In a compelling article in The New England Journal of Medicine, Lisa Harris, MD, points out that matters of “conscience” surrounding abortion and healthcare providers usually focus on refusing to perform abortions. She makes the case that choosing to provide abortions is also an act of conscience, one that is unfairly ignored.
While providing a brief history of conscience laws, Harris observes:
Over the past 40 years, the idea that conscience-based care means not providing or referring for abortion or other contested services has become naturalized. In 2008, the Bush administration extended the protections offered by the Church Amendment to workers who chose not to participate, even indirectly, in care that violated their moral beliefs. The Obama administration rescinded that rule. Antiabortion groups embraced Bush’s rule and criticized Obama’s rescinding of it; prochoice groups responded in the opposite manner. The result is an ongoing false dichotomization of abortion and conscience, making it appear that all abortion opponents support legal protections of conscience and all supporters of abortion rights oppose such protections, with little nuance in either position.
Drawing on Mark Wicclair’s “Conscientious Objection in Health Care: An Ethical Analysis,” and Carole Joffe’s “Doctors of conscience: The Struggle to Provide Abortion Before and After Roe v. Wade,” Harris continues:
Whether or not abortion provision is “conscientious” depends on what conscience is. Most ideas of conscience involve a special subset of an agent’s ethical or religious beliefs — one’s “core” moral beliefs. The conclusion that abortion provision is indeed “conscientious” by this standard is best supported by sociologist Carole Joffe, who showed in Doctors of Conscience that skilled “mainstream” doctors offered safe, compassionate abortion care before Roe. They 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.”
We know, of course, that abortion providers today face “stigma, marginalization within medicine, harassment, and threat of physical harm.” Likewise, “conscientious” providers may have strongly held beliefs in “women’s reproductive autonomy as the linchpin of full personhood and self-determination, or they believe that women themselves best understand the life contexts in which childbearing decisions are made, or they value the health of a woman read than the potential life of a fetus.” These perspectives, writes Harris, are often ignored, with “conscience” invoked only in an anti-abortion context.
Harris makes a really interesting argument that if laws are allowed to protect conscientious refusals of medical care — especially to restrict abortion access — they should also allow conscientious provision:
Persistent neglect of the compatibility between conscience and abortion provision not only misrepresents their relationship, but has consequences for law, clinical practice, and bioethics. First, U.S. federal and state laws continue to protect only conscience-based refusals to perform or refer for abortion, offering minimal legal protection for conscience-based abortion provision. For example, the recent Georgia and Arizona bans on abortion after 22 and 20 weeks’ gestation, respectively, include no allowances for providers conscience-bound to offer care after that limit.
As Harris succinctly puts it: “Whether or not abortion provision is ‘conscientious’ depends on what conscience is.”
Read the full article. Healthcare students and doctors interested in supporting or learning read about abortion and reproductive choice should check out Physicians for Reproductive Choice and Health, Medical Students for Choice, and Nursing Students for Choice.