There has been a lot of media attention recently on conscientious objection, mostly due to HR 4828, the Conscience Protection Act of 2016. This bill protects healthcare providers and health insurance companies from facing discrimination or fines for being pro-life. It states that the government cannot force healthcare providers (like churches and universities) to cover abortions through their insurance plans, nor can the government force healthcare professionals to perform or participate in abortions.
A bill like this seems like common sense to me. After all, historically, individuals have been able to object to, and refrain from, participating in acts which take human lives. Individuals have been allowed to object to participating in wars, and even physicians have been excused from administering the lethal injections now used for capital punishment. It is scientifically certain that abortion, too, takes the life of a human being. Therefore, it is logical that if abortion is to remain legal, the right to conscientious objection should extend to protect a physician’s decision to excuse themselves from performing this procedure.
Frequently though, these types of laws are criticized for being paternalistic and for limiting a woman’s access to abortion. Christian Fiala, of the Abortion Rights Coalition of Canada, refers to Conscientious Cbjection (CO) in the case of abortion as “dishonorable disobedience”, stating that “healthcare professionals who exercise CO are using their position of trust and authority to impose their personal beliefs on patients, who are completely dependent on them for essential healthcare. Health systems and institutions that prohibit staff from providing abortion or contraception services are being discriminatory by systematically denying healthcare services to a vulnerable population…”
In my medical training, I have been told to avoid paternalism with respect to my patients' treatments in favor of “shared-decision making.” “Shared decision-making” is described by the Informed Medical Decisions Foundation as “a collaborative process that allows patients and their providers to make healthcare decisions together. It takes into account the best clinical evidence available, as well as the patient’s values and preferences.” They go on to say that, “Shared decision making brings at least two experts to the table… The provider is an expert in the clinical evidence. Patients are experts in their experiences and what matters most to them.” In this way, the patient and the provider enter a partnership in which they both agree to work together with the information each of them has to develop a solution for the patient that best fits their needs. Ideally, shared decision-making should “honor both experts’ knowledge.” In this model, the patient cannot be forced to undergo a treatment based solely on the physician’s decision. But in the same way that a patient has the right to refrain from a treatment based on what they believe is right for them, so too does the provider have the right to object to administering a treatment that they have good medically-based reasons to believe could cause harm.
Physicians do have reasons to believe that abortion causes harm. The science is clear on the fact that the life of a human organism begins at fertilization. Abortion, therefore, ends the life of a human. Moreover, there is a mound of literature supporting the connection abortion has with breast cancer, preterm birth, and psychological harm. Though these studies are often criticized for coming from supposedly pro-life sources, pro-choice investigative reporter Punam Kumar Gill has recently criticized the pro-choice community for disregarding the massive amount of evidence supporting their claims without good reason in her documentary, Hush.
Thus, given that abortion ends the life of a human being, and that it is associated with grave after-effects, it is well within the realm of shared decision-making for a physician to refuse to perform an abortion on the grounds that it does more harm than good to their patient(s). Implying that this objection is paternalistic also implies that the patient is forced to go along with their decision, but of course this is not the case. Patients are free to find another provider who will provide these services if they truly believe it is what they need. Some physicians, for example, favor more holistic and natural medicine, and refuse to provide prescriptions for painkillers. A patient is free to seek services from a physician elsewhere if this type of physician does not fit their preferences.
Of course, this brings us to the next criticism of CO laws: that they limit a woman’s access to abortions. In certain areas or countries, an overwhelming number of providers invoke CO to abortion such that it’s difficult for women to find anyone who is willing to provide them one. As one example, 69% of all gynecologists in Italy refuse to perform abortions, and over 80% in some regions of the country. It seems to me, however, that if such a large percent of the medical community refuses to perform a procedure, we shouldn’t be asking whether or not to force them to betray their consciences, but asking why so many health professionals oppose the procedure. It seems ridiculous to whine and complain about a medical procedure being unavailable if the reason it’s not available is because medical staff refuse to perform it. For what reason do we have these individuals go through so many years of training if we are simply going to dismiss their medical opinion in the end anyways? If the pro-choice community wants to keep the government out of the doctor’s office, they need to be okay with the doctor’s decision about whether or not they are willing to perform abortions.
This is especially true given that, while abortion is often portrayed as a vital women’s health service, there is nothing essential about abortion as a medical procedure. Let me be clear: there is absolutely no medical indication for abortion in the case of a healthy pregnancy. There is no disease. Moreover, there is no reason to believe that a woman’s health will be improved by carrying out an abortion procedure and, as we already covered, there are actually several reasons to believe her health could be harmed (breast cancer, preterm birth, and psychological stress). Abortion in these 99.99% of cases is a completely elective procedure. To say that a physician is harming their patient by conscientiously objecting to providing an elective procedure is a radical and extremist position, based on false information.
Conscientious Objection, therefore, should be the right of a physician in the case of abortion procedures. It is something that is easily accommodated by the shared decision-making model of medicine, and if limited access results because a large percentage of physicians object to performing the procedure, that is more a reflection on the ethical nature of the procedure itself than a women’s rights issue. Arguments against CO are further weakened by the fact that it is an elective procedure. However, the most important reason CO should remain an option so long as abortion remains legal is the shear fact that it is an act which terminates the life of a human being. No person should be forced to participate in such an act of violence against their will.
1. Fiala, Christian, and Joyce H. Arthur. "“Dishonourable disobedience”–Why refusal to treat in reproductive healthcare is not conscientious objection." Woman-psychosomatic gynaecology and obstetrics 1 (2014): 12-23.
2. "Why Shared Decision Making?" Informed Medical Decisions Foundation. Accessed July 24, 2016. http://www.informedmedicaldecisions.org/shareddecisionmaking.aspx.