Taking Back the “Conscience” Debate: Reproductive Health Care Providers as Conscientious Actors

Over the past 40 years, conservative lawmakers and legal academics have reduced a progressive vision of conscience as an act of doing something positive for social justice to one that allows health care professionals to refuse to provide or refer for contraception, abortion, or other reproductive health care. 

Dr. Lisa Harris, University of Michigan bioethicist and gynecologist and RHTP board member, lays out a compelling case in this month’s New England Journal of Medicine, about the “ongoing false dichotomization of abortion and conscience” and why the provision of care should be included in legal protections of conscience.

Harris reminds us that physicians started providing abortion care before it was legal for reasons of conscience. Citing Carole Joffe’s scholarship, Harris points out that doctors..

“…did so with little to gain and much to lose, facing fines, imprisonment, and loss of medical license. They did so because the beliefs that mattered most to them compelled them to. They saw women die from self-induced abortions and abortions performed by unskilled providers. They understood safe abortion to be lifesaving. They believed their abortion provision honored “the dignity of humanity” and was the right — even righteous — thing to do. They performed abortions “for reasons of conscience.”

But since then, the persistent failure to recognize abortion provision as “conscientious” has resulted in laws that do not protect caregivers who are compelled by their conscience to provide abortion services. As a result:

“Though abortion providers now work within the law, they still have much to lose, facing stigma, marginalization within medicine, harassment, and threat of physical harm.”

Harris argues that the failure of our policies to recognize that conscience compels the provision of abortion care renders “conscience” an empty concept and leaves us all with no moral ground (high or low) on which to stand. You can read her full editorial here.

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