Use Of Conscientious Objection Research Articles

Guidelines for conscientious objection in Spain: a proposal involving prerequisites and protocolized procedure

Healthcare professionals often face ethical conflicts and challenges related to decision-making that have necessitated consideration of the use of conscientious objection (CO). No current guidelines exist within Spain’s healthcare system regarding acceptable rationales for CO, the appropriate application of CO, or practical means to support healthcare professionals who wish to become conscientious objectors. As such, a procedural framework is needed that not only assures the appropriate use of CO by healthcare professionals but also demonstrates its ethical validity, legislative compliance through protection of moral freedoms and patients’ rights to receive health care. Our proposal consists of prerequisites of eligibility for CO (individual reference, specific clinical context, ethical justification, assurance of non-discrimination, professional consistency, attitude of mutual respect, assurance of patient rights and safety) and a procedural process (notification and preparation, documentation and confidentiality, evaluation of prerequisites, non-abandonment, transparency, allowance for unforeseen objection, compensatory responsibilities, access to guidance and/or consultative advice, and organizational guarantee of professional substitution). We illustrate the real-world utility of the proposed framework through a case discussion in which our guidelines are applied.

The overprotection of conscientious objection in Chile's abortion regulation.

This paper critically analyses conscientious objection to abortion in the context of the new regulation of pregnancy termination in Chile. It argues that adequate regulation should not be blind: The bioethical requirements that seek to balance the interests involved must consider the legal regulation of the interests at stake, the context in which they are implemented, and, fundamentally, the effectiveness of the solutions adopted. Attention should be paid to the risks involved in the political use of conscientious objection to prevent the implementation of women's reproductive rights. In describing the process of the entrenchment and expansion of conscientious objection to abortion in Chile, we show how this process has overprotected conscience and how the risks of undermining the effectiveness of the new abortion legislation hinder the enjoyment of rights entrenched by the law.

The Ethical Justification for Conscience Clauses in Nurse-Midwifery Practice: Context, Power, and a Changing Landscape.

In the last century, conscientious objection has moved from objection to conscripted military service to include health care providers who have moral concerns about participation in specific aspects of health care. Although guidance for the use of conscientious objection has developed in both nursing and midwifery, changes in the political landscape may be creating a source of conflict between providers and the use of conscientious objection. Particularly in aspects of sexual and reproductive care like abortion, contraception, and lesbian, gay, bisexual, transgender, or queer health care, the ethical requirement for prompt referral is becoming increasingly difficult to meet in many contexts. Changes to federal regulations protecting conscience clauses have tilted strongly in favor of the rights of providers in recent years; this challenges the delicate balance of patient and provider rights that has developed over the years. These may now represent an unavoidable conflict between different aspects of the ethical obligations of providers, in particular the obligation to seek justice, and bring into question whether the current status of conscientious objection is sustainable. In this article, we examine these conflicts in the context of the current political climate.

Medical and midwifery students\u2019 views on the use of conscientious objection in abortion care, following legal reform in Chile: a cross-sectional study

BackgroundIn August 2017, Chile lifted its complete ban on abortion by permitting abortion in three limited circumstances: 1) to save a woman’s life, 2) lethal fetal anomaly, and 3) rape. The new law allows regulated use of conscientious objection (CO) in abortion care, including allowing institutions to register as objectors. This study assesses medical and midwifery students’ support for CO, following legal reform.MethodsFrom October 2017 to May 2018, we surveyed medical and midwifery students from seven universities located in Santiago, Chile. Universities included 4 secular (2 public and 2 private) and 3 private religiously-affiliated universities; all offering medical degrees with a specialization in obstetrics and gynecology (ob-gyn) and five offering midwifery degrees. We used generalized estimating equations (GEE) to identify characteristics associated with student support for CO, intentions to use CO to refuse to care for someone seeking abortion, and support for CO at the institutional level.Results333 of the 413 eligible students who opened the survey, completed the questions on conscientious objection; 26% were seeking medical degrees with an ob-gyn specialty, 25% were seeking midwifery degrees, and 49% were seeking medical degrees and had not yet decided their specialty. While nearly all endorse requirements for conscientious objecting clinicians to inform (92%) and refer (91%) abortion-seeking patients, a minority (18%) would personally use conscientious objection to avoid caring for a patient seeking abortion (12% secular and 39% religious university students). About half of religious-university students (52%) and one-fifth of secular-university (20%) students support objections at the institutional level.ConclusionsMost students support the regulated use of CO which preserves patients’ access to abortion care. Religious-university student views on the use of conscientious objection in abortion care are discordant with those of their institutions which currently support institutional-level objections.

Objeción de conciencia y aborto en Chile

This paper critically analyzes conscientious objection in the context of the new regulation of pregnancy termination in Chile. It affirms that adequate regulation should not be blind to the hostile context in which abortion rights have been enacted and the difficulties experienced. The bioethical requirements that seek to balance the interests involved must consider the legal regulation of the interests at stake, the context in which they are implemented and, fundamentally, the effectiveness of the solutions adopted. Attention should be paid to the risks involved in the proliferation of objections that are not serious and to the political use of conscientious objection to prevent the implementation of women’s reproductive rights. In describing the process of entrenchment, strengthening and expansion of the conscientious objection in Chile, we show how this process has overprotected consciousness and the risks of undermining the effectiveness of the new abortion law, hindering and dilating the enjoyment of rights entrenched by the law. In response, regulatory measures are proposed to reverse this situation, which are obtained mainly from the bioethical literature on the subject and that look at the adverse context of the guarantee of women’s sexual and reproductive rights.

Chilean Medical and Midwifery Faculty's Views on Conscientious Objection for Abortion Services.

In 2017, Chile reformed its abortion law to allow the procedure under limited circumstances. Exploring the views of Chilean medical and midwifery faculty regarding abortion and the use of conscientious objection (CO) at the time of reform can inform how these topics are being taught to the country's future health care providers. Between March and September 2017, 30 medical and midwifery school faculty from universities in Santiago, Chile were interviewed; 20 of the faculty taught at secular universities and 10 taught at religiously affiliated universities. Faculty perspectives on CO and abortion, the scope of CO, and teaching about CO and abortion were analyzed using a grounded theory approach. Most faculty at secular and religiously affiliated universities supported the rights of clinicians to refuse to provide abortion care. Secular-university faculty generally thought that CO should be limited to specific providers and rejected the idea of institutional CO, whereas religious-university faculty strongly supported the use of CO by a broad range of providers and at the institutional level. Only secular-university faculty endorsed the idea that CO should be regulated so that it does not hinder access to abortion care. The broader support for CO in abortion among religious-university faculty raises concerns about whether students are being taught their ethical responsibility to put the needs of their patients above their own. Future research should monitor whether Chile's CO regulations and practices are guaranteeing people's access to abortion care.

Abortion and conscientious objection: The new battleground

This paper examines the vexed issue of conscientious objection and abortion. It begins by outlining the increasing claims to conscientious objection invoked by physicians in reproductive health services. After an examination of developments overseas, the paper turns to the acrimonious debate in Victoria concerning the conscience clause and the 'obligation to refer' contained in the Abortion Law Reform Act 2008 (Vic) ('ALRA'). This paper questions the interpretation by the Catholic Church that the clause breaches its right to freedom of conscience and freedom of religion. We argue that the unregulated use of conscientious objection impedes women's rights to access safe lawful medical procedures. As such, we contend that a physician's withdrawal from patient care on the basis of conscience must be limited to certain circumstances. The paper then examines international and national guidelines, international treaties and recommendations of treaty monitoring bodies, laws in other jurisdictions, and trends in case law. The purpose of this examination is to show that the conscientious objection clause and the 'obligation to refer' in ALRA is consistent with international practice and laws in other jurisdictions. Finally, the paper turns to the problematic interpretation of conscience and moral responsibility in the context of abortion. We believe that narrow interpretations of conscience must be challenged, in order to incorporate patients' rights to include the choice of abortion and other lawful treatments according to their conscience. We conclude that the conscientious objection provisions in ALRA have achieved the right balance and that there is no justifiable legal reason upon which opponents can challenge the law.

Re-Thinking the Use of Conscientious Objection by Health Professionals: A Regulatory Proposal Based on Legal Abortion Practices in Argentina

“Ninety percent of health-care practitioners will not perform abortions,” warned physicians in Chaco, a province in north-eastern Argentina, during the debate in Argentina’s Senate to extend the legalization of abortion in July 2018. Around this same time, in a nearby province, Misiones, every physician in one hospital declared that they would register as conscientious objectors should the legislation prove successful. Just a few days earlier, Argentina’s press reported that more than 200 girls had been raped and forced to give birth in Misiones, without access to legal abortion under the rape indication. In Argentina abortion is legally permitted in cases where a pregnancy presents a risk to the life or health of the pregnant woman or person and in cases of rape.

Nurses' use of conscientious objection and the implications for conscience.

To explore the meaning of conscience for nurses in the context of conscientious objection (CO) in clinical practice. Interpretive phenomenology was used to guide this study. Data were collected from 2016 - 2017 through one-on-one interviews from eight nurses in Ontario. Iterative analysis was conducted consistent with interpretive phenomenology and resulted in thematic findings. Iterative, phased analysis using line-by-line and sentence highlighting identified key words and phrases. Cumulative summaries of narratives thematic analysis revealed how nurses made meaning of conscience in the context of making a CO. Conscience issues and CO are current, critical issues for nurses. For Canadian nurses this need has been recently heightened by the national legalization of euthanasia, known as Medical Assistance in Dying in Canada. Ethics education, awareness, and respect for nurses' conscience are needed in Canada and across the profession to support nurses to address their issues of conscience in professional practice. Ethical meaning emerges for nurses in their lived experiences of encountering serious ethical issues that they need to professionally address, by way of conscience-based COs. This is the first study to explore what conscience means to nurses, as shared by nurses themselves and in the context of CO. Nurse participants expressed that support from leadership, regulatory bodies, and policy for nurses' conscience rights are indicated to address nurses' conscience issues in practice settings.

Refusing Reproductive Health Services on Grounds of Conscience in Latin America

The years have seen a rise in the use of conscientious objection (CO) as means to deny women their sexual reproductive health rights. While states have an obligation under international human rights law to protect the freedom of thought, conscience and religion of people, they also have obligations to protect the right to the highest attainable standard of health and other fundamental rights. Over the years, International and regional human rights bodies have indicated the need for CO to be limited so as to protect women’s rights. As a means to balance both rights of medical service providers to exercise their moral beliefs and to protect the right to health of women, countries around the world have also sought different ways to regulate the use of CO. Whereas in some countries, some developments have been made to regulate CO so as to protect fundamental rights of women, in others, few guidelines exist in order to ensure availability of services for women in case refusals are made. This article provides an overview of policies regulating CO in Latin America. It considers the regulation of CO under both international law and under various state laws within the region. It suggests that if women’s reproductive rights are to become a reality, then there is a real need that states as well as international and regional human rights bodies continue to find ways to clarify frameworks around CO, so that grounds of conscience do not become an excuse to deny women realisation of their fundamental rights.

"The Fetus Is My Patient, Too": Attitudes Toward Abortion and Referral Among Physician Conscientious Objectors in Bogotá, Colombia.

In 2006, the Colombian Constitutional Court partially decriminalized abortion. However, barriers to access, including improper use of conscientious objection, remain. To explore conscientious objection from the objectors' perspectives, in-depth interviews were conducted in 2014 with 13 key informants and with 15 Colombian physicians who self-identified as conscientious objectors. Recruitment included snowball and purposive sampling techniques. Analysis was conducted in tandem with data collection and focused on objectors' attitudes, beliefs and behaviors related to abortion and referral. Objectors had varied perspectives. Three types of objectors were evident: extreme, moderate and partial. Extreme objectors refused to perform abortions or make referrals, and often lectured their patients; they also provided misleading or false medical and legal information, preventing women from accessing abortions to which they were legally entitled. Moderate objectors would not perform abortions, but respected their patients and viewed referral as a way to save "one out of two" lives. Partial objectors performed some abortions but refused to do others on the basis of gestational age or case-by-case circumstances. Across the typology, objectors linked conscientious objection with medical ethics, and many described a duty to protect the fetus, which they conceptualized as a patient. Conscientious objectors exhibit diverse opinions and behaviors. Potential areas for future investigation include identifying factors that lead objectors to refer and estimating the prevalence of each type of objector. Results suggest potential interventions that could reduce the role of conscientious objection as a barrier to care.

Reproductive Governance in the New Europe

While the European Union currently lacks a mandate to govern reproductive health services and policies, reproductive governance is increasingly debated both at the EU and the nation-state levels. The EU has taken formal positions to promote access to comprehensive reproductive health services. In tension with the EU's position is the Vatican, which promotes the use of conscientious objection to decline the provision of certain health services. Currently, the use of conscientious objection is mostly unregulated, prompting debates about supranational regulation at the Parliamentary Assembly of the Council of Europe (PACE) meeting in Paris in 2010. This article uses the lens of the PACE meeting debate to consider the cultural, historical and political specificities and agendas that give shape to competing arguments about rights, health and state sovereignty. I argue that political rationalities directed towards reproduction locally and the supranational rights debates work synergistically to paralyse European reproductive health policymaking.

Il caso Italia: medicina riproduttiva e obiezione di coscienza

The subject of this article is the Italian law in European context, regulating abortion and the conscientious objection by medical staff. The methodology is one developed by Jasanoff in Designs of Nature. After describing the historical, cultural and national policy, the article proceeds with the analysis of art. 9 of Law May 22, 1978 194, which regulates conscientious objection on the part of medical personnel to the voluntary interruption of pregnancy. The issue of conscientious objection is framed also in the European context. In this regard, the analysis focuses on the document that the Social Health and Family Issues Committee presented to the European Parliamentary Assembly, entitled Women's access to lawful medical care: the problem of unregulated use of conscientious objection. In this document , Italy is seen as an emblematic case of the problematic legal institution of conscientious objection, as confirmed by Table 28 of the Report 2012 of the Ministry of Health on the implementation of Law 194, according to which the percentage of objection exceeds 69%. There is a big focus on the comparison between the levels of involvement and action of different political, institutional, social and cultural entities: the role of the Italian State in producing standards and knowledge in terms of human reproductive medicine, as well as the role of ethics committees and epistemic national communities. The analysis focuses on the development of European and international law, on the contributions of the categories of professionals, on the opinions of bioethicists about the issue of conscientious objection to medical techniques relevant for and moral philosophy, such as the interruption of pregnancy. For this purpose, the article analysed the different perspectives expressed by professional associations, such as the League of not-objector gynecologists called LAIGA, and the committee of bioethicists, such as the National Bioethics Committee, which, in the document of 30 July 2012, entitled Conscientious Objection and bioethics declared to be favour of it.

Il caso Italia: medicina riproduttiva e obiezione di coscienza

The subject of this article is the Italian law in European context, regulating abortion and the conscientious objection by medical staff. The methodology is one developed by Jasanoff in Designs of Nature. After describing the historical, cultural and national policy, the article proceeds with the analysis of art. 9 of Law May 22, 1978 194, which regulates conscientious objection on the part of medical personnel to the voluntary interruption of pregnancy. The issue of conscientious objection is framed also in the European context. In this regard, the analysis focuses on the document that the Social Health and Family Issues Committee presented to the European Parliamentary Assembly, entitled Women's access to lawful medical care: the problem of unregulated use of conscientious objection. In this document , Italy is seen as an emblematic case of the problematic legal institution of conscientious objection, as confirmed by Table 28 of the Report 2012 of the Ministry of Health on the implementation of Law 194, according to which the percentage of objection exceeds 69%. There is a big focus on the comparison between the levels of involvement and action of different political, institutional, social and cultural entities: the role of the Italian State in producing standards and knowledge in terms of human reproductive medicine, as well as the role of ethics committees and epistemic national communities. The analysis focuses on the development of European and international law, on the contributions of the categories of professionals, on the opinions of bioethicists about the issue of conscientious objection to medical techniques relevant for and moral philosophy, such as the interruption of pregnancy. For this purpose, the article analysed the different perspectives expressed by professional associations, such as the League of not-objector gynecologists called LAIGA, and the committee of bioethicists, such as the National Bioethics Committee, which, in the document of 30 July 2012, entitled Conscientious Objection and bioethics declared to be favour of it.

Abortion and Conscientious Objection: The New Battleground

This paper examines the vexed issue of conscientious objection and abortion. It begins by outlining the increasing claims to conscientious objection invoked by physicians in reproductive health services. After an examination of developments overseas, the paper turns to the acrimonious debate in Victoria concerning the conscience clause and the ‘obligation to refer’ contained in the Abortion Law Reform Act 2008 (Vic) (‘ALRA’). This paper questions the interpretation by the Catholic Church that the clause breaches its right to freedom of conscience and freedom of religion. We argue that the unregulated use of conscientious objection impedes women’s rights to access safe lawful medical procedures. As such, we contend that a physician’s withdrawal from patient care on the basis of conscience must be limited to certain circumstances. The paper then examines international and national guidelines, international treaties and recommendations of treaty monitoring bodies, laws in other jurisdictions, and trends in case law. The purpose of this examination is to show that the conscientious objection clause and the ‘obligation to refer’ in ALRA is consistent with international practice and laws in other jurisdictions. Finally, the paper turns to the problematic interpretation of conscience and moral responsibility in the context of abortion. We believe that narrow interpretations of conscience must be challenged, in order to incorporate patients’ rights to include the choice of abortion and other lawful treatments according to their conscience. We conclude that the conscientious objection provisions in ALRA have achieved the right balance and that there is no justifiable legal reason upon which opponents can challenge the law.

Conscientious Objection to Sexual and Reproductive Health Services: International Human Rights Standards and European Law and Practice

The practice of conscientious objection often arises in the area of individuals refusing to fulfil compulsory military service requirements and is based on the right to freedom of thought, conscience and religion as protected by national, international and regional human rights law. The practice of conscientious objection also arises in the field of health care, when individual health care providers or institutions refuse to provide certain health services based on religious, moral or philosophical objections. The use of conscientious objection by health care providers to reproductive health care services, including abortion, contraceptive prescriptions, and prenatal tests, among other services is a growing phenomena throughout Europe. However, despite recent progress from the European Court of Human Rights on this issue (RR v. Poland, 2011), countries and international and regional bodies generally have failed to comprehensively and effectively regulate this practice, denying many women reproductive health care services they are legally entitled to receive. The Italian Ministry of Health reported that in 2008 nearly 70% of gynaecologists in Italy refuse to perform abortions on moral grounds. It found that between 2003 and 2007 the number of gynaecologists invoking conscientious objection in their refusal to perform an abortion rose from 58.7 percent to 69.2 percent. Italy is not alone in Europe, for example, the practice is prevalent in Poland, Slovakia, and is growing in the United Kingdom. This article outlines the international and regional human rights obligations and medical standards on this issue, and highlights some of the main gaps in these standards. It illustrates how European countries regulate or fail to regulate conscientious objection and how these regulations are working in practice, including examples of jurisprudence from national level courts and cases before the European Court of Human Rights. Finally, the article will provide recommendations to national governments as well as to international and regional bodies on how to regulate conscientious objection so as to both respect the practice of conscientious objection while protecting individual's right to reproductive health care.