Conscientious Commitment to Women’s Health
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
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