Abstract
We have evaluated the prevalence of and the motivating factors behind the refusal to provide reproductive health services and the ethical knowledge of the subject among medical students from the Escola Bahiana de Medicina e Saúde Pública, in the state of Bahia, Brazil. The present cross-sectional study involved 120 medical students. A questionnaire was utilized. The dependent variables were students' objections (or not) regarding three clinical reproductive health cases: abortion provided by law, contraceptive guidance to an adolescent without parental consent, and prescription of emergency contraception. The independent variables were age, gender, religion, ethical value, degree of religiosity, and attendance at worship services. Ethical knowledge comprised an obligation to state the reasons for the objection, report possible alternatives, and referral to another professional. Data were analyzed with χ2 tests and t-tests with a significance level of 5%. Abortion, contraception to adolescents, and emergency contraception were refused by 35.8%, 17.5%, and 5.8% of the students, respectively. High religiosity (p < 0.001) and higher attendance at worship services (p = 0.034) were predictors of refusing abortion. Refusal to provide contraception to adolescents was significantly higher among women than men (p = 0.037). Furthermore, 25% would not explain the reason for the refusal, 15% would not describe all the procedures used, and 25% would not refer the patient to another professional. Abortion provided by law was the most objectionable situation. The motivating factors for this refusal were high commitment and religiosity. A reasonable portion of the students did not demonstrate ethical knowledge about the subject.
Highlights
Many diagnostic and therapeutic procedures have been refused by physicians because they are incompatible with their religious, moral, or ethical beliefs.[1]
Aplicou-se um questionário cujas variáveis dependentes foram a existência ou não de objeções quanto à condução de três casos clínicos sobre saúde reprodutiva: o abortamento previsto em lei, a orientação contraceptiva a uma adolescente sem consentimento dos pais, e a prescrição de contracepção de emergência
Among the students who objected to abortion provided by law, a significant association was observed with a higher attendance at worship services and with a high religious motivation as measured by the Hoge scale
Summary
Many diagnostic and therapeutic procedures have been refused by physicians because they are incompatible with their religious, moral, or ethical beliefs.[1]. Conscientious objection is exceptional and is based on ethical, moral, and religious reasons, which, in turn, must be sincere and authentic.[8] It must have a constant character, and should not be a temporary whim, that is, a changeable position according to each circumstance.[9] The right to freedom of religion, of conscience, and of thought is guaranteed by the International Covenant on Civil and Political Rights, considered the legal pillar of the Universal Declaration of Human Rights. The justification must be supported by reasons of an intimate, moral, or religious forum, and the requested procedure should not be an emergency; referral to other physicians to conduct the procedure is possible, without causing damage to the patient.[11,12]
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