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

Abstract

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.

Nurses' attitudes toward, perceptions of, and experiences with conscientious objection

“…Overall, it is unacceptable for healthcare professionals to refuse to provide care to people due to their sexual orientation or race. 35…”

Relationship between nurses' perceptions of conscience and perceptions of individualized nursing care: A cross‐sectional study

“…In the present study, the nurses' placing the item “we should have inner peace to be able to hear the voice of conscience” in the third place is compatible with the statement in the literature indicating that inner peace is necessary to hear the voice of conscience to help others to continue wellbeing of their lives. The reasons for consulting conscience as a reference in nursing can be explained by the fact that conscience has an intuitive aspect, that the majority of the participants were women, that women use their intuition more frequently, and that conscience is frequently used in performing actions because consulting conscience in such cases is widely accepted by the society (Eagen‐Torkko & Levi, 2020). However, within the nursing philosophy, nurses attach more importance to conscience because they spend more time with the patient, and thus they more closely witness the psychosocial characteristics of patients, because they are closer to patients' value‐related problems and because being compassionate in a cultural context is considered as a sign of being conscientious (Mojarad et al, 2018).…”

“…Within the context of nursing care, nurses today face challenging situations that require them to make difficult conscientious decisions when providing health care to patients and cause them to experience dilemmas more than usual (Eagen‐Torkko & Levi, 2020; Gorbanzadeh et al, 2015). In such difficult situations, nurses need a sensitive conscience to guide their values and moral actions while performing their professional roles.…”

The Critical Role of Midwives in Safe Self‐Managed Abortion

“…These conscientious objections are legally protected, but consideration must also go to the harm they can potentially cause, and what the ethical implications are of that harm. 36 In a situation in which the midwife has more information than their patient and declines to share that information although that midwife's choice may cause harm, withholding information must be considered unethical. Informationsharing around self-managed abortion does not ask any midwife to participate in abortion care, nor does it obligate a midwife to initiate the conversation about self-managed abortion with a patient.…”

“…Midwives who oppose access to abortion may feel that sharing information about self‐managed abortion is tantamount to participating in abortion care and decline to do so on grounds of conscience. These conscientious objections are legally protected, but consideration must also go to the harm they can potentially cause, and what the ethical implications are of that harm 36 . In a situation in which the midwife has more information than their patient and declines to share that information although that midwife's choice may cause harm, withholding information must be considered unethical.…”