Conscientious refusal to assist with abortion

Abstract

Abortion is a moral issue affecting the identity and integrity of physicians and nurses. Ethical reasoning helps reasonable and sincere people who do not agree on abortion to understand the sources of disagreement and to explore shared principles in the differences. Discussions of abortion cannot be limited to the conflict between the rights of a woman to control her reproduction and the rights of a fetus to live. Religious, cultural, feminist, and political beliefs must also be considered. This complexity must be considered when examining whether physicians and nurses have rights to refuse to assist in abortion on conscientious grounds. People with fundamentally different moral outlooks already determine what is morally right or wrong, good or evil. Health professionals who refuse to assist in abortion base their decision on beliefs about moral duties, injunctions of natural law, and the essentially nonnegotiable rights of people to be protected from intentional harm. They know and regret the adverse effects for pregnant women but there is no compelling motivation to change their opposition to abortion. There is no morally neutral position from which to judge conscientious refusals in abortion. Society should develop a position that respects autonomy of belief and grants the right to physicians and nurses to conscientiously refuse to assist in abortions. In those countries where the abortion law grants physicians the right to refuse but not nurses, society needs to reflect on why nurses have been accorded second class professional and moral status. In those countries which have not yet formulated an abortion law, the government should consider how it can find enough health workers who will in good conscience assist in abortions. Governments must first seriously consider a presumptive right to conscientious refusal in abortion before health systems can redistribute sectors of responsibility among health workers and implement changes in recruitment policies for relevant specializations.