CONSCIENTIOUS-OBJECTION.INFO

Conscience-based refusal in reproductive medicine

by Sanja Cesar
Published 2017

Abstract (shortened and edited) This paper explains the legal principle of conscience-based refusal in reproductive medicine; analyses legislation, politics, and practice regarding refusal of health care services provision on conscientious grounds in the Republic of Croatia; and indicates the problems in legislation and practice that enable malpractice of this right, thus violating the right of each patient to access lawful medical care in a timely manner.

The Republic of Croatia does not have a uniform and standardized procedure of refusing to provide relevant services for reasons of personal conscience, and there is no systematic data collection on professionals’ refusals to provide standard reproductive services, or its effect on the quality of health care. Lack of monitoring from the Ministry of Health and tolerance for institutionalized conscience-based refusal represent a public health problem that ultimately results in limited access as well as legal and medical insecurity for women. Women who request abortion are stigmatized in society, are faced with disapproval or humiliation in health care facilities, and can also be exposed to unnecessary waiting periods, additional costs, and discrimination.

Read full report: Conscience-based refusal in reproductive medicine

 

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A Look at Conscientious Objection in Croatia

By Amir Hodžić
Apr 25, 2016

For a country sometimes deemed “the most Catholic country in Europe,” abortion is relatively available in Croatia. Terminations are accessible upon request within the first 10 weeks of pregnancy, and under several conditions after that in this 86 percent Catholic nation. But over the last few years, a growing number of gynecologists have been invoking conscientious objection (CO) in their refusal to perform an abortion. This uptick in the practice of CO should be seen as a coordinated, collective action that aims to challenge liberal laws and policies on sexual and reproductive health—part of a larger conservative agenda in this country struggling to balance competing rights claims.
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We can say that Croatia has failed to comprehensively and effectively regulate the practice of CO and thus allowed the denial of reproductive healthcare services to many women. In the last couple of years, we have witnessed the extensive promotion and co-option of the term CO by religiously affiliated groups on the political right aiming to deny women’s right to health and life—disguised as respect for clinicians’ “right” of conscience.

Read full article: Conscience Magazine

Is Your Health Care Compromised?
How the Catholic Directives Make for Unhealthy Choices

CATHOLICS FOR CHOICE
2017

At a time in US history when healthcare can be challenging to access even by those with good insurance coverage, how is it possible to say that Catholic healthcare can be bad for your health? This report will answer that question by showing how the religious rules followed by such institutions take precedence over your health needs and wishes. There are prohibitions on abortion — even for miscarriage management, restrictions on provision of in vitro fertilization to
help women struggling with infertility and for ectopic pregnancies, bans on modern contraceptive methods including sterilization and often an unwillingness to honor advance medical directives. This would be less egregious if it were clear that a hospital is Catholic-owned, but that is not necessarily the case. You may find yourself in a hospital you’ve used for decades that only recently merged with a Catholic healthcare institution, and options you had once exercised are no longer available to you. Between 2001 and 2016, the number of hospitals affiliated with the Catholic church increased by 22 percent. Do you know if your local hospital is one of them? And how do you feel about your healthcare being guided by the bishops’ interpretation of the Catholic faith, rather than by medical necessity or your own religious beliefs?

Read full report: Catholics for Choice

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Health Care Denied
Patients and Physicians Speak Out About Catholic Hospitals and the Threat to Women’s Health and Lives

Apr 26, 2016

One in six hospital beds in the U.S. is in a facility that complies with Catholic directives that prohibit a range of reproductive health care services, even when a woman’s life or health is in jeopardy. In some states, more than 40 percent of all hospital beds are in a Catholic-run facility, leaving entire regions without any option for certain reproductive health care services. The ACLU’s report shares firsthand accounts from patients who have been denied appropriate care at Catholic hospitals, from health care providers forbidden from providing critical care because of the Directives, and from physicians at secular hospitals who have treated very sick women after they were turned away from a Catholic facility.

The Ethical and Religious Directives for Catholic Health Care Services, which are promulgated by the U.S. Conference of Catholic Bishops, set forth standards for the provision of care at Catholic health care facilities. The Directives prohibit a range of reproductive health services, including contraception, sterilization, many infertility treatments, and abortion, even when a woman’s life or health is jeopardized by a pregnancy. Because of these rules, many Catholic hospitals across this country are withholding emergency care from patients who are in the midst of a miscarriage or experiencing other pregnancy complications. Catholic hospitals also routinely prohibit doctors from performing tubal ligations (commonly known as “getting your tubes tied”) at the time of delivery, when the procedure is safest, leaving patients to undergo an additional surgery elsewhere after recovering from childbirth. Catholic hospitals deny these essential health services despite receiving billions in taxpayer dollars. Transgender and gender-non-conforming patients suffer the same and other, similar harms when seeking reproductive health care.

Read full report: ACLU

 

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Conflicts in Care for Obstetric Complications in Catholic Hospitals

Lori R. Freedman & Debra B. Stulberg
18 Dec 2012
AJOB Primary Research, Volume 4, 2013 – Issue 4, Pages 1-10
https://doi.org/10.1080/21507716.2012.751464

Abstract

Background: A recent national survey revealed that over half of obstetrician-gynecologists working in Catholic hospitals have conflicts with religious policies, but the survey did not elucidate the nature of the conflicts. Our qualitative study examines the nature of physician conflicts with religious policies governing obstetrician-gynecologist (ob-gyn) care. Results related to restrictions on the management of obstetric complications are reported here.

Methods: In-depth interviews lasting about one hour were conducted with obstetrician-gynecologists throughout the United States. Questions focused on physicians’ general satisfaction with their hospital work settings and specific experiences with religious doctrine-based ob-gyn policies in the various hospitals where they have worked.

Results: Conflicts reported here include cases in which Catholic hospital religious policy (Ethical and Religious Directives for Catholic Health Care Services) impacted physicians’ abilities to offer treatment to women experiencing certain obstetric emergencies, such as pregnancy-related health problems, molar pregnancy, miscarriage, or previable premature rupture of membranes (PPROM), because hospital authorities perceived treatment as equivalent to a prohibited abortion. Physicians were contractually obligated to follow doctrine-based policies while practicing in these Catholic hospitals.

Conclusions: For some physicians, their hospital’s prohibition on abortion initially seemed congruent with their own principles, but when applied to cases in which patients were already losing a desired pregnancy and/or the patient’s health was at risk, some physicians found the institutional restrictions on care to be unacceptable.

Read full study: ACLU

Conscientious objection to referrals for abortion: pragmatic solution or threat to women’s rights?

Eva M Kibsgaard Nordberg, Helge Skirbekk and Morten Magelssen
BMC Medical Ethics
Feb 26, 2014
https://doi.org/10.1186/1472-6939-15-15

Abstract

Background: Conscientious objection has spurred impassioned debate in many Western countries. Some Norwegian general practitioners (GPs) refuse to refer for abortion. Little is know about how the GPs carry out their refusals in practice, how they perceive their refusal to fit with their role as professionals, and how refusals impact patients. Empirical data can inform subsequent normative analysis.

Methods: Qualitative research interviews were conducted with seven GPs, all Christians. Transcripts were analysed using systematic text condensation.

Results: Informants displayed a marked ambivalence towards their own refusal practices. Five main topics emerged in the interviews: 1) carrying out conscientious objection in practice, 2) justification for conscientious objection, 3) challenges when relating to colleagues, 4) ambivalence and consistency, 5) effects on the doctor-patient relationship.

Conclusions: Norwegian GP conscientious objectors were given to consider both pros and cons when evaluating their refusal practices. They had settled on a practical compromise, the precise form of which would vary, and which was deemed an acceptable middle way between competing interests.

Read full study: BMC Medical Ethics

The Refusal to Provide Health Care in Canada

A Look at “Conscientious Objection” Policies in Canadian Health Care
June 2018

Many people may be unaware that in Canada, doctors have the “right” to refuse to provide legal and necessary treatments for personal or religious reasons. Further, doctors usually don’t even have to refer patients to someone who can provide the objected-to service. This permitted abandonment of patients is not monitored and there are rarely any repercussions for doctors who may cause harm to patients as a result.

This paper explains why so-called “conscientious objection” in health care is unethical and unworkable and has nothing in common with true conscientious objection in the military.

Source: Abortion Rights Coalition of Canada

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Canadian Policies and Laws on “Conscientious Objection” in Health Care

June 2018

This Appendix [to the above paper] describes and critiques the policies of the Canadian Medical Association (CMA) and each College of Physicians and Surgeons across Canada as they relate to the refusal to treat and obligation to refer , in particular for abortion care, but also medical assistance in dying (MAiD). The three territories do not have Colleges and their policies if any were not reviewed.

Source: Abortion Rights Coalition of Canada

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Welcome to the wild, wild north: conscientious objection policies governing Canada’s medical, nursing, pharmacy, and dental professions.

Jacquelyn Shaw and Jocelyn Downie
Bioethics. 2014 Jan;28(1):33-46
doi: 10.1111/bioe.12057

Abstract

In Canada, as in many developed countries, healthcare conscientious objection is growing in visibility, if not in incidence. Yet the country’s health professional policies on conscientious objection are in disarray. The article reports the results of a comprehensive review of policies relevant to conscientious objection for four Canadian health professions: medicine, nursing, pharmacy and dentistry. Where relevant policies exist in many Canadian provinces, there is much controversy and potential for confusion, due to policy inconsistencies and terminological vagueness. Meanwhile, in Canada’s three most northerly territories with significant Aboriginal populations, whose already precarious health is influenced by funding and practitioner shortages, there are major policy gaps applicable to conscientious objection. In many parts of the country, as a result of health professionals’ conscientious refusals, access to some legal health services – including but not limited to reproductive health services such as abortion – has been seriously impeded. Although policy reform on conscientious conflicts may be difficult, and may generate strenuous opposition from some professional groups, for the sake of both patients and providers, such policy change must become an urgent priority.

Source: Bioethics

 

How ‘conscientious objectors’ threaten women’s newly-won abortion rights in Latin America
From Uruguay to Chile, medical staff are refusing to provide abortion services even after their legalisation.

Diana Cariboni
18 July 2018

Women’s rights to legal abortion have increased in Latin America – but so have campaigns and policies for medical staff to be able to ‘conscientiously object’ and refuse to participate in these procedures.

“We didn’t see it coming,” said feminist activist Lilián Abracinskas in Uruguay, a secular country where abortion, same-sex marriage and the marijuana market were each legalised in the last decade.

Read full article: Open Democracy

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Refusing Reproductive Health Services on Grounds of Conscience in Latin America

Diya Uberoi and Beatriz Galli
Nov 2016

Challenging policies and practises based on human rights standards

The years have seen a rise in the use of conscientious objection (CO) as means to deny women their sexual reproductive health rights. While states have an obligation under international human rights law to protect the freedom of thought, conscience and religion of people, they also have obligations to protect the right to the highest attainable standard of health and other fundamental rights. Over the years, International and regional human rights bodies have indicated the need for CO to be limited so as to protect women’s rights.

As a means to balance both rights of medical service providers to exercise their moral beliefs and to protect the right to health of women, countries around the world have also sought different ways to regulate the use of CO. Whereas in some countries, some developments have been made to regulate CO so as to protect fundamental rights of women, in others, few guidelines exist in order to ensure availability of services for women in case refusals are made. This article provides an overview of policies regulating CO in Latin America. It considers the regulation of CO under both international law and under various state laws within the region. It suggests that if women’s reproductive rights are to become a reality, then there is a real need that states as well as international and regional human rights bodies continue to find ways to clarify frameworks around CO, so that grounds of conscience do not become an excuse to deny women realisation of their fundamental rights.

Read full article: SurConnectas

Improper Use of Conscientious Objection in Bogotá, Colombia, Presents a Barrier to Safe, Legal Abortion Care
New Study Identifies Avenues for Intervention

August 10, 2016, News Release

Health care providers who invoke conscientious objection to providing or participating in abortion care in Bogotá, Colombia, can be categorized along a spectrum of objection—extreme, moderate and partial—finds a new study published in International Perspectives on Sexual and Reproductive Health. The study, “‘The Fetus Is My Patient, Too’: Attitudes Toward Abortion and Referral Among Physician Conscientious Objectors in Bogotá, Colombia,” by Lauren Fink of Emory University, ” by Lauren Fink of Emory University, et al., seeks to understand conscientious objection from the perspective of objectors themselves in order to help identify potential interventions to ease the burden of conscientious objection as a barrier to care.

When the Colombian Constitutional Court partially decriminalized abortion in 2006, the Court established a right to abortion in three circumstances: when the life or health (including mental well-being) of the mother is at risk; when a fetal anomaly is incompatible with life; and when the pregnancy is the result of rape, incest or forced insemination. The Court also outlined guidelines for health care providers who wish to invoke conscientious objection. Individuals can object, but institutions cannot; objecting physicians have a duty to refer patients to another provider; and conscientious objection “may not involve disregard for the rights of women.” Nevertheless, improperly exercised conscientious objection is not uncommon in Colombia, leading many women to seek clandestine abortions, which are often unsafe. The authors conducted in-depth interviews with 13 key informants and 15 Colombian physicians who self-identified as conscientious objectors to better understand how conscientious objection is exercised.

Read full article: Guttmacher Institute

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(The following article rebuts the idea that regulation of “conscientious objection” is working, using Colombia as an example).

There is no defence for ‘Conscientious objection’ in reproductive health care
by Christian Fiala and Joyce H.Arthur
https://doi.org/10.1016/j.ejogrb.2017.07.023
European Journal of Obstetrics & Gynecology and Reproductive Biology
Volume 216, September 2017, Pages 254-258

Abstract
A widespread assumption has taken hold in the field of medicine that we must allow health care professionals the right to refuse treatment under the guise of ‘conscientious objection’ (CO), in particular for women seeking abortions. At the same time, it is widely recognized that the refusal to treat creates harm and barriers for patients receiving reproductive health care. In response, many recommendations have been put forward as solutions to limit those harms. Further, some researchers make a distinction between true CO and ‘obstructionist CO’, based on the motivations or actions of various objectors.

This paper argues that ‘CO’ in reproductive health care should not be considered a right, but an unethical refusal to treat. Supporters of CO have no real defence of their stance, other than the mistaken assumption that CO in reproductive health care is the same as CO in the military, when the two have nothing in common (for example, objecting doctors are rarely disciplined, while the patient pays the price). Refusals to treat are based on non-verifiable personal beliefs, usually religious beliefs, but introducing religion into medicine undermines best practices that depend on scientific evidence and medical ethics. CO therefore represents an abandonment of professional obligations to patients. Countries should strive to reduce the number of objectors in reproductive health care as much as possible until CO can feasibly be prohibited. Several Scandinavian countries already have a successful ban on CO.

Read full article: Science Direct

Prevalence of conscientious objection to legal abortion among clinicians in northern Ghana

John K. Awoonor-Williams, Peter Baffoe, Philip K. Ayivor, Chris Fofie, Sheila Desai, Wendy Chavkin,
Int J Gynecol Obstet 2017; 140: 31–36

Abstract: Objective: To assess the prevalence of conscientious objection (CO), motivations, knowledge of Ghana’s abortion law, attitudes, and behaviors toward abortion provision among medical providers in northern Ghana, and measures to regulate CO.

Methods: Between June and November 2015, the present cross-sectional survey-based descriptive study measured prevalence, knowledge, and attitudes about CO among 213 eligible health practitioners who were trained in abortion provision and working in hospital facilities in northern Ghana. Results were stratified by facility ownership and provider type.

Results: Approximately half (94/213, 44.1%) of trained providers reported that they were currently providing abortions. The overall prevalence of self-identified and hypothetical objection was 37.9% and 33.8%, respectively. Among 87 physicians, 37
(42.5%) and 39 (44.8%) were categorized as self-identified and hypothetical objectors, respectively. Among 126 midwives, nurses, and physician assistants, 43 (34.7%) and 33 (26.2%) were coded as self- identified and hypothetical objectors, respectively. A high proportion of providers reported familiarity with Ghana’s abortion law and supported regulation of CO.

Conclusion: CO based on moral and religious grounds is prevalent in northern Ghana. Providers indicated an acceptance of policies and guidelines that would regulate its application to reduce the burden that CO poses for women seeking abortion services.

Read full article: Global Doctors for Choice

Yes We Can!  Successful Examples of Disallowing ‘Conscientious Objection’ in Reproductive Health Care

Christian Fiala, Kristina Gemzell Danielsson,  Oskari Heikinheimo,  Jens A. Guðmundsson and Joyce Arthur
European Journal of Contraception & Reproductive Health Care, Vol 21, 2016 – Issue 3

Abstract
Reproductive health care is the only field in medicine where health care professionals (HCPs) are allowed to limit a patient‘s access to a legal medical treatment – usually abortion or contraception – by citing their ‘freedom of conscience.’ However, the authors’ position is that ‘CO’ in reproductive health care should be called dishonourable disobedience because it violates medical ethics and the right to lawful health care, and should therefore be disallowed.

Three countries – Sweden, Finland, and Iceland – do not generally permit HCPs in the public health care system to refuse to perform a legal medical service for reasons of ‘CO’ when the service is part of their professional duties. We investigate the laws and experiences of these countries to show that disallowing ‘CO’ is not only workable but beneficial. It seems to facilitate good access to reproductive health services because it reduces barriers and delays. Other benefits include the prioritization of evidence-based medicine, rational arguments, and democratic laws over faith-based refusals. Disallowing ‘CO’ also protects women’s rights and avoids discrimination and other human rights harms. Finally, holding HCPs accountable for their professional obligations to patients does not result in negative impacts. Almost all HCPs and medical students in Sweden, Finland, and Iceland who object to abortion or contraception are able to find work in another field of medicine. The key to successfully disallowing ‘CO’ is a country’s strong prior acceptance of women’s civil rights, including their right to health care.

Read the entire article here.

Dispatches: Abortion and the ‘Conscience Clause’ in Poland

October 22, 2014
Hillary Margolis
Researcher, Women’s Rights Division

Poland is one of a select few countries in Europe where access to abortion remains extremely limited: it’s a crime to terminate a pregnancy except in cases of risk to the mother’s life or health, severe fetal abnormality, or rape. In Europe, only Ireland and Malta have more restrictive laws.

The United Nations has taken Poland to task for its abortion laws and practices, and is likely to do so again today. After a visit in 2009, the UN Special Rapporteur on the Right to Health called for the government to remove barriers to safe abortion. A UN expert body, the Committee on the Elimination of Discrimination against Women, also criticized Poland’s abortion record in 2007. At a meeting today with Polish officials, this committee will undoubtedly focus on the lack of progress on access to safe, legal abortion.

Read full story:  Human Rights Watch

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Polish doctor fired for refusing to allow woman have abortion

Prof Bogdan Chazan one of 3,000 physicians who have signed a ‘declaration of faith’
Thu, Jul 10, 2014

A doctor in Poland has been fired from the hospital he works for after refusing to allow a woman have an abortion because of a “conflict of conscience” with his Catholicism.

In April this year, the pregnant woman asked Professor Bogdan Chazan, director of Warsaw’s Holy Family Hospital, for an abortion because her own physician had diagnosed her unborn child with grave health problems.

Prof Chazan sent the woman a letter saying he could not agree to an abortion in his hospital because of a “conflict of conscience,” and instead gave the woman the address of a hospice where, he said, the child could get palliative care once born.

Read full story:  Irish Times

Abortion in Italy: how widespread ‘conscientious objection’ threatens women’s health and rights
Claudia Torrisi, 15 June 2017

Almost 40 years after abortion was legalised – amid mass protests and a broader cultural liberation movement – women still struggle to access crucial services.

A mass in St. Peter’s Square at the Vatican. A mass in St. Peter’s Square at the Vatican. Photo: Evandro Inetti/PA Images. All rights reserved.Laura, from Naples, decided to terminate her pregnancy on 6 June 2008. The baby she was expecting had been diagnosed with down syndrome, she explains. “I was 21 weeks into my pregnancy, and I took this decision.”

Early one morning, Laura went on her gynecologist’s recommendation to a hospital where she was admitted and labour was induced. But, she says, “the ward for abortions was open only half-day, because there weren’t enough doctors available.”

Read full article: Open Democracy

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Abortion in Italy, a Right Wronged

By Ilaria Maria Sala
Nov. 13, 2017

Late last month, Cosimo Borraccino, a left-wing member of the regional council for Apulia, in southern Italy, proposed passing a local law to require the enforcement of national legislation granting women access to abortion. His opponents on the council, mostly from center-right parties, said the bill was unnecessary and that Mr. Borraccino was “slamming into a wall of self-evidence.”

Yet when it comes to reproductive rights in Italy, respect of the law is anything but self-evident. In fact, 9 out of 10 gynecologists in Apulia refuse to perform abortions, even though the right to obtain one has been legal since 1978. Nationwide statistics are only slightly less staggering: Seven out of 10 gynecologists in Italy won’t terminate a pregnancy.

Read full story: New York Times

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Italy: Widespread conscientious objection violates right to health and right to work in dignity

Oct 31, 2017

Many thanks to Tania Pagotto, a Ph.D candidate in comparative public law at Ca’ Foscari University of Venice in Italy. She can be reached at: tania{.}pagotto at unive.it. We thank her for commenting on two recent decisions by the European Committee on Social Rights:

International Planned Parenthood European Network v. Italy (2014), Complaint No. 87/2012, decision published 10 March 2014 (European Committee on Social Rights, Strasbourg, France) Decision online. 

Confederazione Generale Italiana del Lavoro (CGIL) v. Italy (2016), Complaint No. 91/2013 (European Committee on Social Rights, Strasbourg, France) Decision online .

Read full story: ReproHealthLaw

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Conscientious Objection in Italy

Minerva F.

Journal of Medical Ethics 2015;41:170-173.
http://dx.doi.org/10.1136/medethics-2013-101656

Abstract

The law regulating abortion in Italy gives healthcare practitioners the option to make a conscientious objection to activities that are specific and necessary to an abortive intervention. Conscientious objectors among Italian gynaecologists amount to about 70%. This means that only a few doctors are available to perform abortions, and therefore access to abortion is subject to constraints. In 2012 the International Planned Parenthood Federation European Network (IPPF EN) lodged a complaint against Italy to the European Committee of Social Rights, claiming that the inadequate protection of the right to access abortion implies a violation of the right to health. In this paper I will discuss the Italian situation with respect to conscientious objection to abortion and I will suggest possible solutions to the problem.

Source: jme.bmj.com

Freedom of conscience in Europe? An analysis of three cases of midwives with conscientious objection to abortion.

Fleming V, Ramsayer B, Škodič Zakšek T.
J Med Ethics. 2018 Feb;44(2):104-108
doi: 10.1136/medethics-2016-103529. Epub 2017 Jul 29.

Abstract

While abortion has been legal in most developed countries for many years, the topic remains controversial. A major area of controversy concerns women’s rights vis-a-vis the rights of health professionals to opt out of providing the service on conscience grounds. Although scholars from various disciplines have addressed this issue in the literature, there is a lack of empirical research on the topic. This paper provides a documentary analysis of three examples of conscientious objection on religious grounds to performing abortion-related care by midwives in different Member States of the European Union, two of which have resulted in legal action. These examples show that as well as the laws of the respective countries and the European Union, professional and church law each played a part in the decisions made. However, support from both professional and religious sources was inconsistent both within and between the examples. The authors conclude that there is a need for clear guidelines at both local and pan-European level for health professionals and recommend a European-wide forum to develop and test them.

Source: Journal of Medical Ethics

 

Regulation of Conscientious Objection to Abortion: An International Comparative Multiple-Case Study
Wendy Chavkin, MD, MPH, Laurel Swerdlow, MPH, and Jocelyn Fifield, MPH
Health Hum Rights. 2017 Jun; 19(1): 55–68.

Abstract

Since abortion laws were liberalized in Western Europe, conscientious objection (CO) to abortion has become increasingly contentious. We investigated the efficacy and acceptability of laws and policies that permit CO and ensure access to legal abortion services. This is a comparative multiple-case study, which triangulates multiple data sources, including interviews with key stakeholders from all sides of the debate in England, Italy, Norway, and Portugal. While the laws in all four countries have similarities, we found that implementation varied. In this sample, the ingredients that appear necessary for a functional health system that guarantees access to abortion while still permitting CO include clarity about who can object and to which components of care; ready access by mandating referral or establishing direct entry; and assurance of a functioning abortion service through direct provision or by contracting services. Social attitudes toward both objection and abortion, and the prevalence of CO, additionally influence the degree to which CO policies are effectively implemented in these cases. England, Norway, and Portugal illustrate that it is possible to accommodate individuals who object to providing abortion, while still assuring that women have access to legal health care services.

(Note: The above article has been comprehensively critiqued by Christian Fiala and Joyce Arthur: Refusal to Treat Patients Does Not Work in Any Country—Even If Misleadingly Labelled “Conscientious Objection”, Health and Human Rights Journal, 6 Sept 2017.)

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Conscientious objection and induced abortion in Europe

Heino A, Gissler M, Apter D, Fiala C.
Eur J Contracept Reprod Health Care. 2013 Aug;18(4):231-3
Source: informahealthcare.com

Abstract
The issue of conscientious objection (CO) arises in healthcare when doctors and nurses refuse to have any involvement in the provision of treatment of certain patients due to their religious or moral beliefs. Most commonly CO is invoked when it comes to induced abortion. Of the EU member states where induced abortion is legal, invoking CO is granted by law in 21 countries. The same applies to the non-EU countries Norway and Switzerland. CO is not legally granted in the EU member states Sweden, Finland, Bulgaria and the Czech Republic. The Icelandic legislation provides no right to CO either. European examples prove that the recommendation that CO should not prevent women from accessing services fails in a number of cases. CO puts women in an unequal position depending on their place of residence, socio-economic status and income. CO should not be presented as a question that relates only to health professionals and their rights. CO mainly concerns women as it has very real consequences for their reproductive health and rights. European countries should assess the laws governing CO and its effects on women’s rights. CO should not be used as a subtle method for limiting the legal right to healthcare.

At least 100 countries have provisions that allow so-called “conscientious objection” in health care, according to REDAAS (Safe Abortion Access Network of Argentina).

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What International Human Rights Groups and Agreements, and Global Health Orgs, Say About “Conscientious Objection” in Healthcare

August 2024: This document is a compilation of everything relevant to “conscientious objection” in reproductive healthcare, as contained in international human rights agreements, and guidelines/reports by global health and human rights groups and governing bodies that have weighed in on the topic. The excerpts are contextualized by the view that “CO” in healthcare is inappropriate, unworkable, and not a right.

Compiled by Joyce Arthur, Initiative for Reproductive Health Information (IRHI)

Access full document here (PDF): Intl-groups-agreements-CO

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A 2014 white paper from Global Doctors for Choice “examines the prevalence and impact of such refusals [CO] and reviews policy efforts to balance individual conscience, autonomy in reproductive decision making, safeguards for health, and professional medical integrity.” The authors discuss a range of CO policies and laws around the world, drawing upon medical, public health, legal, ethical, and social science literature of the past 15 years (since 2013) in English, French, German, Italian, Portuguese, and Spanish.

Read full report: Global Doctors for Choice – Conscientious objection and refusal to provide reproductive healthcare: A white paper examining prevalence, health consequences, and policy responses, by Wendy Chavkin, Liddy Leitman, and Kate Polin. (Note: Authors are biased in favour of “balancing” refusals with patients’ right to healthcare.)

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‘‘Dishonourable disobedience’’ — Why refusal to treat in reproductive healthcare is not conscientious objection, by Christian Fiala and Joyce H. Arthur, Woman – Psychosom Gynaecol Obstet (2014), http://dx.doi.org/10.1016/j.woman.2014.03.001

Excerpt:

Most western countries allow healthcare professionals some degree of CO through medical policies or codes of ethics— often called ‘‘refusal clauses’’ or ‘‘conscience clauses’’. Typically, healthcare personnel can opt out of providing non-emergency care, but only if they promptly refer the patient to someone else who can help them. The Code of Ethics of FIGO (International Federation of Gynecology and Obstetrics) states (FIGO):

Assure that a physician’s right to preserve his/her own moral or religious values does not result in the imposition of those personal values on women. Under such circumstances, they should be referred to another suitable health care provider. Conscientious objection to procedures does not absolve physicians from taking immediate steps in an emergency to ensure that the necessary treatment is given without delay.

Many countries have enshrined CO into law (Heino et al.,2013):

• Austrian law states: No one may be in any way disadvantaged . . . because he or she has refused to perform or take part in such an abortion. (Government of Austria,1975)
• France’s law says: A doctor is never required to per-form an abortion but must inform, without delay, his/her refusal and provide immediately the name of practitioners who may perform this procedure. . . No mid-wife, no nurse, no paramedic, whatever is required to contribute to an abortion. . . . A private health establishment may refuse to have abortions performed on its premises. (Government of France, 2001)
•  Even though the Australian state of Victoria decriminalized abortion in 2008, the new law retains a CO clause:If a woman requests a registered health practitioner to advise on a proposed abortion, or to perform, direct, authorise or supervise an abortion for that woman, and the practitioner has a conscientious objection to abortion, the practitioner must refer the woman to another registered health practitioner [who] does not have a conscientious objection to abortion. (Australasian Legal Information Institute, 2010)
•  In the United States, almost every state has passed refusal clauses allowing physicians to opt out of providing abortions and other services. In addition, federal law protects doctors and nurses who do not want to perform abortions or sterilizations, and allows health workers to file complaints if they feel discriminated against (Huffington Post,2011).