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Conscience Magazine

Doctoring Conscience

By Dick van der Tak August 22, 2016

Physicians have to make hundreds of decisions per day, and the moral compass of their consciences does not always unconditionally point in one direction or the other. Global Doctors for Choice has firsthand experience in working with reproductive health and abortion providers—and their consciences—from all over the world. Where restrictive abortion policies take their toll on women’s autonomy, hostile individuals, authorities or institutions have also singled out our providers, placing their reputations and livelihoods at risk.

Dick van der Tak
Dick van der Tak

I recall a situation in which two Brazilian physicians were excommunicated by the Catholic church for performing a legal abortion for a nine-year-old pregnant with twins following rape/incest. They steadfastly maintained their commitment to medical standards and refused to compromise the patient’s care, despite pressure to abandon her needs. These physicians fulfilled their professional duties towards their patient and acted appropriately within the framework of Brazilian law, which authorizes abortion in the case of rape and if the patient’s life is endangered by continued pregnancy.

It makes me incredibly proud to be working with an exceptional group of providers such as these, supporting them in finding a balance between their rights and women’s right to reproductive healthcare. Sometimes this means that physicians have to follow their conscience and decide to violate protocols because their patients’ health or safety is compromised. On the other hand, it can mean that physicians are not comfortable providing certain services.

As human rights defenders, providers should be protected and aided by their governments in the promotion of fundamental reproductive rights. However, the reality is often very different.

Many providers are committed to providing reproductive healthcare services under very difficult circumstances, even in the face of threats and intimidation. For example, here in the United States, I heard from an obstetrician-gynecologist who provides legal abortion that her children have been harassed at school and that her medical partners are considering removing her from the partnership. As human rights defenders, providers should be protected and aided by their governments in the promotion of fundamental reproductive rights. However, the reality is often very different. Local law enforcement can be unresponsive, poorly informed or even hostile or corrupt when physicians seek protection from antiabortion harassment.

Such contentious environments take a toll on the work and well-being of providers, as well as on the women for whom they provide care. Many feel intimidated and isolated when confronted with threats and abuse, unsure of where to turn for protection or advice. Some may decide to claim conscientious objection to providing abortion in order to avoid getting into trouble, whereas others have genuine religious or philosophical objections. But decisions to avoid providing contentious aspects of reproductive healthcare increase the pressure and workload on the remaining providers. This, in turn, negatively affects women’s healthcare experiences and their health.

I see the ability to exercise conscience as fundamental to individual integrity. In fact, allegiance to this principle supports our organization’s collective defense of the individual woman’s right to autonomy in reproductive decision making. We understand that respect for physicians’ autonomy means that no one should be expected to perform an abortion against her or his personal conviction. National and international medical associations have similarly defended the individual clinician’s right of conscience. However, they have simultaneously asserted that it should be circumscribed by the primary duty to the patient, including requirements to disclose, refer and impart accurate information, and to provide care in cases of emergency.

These issues are neither simple nor one-sided. Conscience and integrity are critically important to all individuals. Faith and religious observance are deeply personal matters, and they are variously interpreted under changing cultural and historical conditions. A physician working in northern Ghana is one of 17 physicians responsible for the care of approximately 800,000 women. He frequently sees deaths and treats severe complications from unsafe abortions. When asked why he joined our advocacy training, he said, “I work all day, I work all night: I can’t work enough. Clearly I have to learn to think differently about these issues.”

Global Doctors for Choice recognizes the complicated task of honoring the rights of dissenters while limiting their impact on other individuals and communities. I often reflect on how we can respect different views but not allow them to infringe upon the rights of others—particularly when this leads to harm to dignity, health or life. The challenge is to protect these competing interpretations and worldviews without enabling some to dominate and override the others.

Therefore, I welcome the ongoing conversation about conscience and autonomy in the reproductive health field. By engaging with academics, religious leaders, journalists, healthcare workers and all other stakeholders, we can strengthen the network of professionals working together to protect women’s health. We can enhance tolerance and move forward to improve access to comprehensive reproductive health for all.

Dick van der Tak
Dick van der Tak

is the executive director of Global Doctors for Choice.