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Undergraduate Research Honors Ethical Issues and Life Choices (PHI2630)
2013 Conscientious Objection for Abortion Sierra Rubin
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Conscientious Objection for Abortion
Key words: conscientious objection, abortion, Hippocratic oath
Abstract: In this paper, I discuss why conscientious objection should not be used in
cases of abortion. According to a modern day interpretation of the Hippocratic oath,
doctors have the responsibility to do whatever it takes to better the lives of their
patients. This includes abortion if that is what the patient requests. I propose a law
making abortions more accessible for women, stating that there must be at least one
doctor at every hospital who is capable and willing to perform abortions.
Introduction
Many medical professionals, at some point in their career, may be required to perform a procedure that they may not find ethically or religiously acceptable.
Their refusal to perform the procedure or to refer the patient someone who will is called conscientious objection.
Physicians can be faced with many moral hurdles in their practice. For example, a trauma surgeon receives a patient in the trauma bay suffering from multiple gunshot wounds. He diligently works on this patient. The surgeon opens up the patient’s belly and discovers that she is pregnant. He realizes that if he is to save the mother, the baby does not have a good chance of survival, but if he is to save the baby, the mother will certainly not survive. He decides to save the life of the mother,
but unfortunately the fetus did not make it.
Was it right for the surgeon to save his patient’s life? Was it within the
surgeon’s oath to let that patient die to save the fetus? If the mother was on death row, would that have made anything different? Should the surgeon have saved his patient’s life anyway, knowing that she was a convicted murderer?
Conscientious objection is a very controversial issue especially in cases of women requesting abortions. Currently, some states such as California have a law that allows health care workers to refuse to provide service if they feel that the procedure goes against their morals or their religion. All they would have to do is sign a declaration stating that they are against it (Meyers, 115). This makes it very difficult for some patients to find a doctor that will perform their abortion. The rate at which women are requesting abortions remains constant but the number of doctors who are willing to do them is decreasing. In 1991, only seventeen percent
of counties in the US had a physician who was legally allowed and willing to perform
abortions (Meyers 115). Since that number keeps decreasing, it is becoming
increasingly hard for women to find a physician to provide adequate medical care
and perform an abortion if she desires.
In the case of RR vs. Poland, a woman was denied prenatal genetic testing. It was believed that the fetus had a genetic abnormality and RR wished to have an
abortion if that was true. After six weeks of traveling around Poland and being
refused tests from multiple hospitals, she went into an emergency room claiming
that she was having a miscarriage. They finally tested her by amniocentesis and had
to wait two weeks for the results. By the time she got the results confirming the
severe genetic abnormality, it was too late to legally have an abortion under polish
law, and she gave birth to a girl with Turner syndrome. The doctors that RR went to
used conscientious objection to refuse to give her the necessary information to get
an abortion (Westeson, 2).
In another case, P and S v. Poland, a 14 year old girl was raped and requested an abortion. She was harassed and humiliated by health professionals and they deliberately gave her misleading information. One hospital that she went to stated that the whole institution was using conscientious objection to refuse to treat her and they even leaked information about her to the press. Finally, she was able to receive an abortion but she had to travel very far from her home and she wasn’t given proper care afterwards (Westeston 3). In both of these cases, women were denied abortions, or information leading to abortion because healthcare workers used conscientious objection. In both cases, the procedure would have been safe and legal, but it was not performed because of the beliefs of the doctors, affecting both of the patients’ lives in a negative way.
Doctors should not use conscientious objection in cases of abortion or abortion related care because it is their duty to provide the best care possible for their patients. Medical professionals should provide proper medical care for abortions, even if they find abortion morally or religiously impermissible.
In my paper, I start out by outlining the parts of the Hippocratic Oath that are related to the topic. I offer a different analysis of the Hippocratic Oath that can be applied to today’s modern society regarding doctors’ responsibilities to their patients. I show how the oath would be applicable in different situations related to abortion. I also propose a new law that would make abortions more easily accessible to women if doctors still choose to practice conscientious objection.
The Hippocratic Oath
The Hippocratic Oath is an Oath taken by doctors and medical professionals.
When doctors take the oath, they swear to practice medicine honestly and do whatever is in the best interest for the patient. It was originally written by
Hippocrates in Greek but there are English translations and many modern day translations that are used today. Health care providers use the Hippocratic Oath to guide them in everything they do in their profession. A modern day interpretation of the oath says, “The Provider shall respect the autonomy of the intact Purchaser, ie the Purchaser’s ability to decide his/her own future and live according to his/her own ethical values” (Rosalki, 154). In this interpretation the “provider” refers to the healthcare provider and the “purchaser” refers to the patient (Rosalki, 154). This
means that the doctor should provide whichever services the patient requests
because the patient has the right to do whatever he or she wants to his or her own
body. If a procedure goes along with the ethical views of the patient, then it is acceptable for the doctor to perform the procedure, whether or not he or she finds it ethical.
With regards to abortion, the original text of the Hippocratic oath says, “I will not give a woman a pessary to cause an abortion” (Hippocrates). Even though the original Hippocratic Oath is against abortion, it was written in ancient times so we must interpret the general meaning to fit modern day medicine and society. Society and the practice of medicine has changed a great deal since then, so we must adapt our ethical standards to fit. This modern day interpretation of the Hippocratic oath
states that,
“Though the Provider undertakes to maintain and respect the importance of
human life from the time of conception until death, he will with the consent
of the Purchaser, agree to the abortion of an unborn infant, but only in
accordance with the statutory rules currently prevailing. He undertakes in all
circumstances to act in the perceived best interests of the mother, whose
wishes in the matter (within the statutory limits imposed) shall be
overriding” (Rosalki, 155).
This means that if a patient requests to have an abortion performed, the health care provider must do it as long as it is in the legal limitations for abortion set by the state or country in which they are. In doing so, the health care provider would be
acting in the best interest of his or her patient.
Since the Hippocratic Oath guides medical professionals in every aspect of their careers, they should take these points into consideration in regards to conscientious objection. As a health care professional, one has a duty to do whatever
is in the patient’s best interest, according to the oath. The patient also has the right
to his or her own body, and he or she may do anything to it according to his or her
own ethical views. Even if the health care provider has different moral or religious
views, he or she must do what the patient requests, if it is in the patient’s best
interest. Therefore, if a patient requests an abortion, the health care provider must
perform it even if he or she is not personally accepting of it, as long as it is in the
legal limits.
A hypothetical situation relating to the Hippocratic Oath can be if a physician
is the only one within several hundred miles that is capable of performing
abortions. She has the skills to perform abortions, but she morally objects to
them. A pregnant woman is brought to her urgently. An immediate abortion must
be performed within minutes, or the mother and fetus will die. If the abortion is
performed, the mother will live. Should the physician just let the woman die
because she is against performing abortions? If the physician did not care for the
patient to save her life, would that violate the Hippocratic Oath?
Legal Abortion
In order to provide the best care for the patient, the doctor must perform an
abortion legally, according to the guidelines set by the state or country, which he or she is practicing in. The doctor must also provide good medical care before, during,
and after the abortion (abortion counselors 22). This includes plenty of tests such as
pregnancy tests to make sure she is actually pregnant, blood tests to make sure they
have the correct type of blood on hand in case she needs a transfusion, and pelvic
exams to determine how far along the pregnancy is (abortion counselors 22). All of
these plus more are to make sure that the patient is treated to the highest standards
of care and to ensure there is minimal risk of complications afterward.
An example of a legal abortion would be if a woman just found out that she is
pregnant. She is still in her first trimester and she goes to her doctor to get an
abortion. He performs all of the tests before and makes sure she is comfortable during and after the abortion. After the procedure, he makes a follow‐up appointment to make sure she is healing correctly and doesn’t have any symptoms of infection.
If a doctor were to follow all of these guidelines and the abortion was performed safely and legally, he would be doing his duty as a physician to provide the best care for the patient. If it is possible for him to perform a legal abortion, he should do it himself. It is not possible, it would be his responsibility to the patient to refer her to someone who would be able to do the procedure.
Doctors’ Responsibilities
As stated in the Hippocratic Oath, it is the responsibility of the doctor to provide the best possible care for the patient. That means that he or she must do whatever it takes to better the health of the patient. In the case of abortion, using conscientious objection would be going against the Hippocratic Oath. By refusing to do the procedure, the doctor is acting against the patient’s best interest. If the
patient wants the procedure done, she will find a doctor that will do it but there is
no guarantee that that doctor will provide the best care. The other doctor may not
be operating legally or could be careless in the procedure. Also, there may not be another capable doctor in close proximity to the patient. The patient may be unable to afford travel expenses, or may not have enough time to travel. Additionally, other doctors may not be covered by the patient’s insurance provider. She may not be able to afford to pay out of pocket for the procedure. The patient’s primary OB/GYN doctor is responsible. He or she must perform the operation if he is capable in order to provide the best care.
There are some cases where the pregnancy threatens the mother’s life. If she continues to be pregnant or gives birth, she could have an increased risk of losing her life. The doctor is responsible for protecting the patient’s life. If terminating the pregnancy is the only way to save her, it is his duty to do it. In the hypothetical situation mentioned earlier, it would be the doctor’s responsibility to do the procedure to save the mother’s life, regardless of what she believes about abortion.
A doctor refusing to perform an abortion is not in the best interest of the patient. There is a specific window of opportunity to perform an abortion. If it gets too late and the pregnancy is too far along, it would not be legal, or safe to do the procedure. By refusing do perform an abortion, the doctor is increasing the time the patient is pregnant, which is decreasing her opportunity for a safe and legal abortion. It may take even a few weeks to find another doctor who will do the procedure and by that time it might be too late. When doctors go through training, they are exposed to all kinds of unfamiliar
and unusual situations. Many things could make them uncomfortable but they have
to continue with the process if they want to become a licensed physician. When they
go through the course of medical school and training they are fully aware that they
may be exposed to certain procedures that they are uncomfortable with. They
should not have taken on the responsibility of becoming a doctor if they were not
comfortable performing certain duties required of them, at least doctors in the areas
of obstetrics and gynecology. Abortion is a major procedure performed by those
who specialize in that area. Individuals who object to those procedures should not
have gone into that field in the first place. It would be taking on responsibilities that
they knowingly cannot fulfill.
Objection
There are many cases in which the life of a patient is in danger by a
pregnancy and the only way to save her life would be to perform an abortion. There
are also many cases in which her life is not in danger and she wants an abortion for other reasons. Maybe a woman already has six children and does not have the means to support and raise another child. Maybe she is suffering from depression and being pregnant only increases her condition. Maybe she is mentally unstable
and going through labor would not be good for her mental state.
Some people may feel it is acceptable to object to abortion in those cases.
They would argue that the Hippocratic Oath does not apply here because
performing an abortion would not be in the best interest of the patient. If her life is not in danger then the abortion should not be performed because it would not be increasing her health.
A response to this argument would be that in fact, the patient’s health is
increased from the procedure. When the Hippocratic Oath refers to doing
everything possible that is in the patient’s best interest, that also includes her
mental health. If an abortion is required to make a patient more mentally stable, or
even happier, it should be done. For certain mental conditions such as depression, there has not been adequate research on taking the drugs to help with the conditions. It is unknown whether anti depressants can have adverse effects on the fetus or development of the child if taken during pregnancy (Howland 1), so a patient probably would not want to take the risk. It is the duty of the physician to do anything he can to make his patients lives better, and if that includes an abortion, it is his responsibility.
Another objection to this argument is that the fetus can also be considered the doctor’s patient. By performing an abortion, the physician would not be bettering the life of this patient, instead ending it. The Hippocratic oath states that the doctor must protect the life of the patient, but abortion goes against that.
A response to this objection would be that the fetus probably would not have a good life if it were to be born. There is usually a good reason why women have abortions. Whether it is because they are incapable of caring for a child, or they are
living in poverty, usually it prevents a baby from being born into an unfit
environment. By performing an abortion, a doctor is saving an unborn fetus from a
life of misery, and therefore it is still in the patient’s best interest. Proposal
If doctors and health care workers still insist on practicing conscientious objection in abortion cases, something must be done to make abortions more widely
available. If a woman desires to have an abortion, she should not have to travel far or be denied by many doctors until she finds someone who can give her adequate care.
I propose that there should be a law, making abortions more easily accessible for women who wish to have them. It should be required that at least one health care provider per hospital be able and willing to perform abortions. That way, any woman who has access to a hospital can easily have the procedure done if she chooses. Other doctors in the area may practice conscientious abjection, as long as there is at least one who agrees to do the procedure.
Conclusion
Doctors and healthcare workers should perform an abortion, or make sure the patient has proper medical care regarding an abortion, even if abortion goes against their personal, ethical, or religious beliefs. According to the Hippocratic
Oath, the patient has autonomy so she can decide what is right for her body. It is not the right of the doctor to make that choice for her, even if the doctor has different morals. As long as the doctor has the ability to perform a safe and legal abortion, he or she should do it. If it is not possible, it is his or her responsibility to find someone who is able to do the procedure. The Hippocratic Oath also says that the doctor must do everything that is in the best interest of the patient. Even if it is not her physical health at stake, he must do anything in his power to increase her general well being. Therefore, conscientious objection should not be allowed for abortions because it is the duty of the doctor to perform them.
Works Cited
Abortion Counselors. "Abortion." Off Our Backs 1.24 (1971): p. 22. Print.
"Greek Medicine." National Library of Medicine. National Institutes of Health, 07
February 2012. Web. 23 Oct 2013.
Howland. "Antidepressant Medication and Pregnancy: Time for Randomized
Controlled Trials." (2013): n. pag. Web.
Meyers, Christopher, and Robert D. Woods. "An Obligation to Provide Abortion
Services: What Happens when Physicians Refuse?" Journal of medical ethics
22.2 (1996): 115‐20. Print.
Rosalki, J. "The Hippocratic Contract." Journal of medical ethics 19.3 (1993): 154‐6.
Print.
Westeson, Johanna. "Reproductive Health Information and Abortion Services:
Standards Developed by the European Court of Human Rights." International
Journal of Gynecology and Obstetrics 122 (2013): 173‐76. Print.