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Conscientious Objection (CO) in Reproductive Healthcare
Name
Institution
Professor
Date
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Introduction
The healthcare field is riddled with complex ethical dilemmas and controversies that
require careful analysis and consideration. One such case that has generated significant
debate is the issue of conscientious objection (CO) in healthcare. It is the refusal of
practitioners to provide specific medical services or procedures due to sincerely held beliefs,
mostly religious, moral, and ethical. While respecting individual autonomy and freedom of
conscience is crucial, this practice raises essential questions regarding patient rights, access to
healthcare, and the potential for discrimination. This analysis will examine the case of
healthcare professionals refusing to provide reproductive healthcare services, specifically
abortion, on the grounds of conscientious objection.
Case Selection and Background Information
The case selected for this research is based on an article published by Reuters, written
by Joanna Gill, on December 22, 2022. The facts presented highlight the experience of
Beatrice, a 24-year-old law student in Italy who faced challenges when seeking an abortion
(Gill, 2022). In 2021, she discovered she was two months pregnant and wanted to undergo an
abortion. However, she encountered difficulties finding a doctor to perform the procedure due
to their CO. The patient also faced coercion with continuing the pregnancy, gathered medical
certificates, endured a mandatory reflection period, and eventually found a doctor in an area
strongly against abortion.
Italy legalized abortion in 1978 under Law 194 to ensure women’s rights in making
decisions about their reproductive health (Caruso, 2020). However, access to abortion
services remains limited and complicated. According to Health Ministry data, up to 69% of
gynecologists and 46% of anesthetists in Italy refuse to perform abortions based on CO (Gill,
2022). The prevalence of conscientious objectors has increased over the years, reaching 65%
of the entire medical pool by 2020, with some cities having as high as 83% of practitioners
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opting out. These regional differences create significant disparities in access to abortion
services, with more conservative regions, particularly in the south of Italy, having limited
availability. The situation forces women to travel long distances and face time constraints
when seeking abortions. Lack of access to abortion has detrimental effects on women’s
education, employment options, and earnings, according to economists.
The issue of CO and restricted access to abortion is not unique to Italy. Countries like
Poland and Hungary have tightened their abortion laws, while the decision by the US
Supreme Court to overturn the landmark Roe v Wade ruling that has deemed abortion
constitutional for decades has emboldened anti-abortion movements globally (JonesNosacek, 2021). It is common for countries in the Western world to have laws permitting
healthcare professionals to object against certain medical services per the moral foundation
for healthcare professionals. They contend that life begins at birth and any form of life
termination is murder. On the other hand, some abortion rights activists argue that these
professionals fail to fulfill their duty to refer women to alternative healthcare providers
(Caruso, 2020). This practice may hinder women’s access to reproductive healthcare,
particularly in regions with limited alternatives. It is also worth noting that certain
Scandinavian countries, such as Sweden and Finland, have taken a different approach by
prohibiting doctors from refusing legal medical care.
The case presents complex ethical issues surrounding women’s reproductive rights. It
sheds light on the challenges individuals face seeking abortions and the potential
consequences of limited access to reproductive healthcare services. Examining the issues
presented will provide insights into the complex interplay between CO, reproductive
healthcare, and the legal and policy considerations surrounding this controversial topic.
Ethical Principles
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Several ethical principles are at play in this case regarding access to abortion services.
Women’s autonomy and reproductive rights are central issues. Beatrice wished to exercise
her autonomy by choosing to terminate her pregnancy, which she has a legal right to do under
Italian law. However, she faced obstacles that hindered her ability to make this decision
freely. Restricted access limiting women’s choices regarding their bodies violates their
autonomy and reproductive rights.
Beneficence and non-maleficence are also important ethical principles in healthcare
that require providers to act in the best interests of their patients and avoid harm. However,
CO conflicts with these principles by denying patients access to necessary care . Even with
the moral autonomy to refuse care, practitioners must refer patients to alternative providers to
prevent psychological stress, health risks, and financial burdens. However, as Beatrice’s case
highlights, most women are left to explore their options independently. After the doctors at
Naples denied her request for an abortion, they did not provide the student with any guidance
on what to do next, leaving her feeling completely isolated. She was forced to wait out a fiveday reflection period and look for a non-conscientious objector facility to perform the
procedure, which was ultimately found 400 km away in an area with a strong anti-abortion
stance. In the US, this is against the American College of Obstetricians and Gynecologists
(ACOG) ethical committee, which mandates that healthcare providers provide accurate and
unbiased patient information (Jones-Nosacek, 2021). They must also refer patients to other
providers if they cannot offer certain services due to conscience.
Justice is another ethical principle that requires healthcare resources to be distributed
fairly and equitably. COs can lead to inequalities in healthcare access, particularly for
marginalized groups. Such is the crisis created by the newly passed bill in Florida that
permits healthcare providers to refuse certain services based on their moral, religious, or
ethical beliefs (Weber, 2023). Critics have expressed concerns that this law could lead to
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discrimination against specific patient groups, such as women and LGBTQ+ individuals
seeking reproductive healthcare, and could exacerbate healthcare disparities. The potential
implications of this law include doctors declining to prescribe birth control or administer
childhood vaccines, psychologists refusing to treat individuals with gender dysphoria, and
healthcare providers rejecting patients with state insurance.
Finally, integrity is an essential ethical value that requires healthcare providers to act
honestly and transparently. As emphasized by ACOG, CO should not be based on personal
distaste, discriminatory attitudes, or self-protective motives (Jones-Nosacek, 2021).
Healthcare providers must provide medically indicated care in emergencies, even if referrals
are impossible. The principles indicate no easy way to handle this complex issue, as it is
challenging to develop a nuanced approach that considers the rights and obligations of all
stakeholders. Further analysis of existing policies might indicate what policymakers are doing
to meet public health needs while respecting providers’ moral agency.
Legal and Policy Analysis
The legal and policy perspective approaches the issue of CO in the context of
international human rights law. The primary governing body, the United Nations, uses its
monitoring bodies to evaluate whether states have a positive obligation to recognize CO in
healthcare. While the duty is not explicitly determined to date, the bodies emphasize the
importance of ensuring access to legal reproductive healthcare (Abortion Care Guideline,
2022). They stress the need for effective regulatory frameworks, including guaranteeing an
adequate number of willing providers, establishing referral systems, imposing limits on
refusals, and implementing monitoring and enforcement mechanisms.
European, African, and Inter-American human rights bodies also shape the legal and
policy landscape. According to Bucholc (2022), the European Court of Human Rights
recognizes that if counties allow CO, they must organize their health services to have legal
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abortion care. The African Commission on Human and Peoples’ Rights emphasizes the
importance of timely referrals and limits on objections in certain situations. The InterAmerican Commission on Human Rights highlights the need to transfer patients to another
healthcare professional without creating barriers to access. These regional bodies further
contribute to the efforts of ensuring individual rights are observed.
Global medical standards from international foundations such as the World Health
Organization (WHO) and the International Federation of Gynaecology and Obstetrics (FIGO)
also emphasize the duty of healthcare professionals to refer patients and prohibit CO in
emergencies (Williams et al., 2023). They stress the need for timely access to services and
treatment without prejudice or bias. Regarding comparative law, countries like Sweden,
Iceland, Finland, and Ethiopia do not recognize a legal right to CO in healthcare related to
abortion. However, others, such as England, Italy, Norway, and Portugal, that permit CO
have implemented regulations to ensure they do not obstruct access to abortion care (Chavkin
et al., 2017). These regulations include establishing robust referral processes and limiting
refusal to individual providers rather than institutions.
The lack of clear and enforceable regulation regarding CO significantly negatively
impacts access to abortion services. On the one hand, there is a recognition of healthcare
professionals’ rights to exercise their moral or religious beliefs through CO (Bucholc, 2022).
On the other hand, there is a concern for patients’ rights to receive necessary medical
services, particularly regarding safe and legal abortion. The differing opinions on the scope of
application highlight the ethical dilemma of prioritizing individual beliefs over patients’
needs. These conflicts underscore the need for effective regulation and measures that balance
these conflicting rights and ensure women’s access to reproductive healthcare.
Stakeholder Perspectives
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CO is often used for political, social, and personal reasons, leading to different
stakeholder groups with different perspectives. First, some healthcare professionals raise CO
to deny providing abortion services. Motivations such as fear of stigmatization and legal
repercussions vary, depending on the situation. From their perspective, CO allows them to
adhere to their personal beliefs and values (Aborigo et al., 2020). However, this can lead to
conflicts within healthcare teams and delays in abortion services. Secondly, patients seeking
legal abortions want timely access to these services without undue delays caused by CO.
They perceive CO as a barrier that infringes on their choices. They believe access to safe and
legal abortion is a necessary reproductive right.
Thirdly, policymakers are essential in implementing regulations considering
healthcare professionals’ rights and women’s access to reproductive health. Some argue for
restricting CO in certain situations to ensure adequate provision of abortion services (Michel
et al., 2022). Others prioritize the protection of healthcare professionals’ freedom of
conscience. These contrasting viewpoints create conflicts of interest when developing
regulatory measures. The other category is public, with diverse viewpoints depending on their
moral, religious, and political stances toward abortion. Those who oppose abortion tend to
support the broad rights of CO, while abortion rights supporters want to limit CO to reduce
barriers to legal abortions.
Finally, activists have differing opinions on CO. On the one hand, some work to raise
awareness, engage in public advocacy, and lobby for policy changes that address the potential
conflicts and challenges arising from CO. They push for regulatory measures that balance
individual freedom of conscience with the protection of women’s rights and access to
reproductive healthcare. Others support the freedom of healthcare professionals to invoke
CO, citing the importance of accommodating diverse beliefs within the healthcare system.
Ethical Resolution
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In light of the ongoing debate surrounding CO in reproductive health, I propose a
well-justified ethical resolution that considers the ethical principles, legal and policy
implications, and stakeholder perspectives involved. After considering the information
provided, a reasonable resolution would involve implementing the “clinically indicated
procedures” as a standard for permitting CO. According to Zohny (2019), doctors can object
to providing treatments or procedures, but only those not medically necessary. They should
provide all the essential care as mandated by their code of conduct. When it comes to
abortion, in particular, healthcare providers are obligated to assist women before and after the
procedure (Negro et al., 2022). While they may refuse to perform abortions themselves based
on conscience, denying women post-procedural monitoring or care disproportionately
impacts women’s health and well-being. This interferes with their reproductive autonomy and
freedom of choice, which must be respected and facilitated ethically and legally. This
reasonable compromise balances doctors’ moral integrity with ensuring patient access to
beneficial medical care.
The resolution balances the competing interests of reproductive autonomy and
freedom of choice for women seeking abortions with the conscience-based refusal of
healthcare professionals. According to Zohny (2019), it ensures that medical interventions
with clear health benefits and appropriateness for the patient’s condition are prioritized.
However, it is essential to acknowledge that this proposed resolution may not cover all
possible scenarios, and there might be cases where further consideration is needed. It is
crucial to continuously evaluate and refine the criteria for permitting CO to balance between
individual moral integrity and patient access to essential healthcare. Ongoing evaluation and
open dialogue between stakeholders can help identify shortcomings and make adjustments.
Regarding the outcome, the proposed resolution addresses concerns about potential
limitations on patient access to medical services while allowing CO. This outcome is just as it
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considers all stakeholders and recognizes the complex nature of the issue. I support the
approach as it provides a reasonable starting point for implementing CO in healthcare while
preserving doctors’ moral integrity and duty to care.
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References
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Awoonor‐Williams, J. K. (2020). Optimizing task‐sharing in abortion care in Ghana:
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Abortion Care Guideline. (2022). Law and Policy Recommendation 22: Conscientious
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Negro, F., Varone, M. C., Del Rio, A., Marinelli, S., & Basile, G. (2022). Conscientious
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Weber, S. (2023). Florida Docs Can Soon Deny Patient Care Based on Personal, Religious
Beliefs. MedScape. Retrieved 28 June 2023 from
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