When Health-Care Providers Refuse Care, Whose Rights Are at Stake?


Recently, an appeals court in Scotland ruled that a wide range of service providers have a right to object to helping with the provision of abortions, even if the care they provide is not directly related to the termination of a pregnancy. In the original ruling, last year, the duties carried out by the two Catholic midwives who brought the case had been considered so removed from the actual abortion that there could be no objection. The appeals court, however, disagreed. Everyone even tangentially involved, it said, has the right to object to providing a wide range of services. The only exception would be life-saving care.

This ruling highlights issues that have relevance beyond Scotland.

The tragic death of Savita Halapannavar in Ireland last year crystallized that no one really knows for sure when a woman is dying from pregnancy-related complications. Over the years, I have interviewed dozens of medical providers in countries with restrictive abortion laws. A key concern for the vast majority of them was how to make sure their actions were legal. Those working in countries where only life-saving abortions are permitted often expressed fear that they would either turn too many women away, with fatal consequences, or ultimately lose their license for providing care to someone who wasn’t “dying enough.”

Let’s apply this notion in a context where anyone involved, however tangentially, in the provision of abortion services, can refuse to treat a woman who is not dying.

This situation raises questions which, regardless of the answers given, compromise quality care. Who gets to determine how lethal each pregnancy is? Can a treating doctor compel assisting midwives or nurses to intervene if she or he believes the patient otherwise will die? And would midwives and others have the right to sue if they had been compelled to help provide an abortion to a woman who ultimately survived? There are no good answers to these questions, and any regulatory solution would almost inevitably lead to substantial delays in care.

Another key concern with a broadly defined right to conscientious objection in the context of health care is access to care in remote—or sometimes not so remote—areas. In the United States, much anti-choice activism is directed at making abortion impossible rather than illegal. Legislators, judges, and other officials in states including Mississippi, Virginia, and North Carolina have made it their goal to run every last abortion provider out of their state. Already, 35 percent of the U.S. population lives in counties without an abortion provider.

Moreover, broad conscientious objection clauses in combination with the stigmatization of abortion generally can stifle the provision of care anywhere. In small communities where everybody knows each other and where abortion is thought of as “evil,” doctors, nurses, and midwives often object to providing care out of fear rather than faith. After all, they still have to make their living where they are.

When I researched access to abortion for rape victims in Mexico, I came across various innovative “solutions” to this problem. In one area, abortion teams were circulated between public hospitals to ensure that no one had to provide care in his or her home town. In another, abortions were provided with the knowledge only of the senior-most officials at selected hospitals, with the result that many women in need of urgent care were turned away because “we don’t do that here” (even at hospitals where they, in fact, did).

Neither of these approaches solved the underlying problem: that abortions are seen as separate from other medical care (which they are not), and that abortion providers are considered different from other medical providers (again, not true). As a result, patients had to seek legal care in a clandestine manner, and in many cases the additional option of conscientious objection for anesthesiologists or nurses—who were not part of the core teams—made abortions virtually impossible to obtain.

Everyone has the right to freedom of thought, religion, and conscience. But international human rights standards do not protect our right to express those thoughts or that conscience in a manner that infringes on other people’s human rights. The more I learn about the concrete repercussions of conscientious objection in the context of health care, the more it is clear to me that there is no room for it. Ultimately, if you don’t want to provide the obstetric or gynecological services your patient needs—which may include an abortion—maybe you should choose another field of specialty.

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  • http://www.facebook.com/alfonso.taboadaportal Alfonso Taboada Portal

    IN other words, physicians and other medical professionals who want to adhere to the oath hippocratic should be persona non grata in medicine—an astonishing assertion.

    • http://twitter.com/JenGStarr Jennifer Starr

      If the morals and personal religious beliefs of the doctor or pharmacist conflict with the patient and their medical needs, I think the patient should always be placed first. Anyone who enjoys little playing power games (denying and withholding prescriptions and needed medical care simply because you can) and imposing their worldview and religious beliefs upon the patient is obviously in the wrong field.

    • cjvg

      Your point would only be considered true, if you are of the opinion that women do not have a right to life and health, and as such can be refused services that ensure that they have these!

      As far as most decent human beings are concerned women still fall squarely under the protection of the Hippocratic oath, if a health care providers believes they do not he or she should not be allowed to practice!

  • http://www.facebook.com/alfonso.taboadaportal Alfonso Taboada Portal

    Bioethicists and activists liberals even suggest that patients suffering from BIID (body-integrity identity disorder), a sick compulsion to become an amputee , should be treated by having healthy limbs removed, just as transgenders today receive surgical sexual mutilation.
    The ongoing transformation in the methods and ethics of medicine raises profound moral questions for oath that proscribe abortion and assisted suicide and compel physicians to do no poisoned people. There has always been jobs that, despite being legal, shameful and wrong were clearly viewed by society. It was the case of the executioners or slave traders. Were necessary and legal in slave societies or the death penalty, but they knew that their work was “exemplary” and that they were not welcome in their societies. They were a marginal caste. In our time, abortion doctors are in a similar situation. How to sell a society that abortion is a standard medical treatment if there are legions of doctors, social workers, nurses, anesthesiologists and gynecologists who refuse to do? Abortionists you afraid of the objection and of being further cornered in their social ghetto, which gives money but little prestige. Naturally, conscientious objection is a sacred right, the Supreme Court recognized in 1943 that Jehovah’s Witnesses could not be compelled to pledge the flag or perform military service. Idem with abortion. Dr. Henry Morgentaler, who in addition to defending the right to object adds: “In addition, a doctor who does not believe what he does is more likely than not do a good job.” (P. J. Ginés)

    • nettwench14

      If you don’t want to perform it, you should not become a physician, or a health care provider. When it comes to women’s lives, some people are not “more equal” than others. Health care decisions will NEVER be black and white. They should be made by the patient in confidence with her doctor, not by legislators or religious leaders.

      • Heather

        I totally agree. I even think that providers should notify all of their current and new patients of services they choose not to render due to their own personal religious beliefs. Doesn’t it make you wonder if they would lose the majoridy of their patients. Also do you think they would change their minds if their paychecks were negatively affected?

    • Dez

      To be perfectly blunt, I don’t give a damn about your religious beliefs. I go to a doctor’s office for medical advice, not religious counseling. Keep your beliefs in church and your private home. It does not belong in the doctor’s office or hospital. If you can’t, get a new job. Your religious beliefs are of no concern to me when I am the patient. My beliefs are the only relevant ones when it is concerning my health.

    • HeilMary1

      Your denying abortions to women is your criminal infliction of BIID on women who don’t want to be injured and killed by pregnancies.

    • HeilMary1

      Why do you have a sick compulsion to use fetuses to maim and murder women? Do you support organ stealing by the wealthy from the poor? — forced childbearing is multiple organ stealing by pedophile priests so they will have unlimited fresh victims.

    • cjvg

      If you are willing and able to deny needed care to a woman based solely on her gender and the gender appropriate health care that she needs you are NOT fit to be a health care provider!

      A health care provider that is willing and able to violate his oath by considering their wishes and prerogatives more important, then those of his/her patient should never be given the opportunity to violate patients rights in this matter.

      No man is subject to this abuse and loss of the right to chose his own treatment NOT based on the believes of his treating doctor

    • http://www.facebook.com/ingrid.heimark.5 Ingrid Heimark

      Well, I am a believer in conscious objection WERE IT MAKES SENSE! Prescribing BC and not EC does not make sense

    • Arekushieru

      Please don’t call sexual reassignment surgery sexual mutilation. It’s dishonest. It also marginalizes who have actually experienced genital mutilation. Abortion harms no one. If you believe that assisted suicide is wrong and won’t perform it for someone you ARE harming someone. Slave traders are more comparable to anti-choicers not PRO-choicers. If abortion is not standard medical treatment why do miscarriages happen? If abortion is not standard medical treatment, why has it been performed for thousands of years? If abortion is not standard medical treatment, then women should not be receiving pregnancy, labour and delivery care as it is not a medical condition.

      Pregnancy care and delivery are far more lucrative AND far more prestigious. So, the only reason why some doctors perform abortions? Because they care for their patients, unlike anti-choicers and those who ‘conscientiously object’ to abortion.

      Not being indentured into military service is like not being indentured into bodily service. You really are a moron. You’re UPHOLDING the rights of women like the Pro-CHOICE movement does.

  • http://www.facebook.com/alfonso.taboadaportal Alfonso Taboada Portal

    It is becoming increasingly clear that medical who wish to continue in the Oath Hippocratic will face increasing pressure to yield their consciences to the desires and mad caprices of patients and the reigning moral cultural paradigm. Just because abortion and infanticide is legal, that doesn’t mean it is right.

    • HeilMary1

      Just because you are a bloodthirsty misogynist with Fetal Idolatry Derangement Syndrome (FIDS), who uses fetuses instead of fists to maim and murder women on behalf of spoiled pedophile priests, doesn’t make you moral or sane.

    • Dez

      Yes there will be pressure for doctor’s to keep their personal beliefs out of the lives of their patients. They have a job to do and it is not a spiritual advisor. Just because you think abortion is bad does not make it so. Your opinion on abortion should not override mine. Who made you the final authority on abortion and pregnancy? Certainly not me or any other woman.

      • http://www.facebook.com/alfonso.taboadaportal Alfonso Taboada Portal

        The doctor should cure and prevent disease. And always respect the Hippocratic oath.

        • http://twitter.com/JenGStarr Jennifer Starr

          You don’t actually have an answer, do you?

        • http://twitter.com/JenGStarr Jennifer Starr

          No one gives a woman a pessary for an abortion anymore.

        • Dez

          No the doctor’s should respect the rights of their patients and not impose their beliefs onto them. Of course you think doctors should do what you think is right. Not going to happen. When it’s my health being affected your opinion is irrelevant.

        • http://twitter.com/JenGStarr Jennifer Starr

          And furthermore if we’re going to talk about the Hippocratic Oath, denying a woman a way to prevent a pregnancy (contraception) or forcing her to carry an unwanted pregnancy definitely falls under the definition of ‘doing harm’.

        • cjvg

          is that why you have never uttered one single objection against elective plastic surgery?
          Because everyone needs a nose job or new breasts or a pec implants?!
          Or you are ok with those surgeries when an legal adult choses to have them, because it does not interfere with your religious believes?!

          You have no right to dictate your believes must govern my rights and choices!

        • Arekushieru

          Pregnancy IS the leading cause of death worldwide for women and a medical condition. Hm, that fits, after all, doesn’t it?

      • http://twitter.com/Tonks07 Mandy

        Exactly.

        ·
        “Doctors in emergency rooms have no right to refuse to provide medical care to someone who overdosed on heroin, even though heroin is illegal and many people are morally opposed to its recreational use.
        They have to care for drunk drivers, even though driving drunk is both illegal and a pretty universally assy thing to do.

        Why, then, should a hospital be forced to bend over backwards to accommodate people’s religious beliefs surrounding abortion, a legal medical procedure protected by the Constitution?”

        —Erin Gloria Ryan, “Nurses Fight
        For Their Right To Refuse Women Care”

    • cjvg

      You mean you think it is amoral that adult women should have the same legal right to determine what medical care they prefer, just like men can?!

      Or are you arguing that doctors should have the right to determine what medical care a man should or can receive over his objections?!

      What if you run into a doctor who feels you should have a vasectomy or a castration ?
      (maybe the doctor feels you are to violent or you are not stable enough to have kids)

      That is alright by you, as long as the doctors ethics and morals dictate that he/she feels this is the right medical treatment, even if it is against the patients wishes?!

      • http://www.facebook.com/ella.warnock.7 Ella Warnock

        Nope, there’s no other human body part that is a matter of such intense, inappropriate interest and under some bizarre rule of morality as the uterus. The fact that in this day and age that we’re STILL having a collective discussion about what the proper use and role of one is (you know how anti’s always pretend there’s not an actual human attached to it), almost makes my head explode.

        They will sit there and right in front of you discuss wombs and uteri and rape and birth as if you don’t exist. And you don’t – in any other capacity than what you can (potentially) do for or against a zygote, embryo, or fetus. This is how we know — despite women’s suffrage, feminism, Roe v Wade — we’re seen as something less than fully human. For many, men AND women, humanity only comes into play when the potential of another human exists, which then becomes more human than we are.

        How can they possibly pretend any longer that they care about women? It’s inexplicable that anyone would take them seriously. “What about the women in the womb?” they simper. Well, there are no women in the womb, but if there were, here’s the advice I’d give her: Stay there. It’s the only way they’ll ever concede that you’re a human being.

  • http://twitter.com/cluelesscamper Marianne Mollmann

    I think what is most disturbing to me about the conversation about conscientious objection is the notion that women’s choices are merely “whims” and that doctors and nurses and others necessarily will know what’s better for them. Everyone is different and people make different choices due to their context or background. Even people in similar contexts and with comparable backgrounds may choose differently face with the same choices, just because of who they are and what they want in their lives. Respect for human rights demands respect for those choices.

    Medical providers may face many circumstances where they, themselves, would choose differently than their patients. A doctor may feel anxious and dismayed that a 22-year-old woman is adamant that she wants to be sterilized, because, in the doctor’s experience, younger women are more likely than older women to regret such decisions (though certainly not all and not even the majority do). It is paramount that the doctor, in this circumstance, share all information with the woman about alternative options to avoid childbearing, and the woman may choose to share with the doctor her motivation for the intervention, so that the doctor can better help her from a medical perspective. The woman may decide to be sterilized for any number of reasons that are unknown to the doctor, and the doctor can only provide quality care by trusting her instincts and choices and by providing the quality care she believes she needs.

    This situation is not any different for women and girls who need abortions. Doctors can provide information about treatment options, in fact, are duty-bound to do so. But doctors cannot substitute their choice for that of the patient. We do not accept this for do-not-resucitate order, or for any other medical procedure for that matter, and we must not accept it for abortion.

    Women and girls do not have abortions on a whim or because of some capricious desire. Women and girls have abortions when they need them. No one gets pregnant in order to be able to go through that. Suggesting that women and girls who abort are capricious and whimsical and–essentially–out of their mind, is not only mysogynistic, it is wrong.

    • http://www.facebook.com/alfonso.taboadaportal Alfonso Taboada Portal

      Some radicals, forgetting his past support conscientious objection politically correct issues as the refusal of military service. Have tried to reconstruct the patient-physician relationship such that the patient’s wishes always prevail, diluting or negating this longstanding professional right and duty. However, patient autonomy carries much less moral weight. Patients wishes are routinely denied by conscientious medicians for such things as unnecessary surgery, castration (marshall applewhite), unwarranted antibiotics, assisted suicide, etc., even in those situations where the requested treatment is within the bounds of accepted practice or in instances when other (ignorant, sloppy, or unscrupulous) physicians might accede to the request. (Vgr: Marshall Applewhite and his disciples castrated).

      • http://twitter.com/JenGStarr Jennifer Starr

        Irrelevant and disingenuous. And I suspect you know that.

      • MaiaC

        Again with the LOGIC FAIL…
        When a military conscientious objector does not participate, no one else’s rights are at stake. It’s not like you’re in the field and decide to become CO and put your unit at risk (in which case your analogy might make sense). A military CO puts no one else’s ability to serve (or even their safety in doing so) at risk.

  • http://www.facebook.com/alfonso.taboadaportal Alfonso Taboada Portal

    The record of your opinion but there are alternative views and more judicious: The “consumerist medicine” refers to interventions that are directed not to treat real diseases, but to satisfy personal desires of patients suffered coast taxpayer money.

    • Dez

      Since women are tax payers as well, their reason for an abortion is none of your business.

    • http://twitter.com/pmason03 Pam Mason

      What tax payer money? See: Amendment, Hyde

  • http://www.facebook.com/alfonso.taboadaportal Alfonso Taboada Portal

    Wesley J. Smith notes that “the term designates consumerist medicine interventions using traditional methods and tools of medicine (surgery, medicine, technology) not to treat real diseases, but to satisfy personal desires of patients, consolidate their lifestyles or help them achieve their goals unrelated to health. “

    • http://twitter.com/JenGStarr Jennifer Starr

      You seem to see that as a bad thing. Can you explain to me why patients should be held hostage to and inconvenienced by the peculiar caprices and whims of the health care provider?

      • http://www.facebook.com/alfonso.taboadaportal Alfonso Taboada Portal

        The doctor has the right and duty to cure and prevent disease. And always respect the Hippocratic oath.

        • http://twitter.com/JenGStarr Jennifer Starr

          That doesn’t answer the question. Why should the religious beliefs of the healthcare provider be above those of the patient? In fact, shouldn’t it be the other way around?

        • HeilMary1

          Pedophile priests do not have the right to force doctors to force all women into suicidal incubating slavery.

        • cjvg

          Before the wide spread use of legal effective contraception and safe legal abortion became available, (repetitive) pregnancy, childbirth were the biggest killers of women.

          So yes it is very respectful of the Hippocratic oath to provide these, anything less would actually be a severe violation.

          On top of that you and the anti-choice crowd are exceptional dishonest by promoting unwanted births but not uttering a single peep about the abysmal American statistics for a baby actually surviving its first day after birth.

          Lowest first-day mortality rates are found in Cyprus, Estonia,
          Iceland, Luxembourg, Singapore and Sweden.
          less than 0.5 / 1,000 live births
          Less than 1 birth in every 2000 live births will result in death. LESS!

          US first-day mortality rates 3 / 1000 live births = 11,300 death
          USfirst month mortality rates 4 / 1000 live birth = 18,400 death
          US first 5 year mortality rate 8 / 1000 live births = 32,200 death

          Best countries, first day mortality< 0.5/ 1000 live births = < 0.5
          Best countries, first month mortality 1 / 1000 live births = 1.0
          Best countries, 5 year mortality rate 3 / 1000 live births = 3.0

          Can you see it now?, even looking at the numbers per 1000 live births it is more then double!
          Lets give you the percentages.

          US first day deaths = 35%
          Best countries first day = 13% 13% 14% 15% 18% 19%
          respectively for the 6 different countries

          And that is just the numbers on infants, now lets see how "healthy" it is for a woman to give birth in the US
          America has the highest maternal mortality rate of any industrialized country, according to the federal Health and Human Services Administration.

          The head of the WHO has stated that the US is the most dangerous country of all industrialized western countries, for women to give birth in (and plenty of other 3rd world countries too)!

          Unfortunately, observers and so-called experts say the numbers are not that high. They aren't at "epidemic" portions. And if you compare the U.S. to Niger, then yes, the American women don't seem to be at a high risk. But the numbers are increasing steadily. So when should we start to worry?

          major causes of maternal death: hemorrhage, embolisms, stroke, heart attack, infection and pregnancy-induced hypertension, The majority of these deaths are considered preventable.

          More disturbing still, the CDC stopped publishing U.S. maternal mortality statistics after 2007.
          Their reasoning was that there is no standard form for reporting maternal deaths!

          The lack of comprehensive data collection is masking the full extent of maternal mortality and morbidity in the US. Reporting of pregnancy-related deaths as a distinct category is mandatory in only six states, and despite efforts in some other states to use additional methods to track maternal deaths (such as death certificate pregnancy check boxes and data-linking birth certificates with death certificates of women of childbearing age), systematic undercounting of pregnancy-related deaths persists.

          statistics released in September of 2010 by the United Nations place the United States 50th in the world for maternal mortality — with maternal mortality ratios higher than almost all European countries, as well as several countries in Asia and the Middle East. (deaths per 100.000 births)
          And this is when only the reported numbers of maternal death after child birth are used (there are plenty not being reported and pregnancy related deaths are not even collected)
          WHO and CDC reports.

    • http://www.facebook.com/ella.warnock.7 Ella Warnock

      Every choice I make is ultimately one that directly or indirectly affects my health, every facet of it. I don’t think you’d feel that you should personally prohibit my having, say, a face lift or liposuction. Yet somehow when my uterus is the body part in question, it suddenly becomes public property and occasion to employ any number of methods to control and decide and influence how I shall deal with it. It’s unfortunate that you feel this way, but thankfully I’m able to give your comments all the weight and consideration they deserve.

  • GoodOne

    Here is where we get that logic thrown back in our faces. When we say do not work in a field if you cannot do the job they rightfully say do not work at a company that does not provide the full range of women’s health services. We need a better approach cause they sure can hurl that right back at us.

    • http://twitter.com/JenGStarr Jennifer Starr

      Because we’re supposed to be telepathic? This involves more than just places where we work. It involves hospitals we go to for health care, pharmacies we visit to fill our prescriptions–all of those things. Why should we be at the mercy of people who just decide on a whim that they don’t feel like doing their jobs?

    • cjvg

      A company that discriminates what kind of insurance or what level of health care they will provide based on gender is breaking the law.
      IE a company that provides different levels of compensation or benefits (which is what health care is) for men and women who do the same job is breaking the law.

      A professional who is refusing to fulfill the job he was hired to do is not breaking the law, they are just lousy employees with a poor work ethic, and should not be protected for refusing to do their job.

  • Heather

    My healthcare provider today told me that she would not be able to prescibe me plan B because it was against her religion. She then wrote me a perscription for condoms and mentioned that when I got a period she would perscribe birth control. I also have other medical issues that even make it hard for me to step ouside my own front door. This same provider told me that I suffer from social anxiety and OCD. That being said I told her that it was exremely difficult for me to even go to her office for treatment and that going to plan parenthood would cause me emotional distress due to the fact that their waiting area is always full of people. My pharmacy told me that they can’t dispense it to me until I bring them an order from my doctor. I can’t purchase it because I am income sensitive due to losing my job.

    I felt so embarrassed for even asking for plan B. I even felt ashamed. I even feel that she was contradicting herself when she refused to perscribe plan B, which is used to prevent pregnancy, not abort. Then offered to prescribe oral birth control, which is also used to prevent pregnancy, not abort. I feel descriminated against as a woman who was refused the right to choose.

    Is there anyone out there who could help me with this issue. Can my provider refuse to prescribe me plan B based on their own personal religious beliefs an then offer birth control. What about my rights as a woman, a patient and my religious beliefs and morals. Aren’t I too, protected under the constitution or law. I read that providers cannot deny Emergency contraceptives based on their religious beliefs in a emergency situation. That being said, Am I being violated since emergency contraceptives are time senitive and need to be taken in a timely manner in order to prevent ovulation. Doesn’t that constitute an emergency. Isn’t that why the medication is called “Emergency Contraceptive”. Please someone, give me some insight. Do I have any legal rights?

    • http://www.facebook.com/ingrid.heimark.5 Ingrid Heimark

      If I were you, I would change my health care provider, the longer time before using EC, the greater the risk of abortive action, and she should know that. It seems to me that your provider are not very knowledgeable. That’s one of the reasons I truly believe EC should be available even at gas stations

  • http://www.facebook.com/ingrid.heimark.5 Ingrid Heimark

    Abortion IS different than any other medical care, because it involves the destruction of unborn life, no other medical procedyre harms any other than the patient itself, should something go wrong. Maybe except for live-transplants, but then the person at risk gives his consent. How it is possible to discuss abortion without even recognizing the existense of the fetus, no matter the value one assigns it, is incredible.
    I want to ask the author of this article: Has the human fetus no value at all?

    • cjvg

      “but then the person at risk gives his consent”?!

      That is considered necessary by you?

      Why, the woman should be forced to donate the use of her body for 40 weeks (10 months) for the benefit of a fetus.
      She has no choice in if she is willing to take the health risks and financial costs as well as social and professional cost associated with this.

      She must and should be forced to remain pregnant and gestate and birth a fetus against her will according to your view.

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