Quotas: Enabling Conscientious Objection to Coexist with Abortion Access

Abstract

The debate regarding the role of conscientious objection in healthcare has been protracted, with increasing demands for curbs on conscientious objection. There is a growing body of evidence that indicates that in some cases, high rates of conscientious objection can affect access to legal medical services such as abortion—a major concern of critics of conscientious objection. Moreover, few solutions have been put forward that aim to satisfy both this concern and that of defenders of conscientious objection—being expected to participate in the provision of services that compromise their moral integrity. Here we attempt to bring some resolution to the debate by proposing a pragmatic, long-term solution offering what we believe to be an acceptable compromise—a quota system for medical trainees in specialties where a conscientious objection can be exercised, and is known to cause conflict. We envisage two main objectives of the quota system we propose. First, as a means to introduce conscientious objection into countries where this is not presently permitted. Second, to minimise or eliminate the effects of high rates of conscientious objection in countries such as Italy, where access to legal abortion provision can be negatively affected.

‘Maternal request’ caesarean sections and medical necessity

“…When this is regulated properly, individuals retain their right not to provide, but the healthcare system in which they operate takes responsibility for ensuring availability of services. 31,32 The provision of PCS is not, therefore, a case where a patient is making a wild and unreasonable request for inappropriate treatment that would undermine doctors' professional integrity. 8,33 It is not, for example, a request for medication with no prospect of benefit, or a request to amputate a healthy limb.…”

“…When this is regulated properly, individuals retain their right not to provide, but the healthcare system in which they operate takes responsibility for ensuring availability of services. 31 , 32 …”