Yes we can! Successful examples of disallowing ‘conscientious objection’ in reproductive health care

Abstract

Reproductive health care is the only field in medicine where health care professionals (HCPs) are allowed to limit a patient’s access to a legal medical treatment – usually abortion or contraception – by citing their ‘freedom of conscience.’ However, the authors’ position is that ‘conscientious objection’ (‘CO’) in reproductive health care should be called dishonourable disobedience because it violates medical ethics and the right to lawful health care, and should therefore be disallowed. Three countries – Sweden, Finland, and Iceland – do not generally permit HCPs in the public health care system to refuse to perform a legal medical service for reasons of ‘CO’ when the service is part of their professional duties. The purpose of investigating the laws and experiences of these countries was to show that disallowing ‘CO’ is workable and beneficial. It facilitates good access to reproductive health services because it reduces barriers and delays. Other benefits include the prioritisation of evidence-based medicine, rational arguments, and democratic laws over faith-based refusals. Most notably, disallowing ‘CO’ protects women’s basic human rights, avoiding both discrimination and harms to health. Finally, holding HCPs accountable for their professional obligations to patients does not result in negative impacts. Almost all HCPs and medical students in Sweden, Finland, and Iceland who object to abortion or contraception are able to find work in another field of medicine. The key to successfully disallowing ‘CO’ is a country’s strong prior acceptance of women’s civil rights, including their right to health care.

Chinese abstract

生殖健康服务机构是所有医疗服务机构(HCPs)中唯一一个可以以“良心上的反对”来限制病人得到合法的医疗服务（往往是堕胎或避孕）的领域。但是，本文作者认为，在生殖健康服务机构，这种“良心上的反对” (‘CO’)可以被称为不光彩的反对，应该被禁止，因为这种行为违背了医疗道德和病人合法的得到医疗保健的权利。三个国家：瑞典，芬兰和冰岛，不允许医疗机构(HCPs)以“良心上的反对”的名义反对合法的医疗服务。调查这些国家的法律及经验的目的是为了表明：不允许‘CO’是可行的和有益的。它有利于病人得到方便的生殖健康服务，因为它减少了障碍和延误。其他的好处包括循证医学合理的参数，基于信仰的拒绝民主法律的优先权等等。最值得注意的是，不允许‘CO’保护了妇女的基本人权，同时避免歧视，危害妇女健康。最后，坚持医疗机构（HCPs）专业人员对自己的医疗义务负责，对患者无任何负面影响。几乎在瑞典、芬兰和冰岛的所有医疗机构，反对避孕及堕胎的医疗人员和学生都能在医疗的别的领域找到工作。成功禁止‘CO’的关键是一个国家对于女性公民权利包括卫生保健权利的大力接受。

Keyword:

• Abortion
• conscientious objection
• dishonourable disobedience
• Sweden
• Finland
• Iceland
• refusal to treat
• reproductive health care