Conscientious commitment

Conscientious commitment is the provision of necessary or beneficial health care to patients in need despite stigma, unjust laws, or oppressive systems. While the exercise of “conscientious objection” denies care that the patient has requested, conscientious commitment provides it. In other words, conscientious commitment upholds medical ethics and the rights of patients, while “conscientious objection” violates these fundamental values. Being conscientiously committed means giving priority to patient care over adherence to conservative religious doctrines or personal self-interest. It also means that healthcare providers are inspired to overcome barriers to delivery of reproductive services to protect and advance women’s health. For example, a doctor may decide to do an abortion to save a woman’s life even though abortion is illegal in their country.

Conscientious commitment

Bernard Dickens
12 April 2008, Lancet

In some regions of the world, hospital policy, negotiated with the health ministry and police, requires that a doctor who finds evidence of an unskilled abortion or abortion attempt should immediately inform police authorities and preserve the evidence. Elsewhere, religious leaders forbid male doctors from examining any part of a female patient’s body other than that being directly complained about. Can a doctor invoke a conscientious commitment to medically appropriate and timely diagnosis or care and refuse to comply with such directives?

We have become familiar with the opposite stance of conscientious objection: the conviction, commonly based on religion, that provision of, for example, contraception, contraceptive sterilisation, abortion, access to reproductive technology, and pain control by life-shortening means goes against a health-care provider’s ethical values. Indeed, objection is properly accommodated in law and ethics provided that objectors refer their patients to suitable and accessible providers who do not object.

Marie Stopes, a pioneer of birth control

Marie Stopes, a pioneer of birth control

Religion has no monopoly on conscience, however. History, both distant and recent, shows how health-care providers and others, driven by conscientious concerns, can defy laws and religious opposition to provide care to vulnerable, dependent populations. They might also defy the medical establishment. Pioneers of the birth control movement were not doctors, and were opposed by medical, state, and religious establishments. As long ago as 1797, Jeremy Bentham advocated means of birth control, and in the following century, John Stuart Mill was briefly imprisoned for distributing birth control handbills. Charles Bradlaugh and Annie Besant were similarly prosecuted, in 1877, for selling pamphlets about birth control.

Religious opposition fuelled prosecution of proponents of family planning well into the 20th century. In 1915, Margaret Sanger, an American nurse who worked in the ghettos of New York and espoused the cause of birth control, fled prosecution to the UK, where she met and motivated an English botanist, Marie Stopes. The momentum towards popular and political acceptance of family planning generated by these courageous pioneers, who defied the power of organised religion, conservative convention, and at first the medical establishment, rewarded their conscientious commitment. Nevertheless, until 1969, the Canadian Criminal Code penalised the spread of knowledge of contraceptive means as a crime against morality, and family planning initiatives remain under attack particularly from the Roman Catholic Church hierarchy.

Read full article: The Lancet



Conscientious Commitment to Women’s Health

By Rebecca J. Cook and Bernard Dickens
Conscience Magazine, 2016 Issue 2
Aug 22, 2016

In the course of the 20th century, the progressive relaxation of restrictive laws affecting women’s reproductive health has generated a reaction, particularly among healthcare practitioners who hold conservative religious beliefs, of invoking rights of conscience to object to participation in such practices as prescribing or dispensing contraceptive products and undertaking contraceptive sterilization procedures and elective abortions. The call for healthcare practitioners’ conscientious commitment to undertake procedures to protect women’s health often arises in response to other practitioners’ failures or refusals to provide care.

Practitioners conscientiously committed to promoting the health of pregnant women would recognize that the women, rather than the fetuses, are their patients. Accordingly, as patients, the women rather than their caregivers determine whether or not they receive available treatment indicated for their care, either related or unrelated to pregnancy itself, such as chemotherapy for cancer, that may affect the fetuses they bear or may bear in the future.

Read full article: Conscience Magazine


Conscientious commitment to women’s health.

Bernard Dickens, Rebecca Cook
Int J Gynaecol Obstet. 2011 May;113(2):163-6.
doi: 10.1016/j.ijgo.2011.02.002.


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.

Source: Int J Gynaecol Obstet