Doctors who perform abortions for women are compelled to do so because of strong moral reasons, just as those who refuse to perform abortions are repelled from doing so by their own convictions, says research published today in the New England Journal of Medicine by University of Michigan bioethicist and gynaecologist, Dr. Lisa Harris, M.D., Ph.D. Exercising conscience in healthcare is usually considered synonymous with refusing to provide contested services, like abortion, but Dr. Harris, an assistant professor of obstetrics and gynaecology at the University of Michigan Health System, says doctors can also be “conscientious” providers of abortion.
The journal article begins:
“The persistent failure to recognize abortion provision as “conscientious” has resulted in laws that do not protect caregivers who are compelled by conscience to provide abortion services, contributes to the ongoing stigmatization of abortion providers, and leaves theoretical and practical blind spots in bioethics with respect to positive claims of conscience — that is, conscience-based claims for offering care, rather than for refusing to provide it.”
To read Dr Harris’ paper, please visit the New England Journal of Medicine website where the article is offered as a free text.
The history of abortion is liberally peppered with the, sometimes violent, effects of the dichotomy in moral belief around the subject.
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On one side, the Church remains steadfastly against any form of abortion, without regard to the circumstances surrounding the conception, be they rape or incest, or even if the continued pregnancy would likely result in the deaths of both mother and foetus. It is better for the immortal soul, they contend, that even a raped woman endure nine months of nourishing the product of that rape within her body and then the rest of her life raising and looking out for the child, than to commit the grievous sin of terminating the pregnancy. Traditionally, the laws of most countries have bowed to the Church’s will in this respect, enacting laws which prohibit seeking or performing abortion services.
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On the other side, are the individuals who through time have felt compelled to risk everything in order to provide abortion services to those who are in need of them. Well before the landmark legal case of Roe v. Wade, which established the legal right of a woman to an abortion until such time as the foetus was viable, some doctors, midwives and nurses have undertaken to provide abortion illegally, to women who sought it, most likely after seeing the results of women who attempted to perform abortions on themselves, or sought the assistance of unqualified and dangerous providers with tragic consequences.
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Dr. Harris highlights both contemporary and historical evidence that conscience is the primary motivator amongst professional healthcare providers who undertake abortion. She cites the 1995 study by sociologist Carole Joffe which demonstrated that safe, compassionate abortion care was provided by skilled, mainstream doctors risking fines, the loss of their medical license, imprisonment, personal harm, threats to their families and ostracism, prior to abortion becoming legal in 1973.
“They did so because the beliefs that mattered most to them compelled it. They saw women die from self-inducted abortion and from abortions performed by unskilled providers,
“They understood safe abortion to be lifesaving. They believed their abortion provision honored ‘the dignity of humanity’ and was the right — even righteous — thing to do. They performed abortions ‘for reasons of conscience.'” Dr. Harris writes in the study.
She says contemporary abortion providers are motivated by conscience as well:
“Though today abortion providers work within the law, they still have much to lose, facing stigma, marginalization within medicine, harassment and the threat of (or actual) physical harm.….However doctors … continue to offer abortion care because deeply-held, core ethical beliefs compel them.”
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Federal and state laws continue to protect only conscience-based refusals to perform, or refer for, abortion, offering minimal legal protection for conscience-based abortion provision.
In addition, equating conscience with only the refusal to perform abortion continues to stigmatize physicians who are abortion providers.
“If physicians who offer abortion don’t have a legitimate claim to act in ‘good conscience,’ as do their counterparts who oppose abortion, then the implication is that they act in ‘bad conscience’ or lack conscience altogether,” Dr. Harris writes.
She says bioethicists have focused on moral claims to refuse care provision, largely neglecting that moral integrity can be injured as much by not performing an action required by one’s core beliefs as by performing an action that contradicts those beliefs.
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Harris acknowledges that those who oppose abortion will likely argue that abortion providers have motivations other than conscience. While she disagrees, she says this highlights the importance of distinguishing claims of conscience from other types of claims:
“Certainly, if abortion providers’ conscience-based claims require scrutiny, so do conscience-based refusals, to ensure that refusals are indeed motivated by conscience and not by political beliefs, stigma, habit, erroneous understanding of medical evidence or other factors.”
In addition to calling for recognition of “conscientious provision” of care, Harris calls for a standard curriculum and a standard of care for conscientious refusals.
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Lisa H. Harris. Recognizing Conscience in Abortion Provision. New England Journal of Medicine, 2012; 367 (11): 981 DOI: 10.1056/NEJMp1206253
Joffe CE. Doctors of conscience: the struggle to provide abortion before and after Roe v. Wade. Boston: Beacon Press, 1995.