and convenience of access may be offset by the absence of medical counselling. Opposition to EC based on the possibility of the drug acting after fertilization but before implantation departs from standard medical criteria of pregnancy. Physicians who propose to apply non-medical criteria, and use religious objections to abortion to deny prescription of EC, must publicize their opposition in advance, so that women may seek assistance elsewhere. When objecting practitioners, or facilities, become responsible for women for whom EC is indicated, such as rape victims, they are bound ethically and legally to refer them to reasonably accessible non-objecting sources of care.

Cook RJ, Dickens BM. Access to emergency contraception. J Ob Gyn Canada. 2003 Nov;25(11):914-916.