Global Doctors for Choice Convening on Conscientious Refusal of Care

Posted: apríl 13, 2011 in Aktuality

(October 23 – 24, 2010/Seville, Spain) Purpose of Meeting Regarding Conscientious Refusal of Care (CRC)

Over the last ten years, some countries have broadened the circumstances under which abortion is legal and others have introduced measures to increase women’s access to existing services.1 In spite of this progress, in both contexts where abortion is available upon request and where it is legally restricted, medical professionals’ refusal to provide legal services because of conscientious objection threatens women’s access to legal and safe abortion as well as to other components of reproductive health care.

The right of the medical practitioner to refuse to provide services that he or she finds objectionable on moral or religious grounds is recognized by international human rights conventions such as the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), the International Covenant on Civil and Political Rights (ICCPR) and the American Convention on Human Rights (ACHR) as well as by international authorities such as the World Medical Association, the International Federation of Gynecologists and Obstetricians (FIGO) and the European Court for Human Rights.

However, the right to conscientious objection is also perceived as secondary to the obligation to treat, provide benefit and prevent harm to the patients for whose care they are responsible. In the case of abortion, these international conventions and authorities require physicians who invoke conscientious objection to refer women requesting legal abortion to colleagues who will perform the procedure. Countries such as Britain, Denmark and Guyana render conscience objection inapplicable in situations where the woman’s life or health are in danger and alternative services are not immediately available. Yet, a review of documented cases in Argentina, Brazil, Colombia, Mexico, Peru, Poland, Romania and the United States suggests that conscientious objection has become a serious barrier to access to legal abortion services. Moreover, medical professionals frequently claim conscientious objection, even in cases involving rape victims and patients with critical physical and mental health conditions.

CRC is increasing as an anti-abortion tactic, as a political issue and as a means of restricting reproductive health care. The resulting loss of providers and the undermining of law and regulation have consequences for patients, for doctors, and for health systems.

Global Doctors for Choice (GDC) and Collaborators

GDC is predicated on the notion that physicians have specific contributions to make to improve access to reproductive healthcare as they bring scientific authority, commitment to their patients’ best interests, and firsthand familiarity with the devastating consequences of lack of care. Therefore GDC’s unique niche is to contribute the medical and scientific perspective to public discourse about individual providers’ rights to conscientiously object and health systems’ obligations to provide lifesaving and legal care. GDC’s commitment to the defense of human rights and medical care grounded in science mandates its involvement in this issue.

Simultaneously, GDC believes it is necessary to collaborate with others similarly committed to reproductive health care and rights. Such transnational collaborations have special cogency in this “globalized” era, a time when political ideas, technologies and patients are increasingly moving across borders. In order to be effective, a variety of stakeholders must come together: lawyers, human rights experts, physicians, health administrators, policy makers, women’s rights groups, non-governmental organizations and professional medical associations.

GDC convened an initial meeting of such a multi-perspective group to discuss a strategic response. The list of collaborators is attached. The group reviewed data from Poland, Ireland and Brazil; heard descriptive reports about conscientious refusal of care in Spain, Portugal, and Italy; listened to a legal analysis of the issues; and learned about the CRC positions and the relevant workings of certain international agencies (Council of Europe, International Planned Parenthood Federation, World Health Organization, and some national medical societies).

The following themes emerged from the discussion:

  • The salient distinction between institutional or health system level obligation to provide care, and an individual’s religiously/philosophically-based conscientious objection;
  • The obligation to follow state law and provide legally available services when an individual or institution receives state funding to do so;
  • The necessity of consistent application of rigorous criteria for identification as an objector (analogous to the documentation and proof required when claiming conscientious objection (CO) status in order to refuse military service);
  • Anecdotal reports show that some doctors would not qualify if rigorous standards were applied. A distinction needs to be made between disinterest in a controversial subject, desire to increase financial remuneration (“CO by day, provider by night”) and a principled deeply held position.

The group:

  • agreed it was necessary to map the landscape of healthcare topics ( and gather data) where CRC is salient. Thus far, the list includes: abortion, emergency contraception (EC), sterilization, assisted reproductive technologies (ART), prenatal diagnosis, end of life care and lesbian, gay, bisexual, transgender and queer (LGBTQ) care;
  • identified some positive policy models of response, including public policies in South Africa, Portugal, and Colombia; and institutional response by several academic institutions in the US providing medical training in abortion.
  • concurred about the importance of evidence and the need for research on the impact of

CRC on delay in obtaining care, consequent morbidity, the patient, her family, her community, society and health systems.

Read the whole statement here


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