Conscientious Commitment to Women’s Health
In the course of the 20th century, the progressive relaxation of restrictive laws affecting women’s reproductive health has generated a reaction, particularly among healthcare practitioners who hold conservative religious beliefs, of invoking rights of conscience to object to participation in such practices as prescribing or dispensing contraceptive products and undertaking contraceptive sterilization procedures and elective abortions. The call for healthcare practitioners’ conscientious commitment to undertake procedures to protect women’s health often arises in response to other practitioners’ failures or refusals to provide care.
Practitioners conscientiously committed to promoting the health of pregnant women would recognize that the women, rather than the fetuses, are their patients. Accordingly, as patients, the women rather than their caregivers determine whether or not they receive available treatment indicated for their care, either related or unrelated to pregnancy itself, such as chemotherapy for cancer, that may affect the fetuses they bear or may bear in the future.
A similar concern has been observed regarding the treatment of women who experience spontaneous abortion. In hospitals owned or operated by Roman Catholic authorities, religious doctrines may be applied to prevent uterine evacuation in the event of threatened spontaneous abortion while a fetal heartbeat is detected.
Protocols, ethics committee decisions on clinical cases and rulings in such cases by religious officeholders that deny patients the available care their physicians consider to be in their best interests or that result in injury by delay of care or because of transportation of patients to other facilities raise serious concerns in law and in healthcare providers’ professional ethics. Treating threatened spontaneous abortion via uterine evacuation is legally distinguishable from deliberately inducing abortion. Concerns in professional ethics include whether conscientious physicians can allow compromise of their judgment, and of their provision of best care to their patients, by third-party doctrinal intervention. Conscientious commitment to patients’ safest care and healthcare providers’ own safety from legal liability and professional censure may coincide.
From a medical perspective, the ectopic embryo or fetus may never be considered viable, but much turns on how the purpose of a treatment is characterized (e.g., whether by an attending physician, a hospital committee or chaplain or a more senior church official such as a bishop) and by whom decision makers are influenced.
The need has grown for physicians’ and other healthcare providers’ conscientious commitment to delivery of women’s reproductive health services, to counter the rise of providers’ religiously based claims to deny services on grounds of their conscientious objection.
For instance, a leading Catholic healthcare theologian, Thomas O’Donnell, claims that no intervention is permissible unless, or until, the fallopian tube is so pathologically affected that ending the tubal pregnancy is justified. Further, he finds that removal of a nonviable fetus from the fallopian tube is not theologically different from its removal from the uterus, which is condemned as abortion. However, the Catholic bioethicist Kevin O’Rourke claims that all treatment options are permissible. Removing the affected fallopian tube (salpingectomy) is justified, because the direct intention is to save the mother’s life—the fetal death being an unintended but unpreventable effect. Salpingostomy, in which the tube is not removed, is similarly defensible, because the intention is to remove the woman’s damaged tubal tissue and the damaging trophoblastic tissue (e.g., by use of methotrexate), not to kill or destroy the embryo.
Theologic analysis and debate are governed by their own principles, but what constitutes abortion is also a matter of law.
The need has grown for physicians’ and other healthcare providers’ conscientious commitment to delivery of women’s reproductive health services, to counter the rise of providers’ religiously based claims to deny services on grounds of their conscientious objection. Conservative legislatures in many countries have enacted laws to protect such objection, publicly invoking the virtues of conscience to pursue the sometimes less visible aim of reduction of women’s reproductive choices.
Respect for conscience requires accommodation of both objection to participation in services and commitment to their delivery. Conscientious commitment may call for courage when treatment is provided that contradicts nonmedical directives such as those by religious institutions and officers. Healthcare providers’ professional ethics require mutual tolerance and accommodation, however, and resistance to forces of intolerance. The FIGO Ethical Guidelines on Conscientious Objection provide, in Guideline 4, that “[p]ractitioners have a right to respect for their conscientious convictions in respect both of undertaking and not undertaking the delivery of lawful procedures, and not suffer discrimination on the basis of their convictions.” Institutions that would apply punitive sanctions against those whose exercising of their rights to conscience the institutions disapprove weaken the justification for protection of the exercise of conscience they require or approve.