Academic journal article Issues in Law & Medicine

Conscientious Objection to Referral for Reproductive Services

Academic journal article Issues in Law & Medicine

Conscientious Objection to Referral for Reproductive Services

Article excerpt

Conscientious objection in health care is the refusal to participate in, write prescriptions for, perform or refer for reproductive services that may destroy human life. Deeply held moral or religious beliefs may cause physicians and other providers to invoke conscientious objection to the following:

* Abortion

* Contraception

* Emergency contraception

* Physician-assisted suicide

* Physician aid in dying

* Medical aid in dying

Oaths for Medical Practice

The Hippocratic Oath has been sworn for several millennia to establish sacred principles of trust between a physician and a patient. Those principles include "doing no harm," working for the benefit of the patient, refusing to give lethal drugs when requested, not to give agents for abortion, and not to do procedures outside of one's training.1 The Osteopathic Oath, first written in 1938 with minor revisions in 1954,2 echoes similar values of professional ethics. It begins with the promise to preserve the health and life of the patient and includes giving no drugs for deadly purposes though it be asked. The principal role of the physician as a healer was firmly established through these two oaths.

Over the years, the use of a professional oath has been considered optional by some medical schools, or the oath was changed to reflect changing societal norms. The principles outlined in both the Osteopathic and Hippocratic Oaths are considered out of date by some. Passage of laws that permit both abortion and physician-assisted suicide are not consistent with the oath's tenets. The long-held understanding of the physician as a healer has been modified to reflect the physician as a healthcare agent with expected compliance to requests by patients for services that the physician may find objectionable, harmful or lethal.

Moral Distress and the Slippery Slope

The conscience protects moral integrity by providing moral distress when ethical boundaries are breached. The slippery slope in ethics describes increasing comfort with engagement in behaviors that would have caused moral distress prior to participating. As boundaries are crossed, the next boundary becomes easier to traverse.

The slippery slope is evident in attitudes toward abortion after legalization in 1973. Even those who morally objected to abortion struggled for answers to the very few women who found themselves in the most desperate situations. Certainly, providing a way out of a pregnancy for just a few could not be too bad. By 1978, the focus was changing, and posters appeared with captions like, "Join the 1.5 million women in America who have had abortions." The desperate few had become a club to join, and those objecting were shamed for denying women their newly found "right to privacy" Physicians philosophically aligned to the pro-choice agenda were available to provide abortion services for those seeking them. The promoted concept was that the growing embryo was just a "glob of tissue" or a tumor to be removed to relieve the patient of an unwanted burden. If women were educated that the embryo or fetus was indeed a separate living human being, they were most likely to make a life-affirming choice.

As demand for abortion services grew, the numbers of physicians willing to perform the procedure did not keep up with the demand. Even for those sympathetic to a woman's ability to control her fertility, the concept of a woman having the right to abort for any reason at any gestational age, including post-viability caused moral distress for physicians and others, limiting participation. Additionally, laws were passed in many states to restrict access to abortion after viability, or after human characteristics developed, like the ability to feel pain. States with laws more sympathetic to animal rights than rights of the fetus acted with abortion restrictions aimed to create a more civil society.

Decisions in Time of Stress

Some understanding of how human beings react to stress and grief is important in this discussion. …

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