Conscientious Objection or Dishonorable Disobedience?

Journal of Midwifery & Women’s Health
Amy Levi
2015, American College of Nurse Midwives

The American College of Nurse-Midwives (ACNM) clearly identifies the primacy of the needs of the woman in its position statement on reproductive health choices, in which it affirms that “every woman has the right to make reproductive health choices that meet her individual needs.”1 What is not clear in the ACNM statement is how this position is addressed when a midwife is not supportive of a woman’s choice, whether that choice is induction of labor without a clinical indication, primary cesarean without labor, the use of emergency postcoital contraception, or abortion. At what point do the personal beliefs of the midwife, whether based on personal preference or personal moral code, take precedence over one’s professional responsibility to provide compassionate, evidence-based care to the woman and her family? How do midwives meet the needs of women when the woman’s preferences conflict with what the midwife believes is reliable and scientifically based evidence or when they conflict with the midwife’s own ethical or moral beliefs? Can the midwife opt out of care for women who choose circumcision for their newborns if the midwife does not support that choice? In addition to respecting women’s choices, how can midwives best ensure that they are respecting their own beliefs and moral codes?