Reframing Conscientious Care: Providing Abortion Care When Law and Conscience Collide

Abstract

While the concept of conscience has broad philosophical underpinnings relating to moral judgment, agency, and discernments of right and wrong, debates in bioethics have tended to engage the concept primarily vis-à-vis rights of conscientious refusal. Here, we suggest a broader frame for thinking about claims of conscience in healthcare. Drawing on empirical findings from our research with abortion providers in North Carolina, we elucidate an empirically grounded approach to ethically justified care when healthcare providers face legal or institutional policy mandates that raise possible moral conflicts. We highlight, in particular, how providers may be motivated by matters of conscience, including relational concerns, in the active provision of certain forms of care. In so doing, we challenge the dichotomy between conscientious refusal and morally compromised action, demonstrating how providers may work within the constraints of laws or institutional policies that raise moral challenges and act in accordance with conscience.

The Zika epidemic and abortion in Latin America: a scoping review

“…Several scholarly bodies have called for expanded access to safe abortion in Latin America, particularly given contemporary concerns about Zika and CZS [ 41 , 45 , 50 – 52 , 61 , 63 , 75 ]. However, our findings suggest that, even where abortion is legal, social and religious norms may dissuade health care practitioners from providing abortion services, and/or prevent women from accessing services [ 45 , 49 – 52 , 63 ], which is supported by previous research about abortion worldwide [ 42 , 76 – 79 ]. Although it did not emerge as a key theme in our review, it is contextually important to note that the Catholic church (and increasingly, Evangelical Protestantism) plays a key role in promoting restrictive abortion legislation in the region: religious leaders and institutions are uniquely positioned to influence the actions of politicians and policymakers, and they have historically exercised this power on matters concerning reproductive health policy [ 79 – 81 ].…”

When Policy Produces Moral Distress: Reclaiming Conscience

“…In “Reframing Conscientious Care: Providing Abor‐tion Care When Law and Conscience Collide,” Mara Buchbinder and colleagues draw our attention to another dimension of the problem of reducing conscience to refusal: what about the conscience problems experienced by the professionals who are attempting to provide safe, effective health care that includes services that others associate with conscientious objection? Here, the person with the conscience problem is not the physician who views abortion as morally wrong and did not seek clinical training in this procedure and so is at little risk of being involved in it.…”

Conscience, Courage, and “Consent”

“…In this issue of the Report, the authors present a thoughtful and nuanced analysis of positive claims of conscience in patient care. 3 They document the range of options available to these physicians and analyze the choices in terms of "relational ethics" rather than the sharper-edged principles of autonomy and rights, which too often pit patients and physicians against each other. In our own work, we have also stressed the importance of relational approaches to health law and ethics.…”

“…2 The consequences of facilitating refusal by means of conscience-clause mechanisms are dramatically evident in public health law, where "too much protection" of a parent's right to refuse child-hood vaccinations for nonmedical reasons is associated with high local rates of refusal and of outbreaks of preventable disease. 3 In "Reframing Conscientious Care: Providing Abortion Care When Law and Conscience Collide," Mara Buchbinder and colleagues draw our attention to another dimension of the problem of reducing conscience to refusal: 4 what about the conscience problems experienced by the professionals who are attempting to provide safe, effective health care that includes services that others associate with conscientious objection? Here, the person with the conscience problem is not the physician who views abortion as morally wrong and did not seek clinical training in this procedure and so is at little risk of being involved in it.…”

“…In order to address this question, Mara Buchbinder and her colleagues from the University of North Carolina School of Medicine conducted interviews with North Carolina providers of pregnancy termination services, talking with them about how their practices have been affected by the state's WRTK Act. In this issue of the Report , the authors present a thoughtful and nuanced analysis of positive claims of conscience in patient care . They document the range of options available to these physi‐cians and analyze the choices in terms of “relational ethics” rather than the sharper‐edged principles of autonomy and rights, which too often pit patients and physicians against each other.…”