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15 May 2014

The conscientious objection debate

Writing on RH Reality Check, Joyce Arthur and Christian Fiala make an impassioned case for 'Why We Need to Ban "Conscientious Objection" in Reproductive Health Care.'

Their article begins:

‘Do health-care professionals have the right to refuse to provide abortions or contraception based on their “conscientious objection” to these services? Many pro-choice activists would retort, “No way! If you can’t do your job, quit and find another career!” We agree with them, and have detailed why in our new paper, ”‘Dishonourable Disobedience’: Why Refusal to Treat In Reproductive Healthcare Is Not Conscientious Objection.”

‘Reproductive health care is the only field in medicine where freedom of conscience is accepted as an argument to limit a patient‘s right to a legal medical treatment. It is the only example where the otherwise accepted standard of evidence-based medicine is overruled by faith-based actions. We argue in our paper that the exercise of conscientious objection (CO) is a violation of medical ethics because it allows health-care professionals to abuse their position of trust and authority by imposing their personal beliefs on patients. Physicians have a monopoly on the practice of medicine, with patients completely reliant on them for essential health care. Moreover, doctors have chosen a profession that fulfills a public trust, making them duty-bound to provide care without discrimination. This makes CO an arrogant paternalism, with doctors exerting power over their dependent patients—a throwback to the obsolete era of “doctor knows best”...’

The debate about the use (and abuse) of CO in reproductive healthcare is a long-running one. Arthur and Fiala argue that ‘Unfortunately, a global consensus seems to have emerged among (pro-choice) medical professionals that clinicians do indeed have a right to deny reproductive health care that they personally disagree with,’ and cite as a recent example a special supplement called “Conscientious Objection to the Provision of Reproductive Healthcare,” published by the International Journal of Gynecology and Obstetrics (IJGO) in December.

Arthur and Fiala argue, in contrast to this consensus, that attempts to evoke CO can result in a systematic denial of care to patients, and in many cases is not a genuine conscience-based objection:

‘As our article documents, the obligation to refer is systematically ignored or abused. Many, if not most, anti-choice doctors cannot be trusted to refer because they feel this still makes them “complicit.” Also, their idea of “accurate” information on abortion or contraception may bear little relation to the actual evidence and too often strays into ideology and moral judgment. In terms of emergency care, some anti-choice doctors will let women die rather than do an abortion, regardless of the law or any CO requirements, as has occurred in Poland, Ireland, and elsewhere. Since doctors will express different opinions about a particular woman’s risk of death anyway, it’s easy for doctors to refuse treatment and deny culpability if something goes wrong.

‘Expecting doctors to make the required compromises in their exercise of CO rests on the misconception that they will be rational. But we can’t trust people to set aside deeply held beliefs that have already been deemed strong enough to invoke CO. As soon as we allow any degree of CO, we’ve made medical care contingent on the provider’s personal or religious beliefs, instead of the patient’s right to health care. Further expansions of CO cannot even be opposed with evidence-based arguments since we’ve already ceded the ground to religious doctrine.’

Jennie Bristow, editor of Reproductive Review, comments:

It is true that campaigns against abortion have often appropriated the language of ‘conscience’ to push across a more political agenda. However, there are good reasons why prochoice advocates have supported the ability of medical professionals to opt out of performing a procedure that goes against their conscience. The idea of forcing a doctor to perform an abortion when he or she thinks that this is murder sits very uncomfortably with the principles at the heart of a liberal society. So too, of course, does the idea of forcing a women to continue with a pregnancy that she does not want.

In this regard, choice goes both ways; no woman or doctor should be forced to have or perform an abortion, but women and doctors should be free to choose for themselves whether to have or perform an abortion. That is ultimately why having laws that ban or restrict abortion are such a problem.

If there were fewer legal restrictions on abortion, conscientious objection would not be an issue. Doctors and nurses motivated to provide abortions would be more free to do so, and women would be able to access abortion care from the people who they know will be sympathetic to their situation.

Compelling doctors to perform abortions against their wishes would, conversely, lead to unpleasant care for women and set a worrying precedent about how much the law can dictate the beliefs and practice of those working in reproductive healthcare. This includes those doctors and nurses who are motivated by their consciences to perform abortions, and care for the women who need them.

The problem of abortion is one of too much legal regulation and restriction already. It is hard to see how laws designed to compel professionals to act against their conscience can be of benefit to anybody.

Read the full article by Joyce Arthur and Christian Fiala here:

Why We Need to Ban ‘Conscientious Objection’ in Reproductive Health Care. By Joyce Arthur, Abortion Rights Coalition of Canada and Christian Fiala, Gynmed Clinic for Abortion and Family Planning. RH Reality Check, 14 May 2014

Also read:

Competing Rights: Exploring the boundaries of ‘conscientious objection’. Wendy Chavkin, of Global Doctors for Choice, discusses the ‘thorny issues’ of conscience, integrity, and autonomy in this debate. Reproductive Review, 29 May 2014

The CO debate: ‘Conscientious Objection’ is still dishonourable disobedience. An article by Joyce Arthur and Christian Fiala arguing ‘Why We Need to Ban “Conscientious Objection” in Reproductive Health Care’ provoked much response. Here, Arthur and Fiala respond to their critics. Reproductive Review, 14 July 2014