Institutional CO and violation of pro-choice right to conscience

Most CO laws and policies shield only healthcare professionals who refuse to participate in a given medical service like abortion, but fail to protect those who are ready to perform such interventions. Bioethicist Bernard Dickens refers to the stance of pro-choice healthcare workers as‘‘conscientious commitment,’’ pointing out that ‘‘religion has no monopoly on conscience’’. For example, many doctors and healthcare personnel working in illegal settings around the world have provided safe abortions to women in desperate need. ‘‘Conscientiously committed practitioners often need courage to act against prevailing legal, religious, and even medical orthodoxy following the honourable medical ethic of placing patients’ interests above their own.’’(Dickens, 2008) Such practitioners deserve legal and institutional protection for their commitment to their patients. Physician Lisa H. Harris has also recognized that caregivers may be compelled by conscience to provide abortion services, noting that the one-sided ‘‘equation of conscience with non-provision of abortion contributes to the stigmatization of abortion providers,’’ leading to provider shortage sand even harassment and violence (Harris, 2012).

A prime example of negating a pro-choice right to conscience is when health systems such as Catholic hospitals claim the right to exercise their ‘‘conscience’’ by refusing to perform some reproductive health services, and then imposing that on all their staff and patients regardless of differing personal beliefs. Such policies may even be unwritten because they are based on the personal religious beliefs of hospital administrators (Nowicka, 2008). In Austria, almost all hospitals, both Catholic and public, refuse to provide legal abortions (Wimmer-Puchinger, 1995), and the director of a Catholic hospital even admitted in a media interview that a doctor would be fired for performing an abortion (Pongauer Nachrichten, 2004).

However, many Catholic healthcare personnel believe they are helping women and saving lives by providing abortions, and that being prohibited from doing so — even to save a woman’s life — would be a violation of their own religious beliefs, as well as medical ethics and the directive to ‘‘do no harm’’. Indeed, 37% of obstetricians/gynaecologists who practice in religiously affiliated institutions have had a conflict with their institution over its doctrinal-based policies (not just abortion), including 52% of Ob/Gyns in Catholic institutions (Stulberg et al., 2012).

At a Catholic hospital in Arizona, a nun in charge of the hospital’s ethics committee was ‘‘automatically excommunicated’’ and ‘‘reassigned’’ after she decided to save a woman’s life by providing an emergency abortion. As further punishment, the local bishop even revoked the hospital’s Catholic designation (Associated Press, 2010). In Germany, two separate Catholic hospitals refused to give a raped woman a gynaecological examination to preserve evidence,or even any counseling or support. Staff had been threatened with dismissal for treating her, because the hospitals wanted to avoid having to offer advice on abortion or emergency contraception (The Local (Germany), 2013).

American women experiencing an ectopic pregnancy or miscarriage have been denied emergency life-saving treatment by religiously affiliated hospitals, in violation of accepted medical standards and federal laws (National Women’s Law Center, 2011). Ectopic pregnancies, in which the embryo implants outside the uterus, are life-threatening to women. The pregnancy cannot be saved under any circumstance, so the standard of care is to immediately administer the drug methotrexate or to surgically remove the pregnancy. But because methotrexate is also used for abortion, Catholic hospitals refuse to provide it. Instead, they frequently force women to wait until their fallopian tube ruptures, increasing the woman’s suffering and putting her life and future fertility at serious risk.

When CO is invoked by a health system on behalf of all its employees, it will likely impede women’s access to sexual and reproductive health services far more than CO by individual doctors. In smaller communities, religiously based hospitals are often the only facility around, which reduces or eliminates access to a range of reproductive health services (female sterilization, emergency contraception, abortion etc.) for the entire region. This abandons local women to risk needless suffering or even death if they require essential reproductive healthcare (Berer, 2013; Catholics for a Free Choice, 2003). The woman’s religion or beliefs are disregarded by the institution, even though Catholic women in the U.S. have abortions at the same rates as non-Catholics, and 98% have used a form of contraception banned by their Church (Catholics for Choice, 2011). Further, institutional CO sanctions only one sectarian religious view among many, since most organized religions, including Catholicism, have liberal streams of thought that support the right to abortion in some or most cases (Maguire Daniel, 2001). Despite this, most religiously affiliated institutions that exercise CO are publicly funded and serve entire communities with diverse views. In effect, female citizens of countries with government-funded healthcare are paying taxes to support a discriminatory system that denies them essential care based on their child-bearing capacity.

An amended resolution allowing institutional CO was forced through by anti-choice voting members in October 2010 at the Council of Europe, via a series of political tactics that subverted a democratic vote. The original resolution would have provided the first-ever official recommendations on how governments could ‘‘balance’’ women’s right to required healthcare with healthcare workers’ claim of CO. The corrupted resolution elevated a foetus over a woman’s life, even the life of her family and other children, and essentially gave hospitals in Europe an escape clause from being held responsible or financially liable for neglect or harm inflicted onto patients (Council of Europe Parliamentary Assembly, 2010). The resolution still stands, although later decisions by the European Court of Human Rights in abortion-related cases (R.R. v. Poland; P. and S. v.Poland) tried to redress the situation with this oxymoronicruling: ‘‘States are obliged to organize their health service system. . .to ensure that the effective exercise of freedom of conscience by health professionals. . .does not prevent patents from obtaining access to services to which they are entitled. . .’’ (European Court of Human Rights, 2012)

International human rights frameworks confirm that the right to freedom of thought, conscience, and religion is a right that only individual human beings can enjoy. In the words of Christine McCafferty, the Rapporteur for the committee that produced the Council of Europe report: ‘‘. . .only individuals can have a soul or a conscience. . . Institutions such as hospitals cannot, by definition, have a conscience.’’(Council of Europe Parliamentary Assembly, 2010)

Source: Fiala C, Arthur JH. ‘‘Dishonourable disobedience’’ — Why refusal to treat in reproductive healthcare is not conscientious objection. Woman – Psychosom Gynaecol Obstet (2014),