Can Doctors Say No to Providing Abortion Care?

The religious rights of a small group of medical professionals do not trump those held by the remainder of the citizenry.

I recently returned to Australia from Seville, where I attended an international conference on all aspects of abortion care. Among the issues discussed were the barriers women face to accessing termination services, even in countries where the procedure is legal.

Foremost among these is refusal by medical practitioners and healthcare institutions on grounds of religion or conscience. They include religious doctors as well as public hospitals and clinics operated by Catholic groups and associations. Abortion is not the only service such individuals and institutions don’t offer. The list includes birth control (including emergency contraception for rape victims), sterilisations, infertility services and comprehensive HIV/Aids prevention information.

Women suffer profound costs to their health and dignity when the medical professionals and institutions they are forced to rely on – and whose salaries and budgets they fund through their taxes – disregard the informed choices they make about their reproductive healthcare. In Poland, a woman effectively lost her sight when all three of the doctors who predicted this outcome refused to grant permission for her to abort. In Columbia, a 13-year-old rape victim was repeatedly refused an abortion despite her attempts at suicide when pregnancy and sexually transmitted infections were diagnosed. Countless women across the world have had religious doctors deny them accurate results from pre-natal scans to preclude them having the option of abortion.

Despite the heartless and arrogant nature of such medical practice, Catholic medical staff and institutions staunchly defend it, and dismiss the suffering and loss of autonomy women endure as a result. In Australia, where the state of Victoria recently passed an abortion law that required refusing doctors to refer and to treat in a life-threatening emergency, Catholic leaders slammed the new law as the “nastiest human rights abuse”. A group calling itself Doctors in Conscience condemned the demand that religious doctors provide an abortion where their refusal would see a woman die as ushering in “a new era of healthcare in Australia in which individual health workers and healthcare organisations can be coerced to act contrary to their consciences”.

In the same way religious doctors and institutions deny the rights and duties of medical colleagues whose conscience impels them to support a woman’s informed medical choice to abort a problem pregnancy. When a 27-year-old mother of four staggered into a Catholic hospital in America last November, 11 weeks pregnant and gravely ill, the doctors told her that if she continued with the pregnancy her risk of mortality was “close to 100%”. But when Sister Margaret McBride authorised the abortion necessary to save the woman’s life, she was sacked and excommunicated. The priest heading up the hospital ethics committee justified this decision with the pronouncement that: “The reason for [an abortion] never matters.”

Secular moral principles – those to which everyone in society can subscribe – do not support the unilateral denial by medical practitioners of particular types of care to certain sorts of patients. This is for the simple reason that no right, whether legal or moral, is absolute.

The rights of a religious medical provider to refuse to terminate a pregnancy must be balanced against the similarly compelling rights of the patient to follow her conscience in choosing abortion. Medical practitioners also have an obligation to treat, a duty that in part flows from the monopoly they exercise over healthcare. Patients, relatedly, have a right to timely medical care as well as an entitlement not suffer direct or indirect sex discrimination.

The religious rights of a small group of medical professionals do not “trump” those held by the remainder of the citizenry. A compromise between the two is required.

A consensus on the necessary features of such a settlement is now emerging from statutes and case law in jurisdictions around the world. So far, what seems to be agreed is that institutions lack consciences. Only individuals have a right to refuse care on conscience grounds. Medical staff who are directly involved with the procedure are the only ones entitled to refuse co-operation on conscience grounds, and such refusals cannot encompass pre- or post-operative care. Emergency abortion care must be provided and, in non-urgent cases, medical professionals must disclose their conscientious objection to the patient as soon as possible and ensure an effective referral is made. Institutions and healthcare systems must guarantee the availability of full-service staff to meet patients’ demand and there must be consequences for an individual or institution where conscience claims result in women being denied the care to which they are entitled.

The final feature of emerging conscience law also constitutes my final ethical point about conscientious action – that it cannot be invoked to violate the fundamental right of women to lawful healthcare. Conscientious exemptions to treat are grounded in concerns about dirty hands and the limited right of an individual, in a society committed to individual freedom, to avoid direct involvement with something her conscience or religion forbids. Deploying conscience claims as a means to deny women’s access to lawful services, however, lacks all moral legitimacy.

This is not to say that morality precludes medical objectors from moving beyond the avoidance of doing wrong themselves to acting to stop what they believe is wrong all together. Rather it is to remind them that such behaviour is called civil disobedience – not conscientious objection – and requires far more sacrifice from them (including a willingness to go to prison) to be worthy of respect.

Publication history

Abortion is about balancing rights - religious medics don't get the final say