In an article published in the Journal of Medical Ethics, Bruce Philip Blackshaw of the department of philosophy at the University of Birmingham, United Kingdom, and Daniel Rodger from the School of Health and Social Care, London South Bank University, United Kingdom, defended conscientious objection to abortion provision, claiming that the usual arguments critics make for disqualifying conscientious objection in healthcare do not apply in cases of abortion.
The first criticism of conscientious objection to providing abortions is that doing so would be refusing to provide a legal and beneficial procedure to patients. They counter that while having an abortion may have some socioeconomic or health benefits, it does not mean that the practice is clinically indicated. They state that if this were so, abortions would be clinically indicated for all pregnant patients. Likewise, they state that a pregnancy must “pose a substantially elevated risk above the normal risks of pregnancy to be clinically indicated.”
The authors divide abortions into 4 categories: (1) pregnancies posing a threat to the mother’s life, (2) pregnancies involving severe fetal deformities, (3) pregnancies resulting from rape or incest, and (4) low-risk healthy pregnancies. They agree with critics of conscientious objection that pregnancies in the first category are medically beneficial and clinically indicated. They state abortions in the other 3 categories are usually performed on the basis of mothers’ mental health; however, the authors do not believe that there is sufficient evidence to prove “abortion positively impacts mental health or that denial of abortion has a long-term negative impact.” They cite studies indicating that induced abortion can be harmful to mental health, and one that indicates abortion has little or no impact on mental health (6). They specified that they are unaware of any studies examining abortion and mental health outcomes for rape victims.
Because most people would argue that doctors should be allowed to refuse actions that oppose the values and principles of medicine, the authors examined the nature of harm, which they state is “a crucial concept underlying these principles.” In their argument, they define harm as an action that places an individual outside of statistical normality. From this, they make the point that giving someone a painful disease that is widespread in a population does not qualify as harm because the suffering experienced from the disease is statistically normal. They synthesized these 2 perspectives to argue that because taking a pregnancy to term is statistically normal, you cannot harm a woman by refusing to perform an abortion.
The second common criticism of conscientious objection is that such a choice may be based on personal, and thus unverifiable, beliefs. The authors state that if personal beliefs are not a legitimate basis for objections, then doctors must be required to perform any action that is included in the scope of their professional practice, even in cases where the clinician feels that those treatments could be harmful or lethal. The authors feel that relying on personal beliefs in healthcare is difficult to avoid and is therefore not a valid criticism of conscientious objection in cases of abortion.
The authors conclude their defense by stating that “if a procedure or treatment within the scope of practice is not clinically indicated, then it should qualify for [conscientious objection].”
Blackshaw BP, Rodger D. Questionable benefits and unavoidable personal beliefs: defending conscientious objection for abortion [published August 31, 2019]. J Med Ethics. doi:10.1136/medethics-2019-105566