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      Quotas: Enabling Conscientious Objection to Coexist with Abortion Access

      research-article
      1 , , 2
      Health Care Analysis
      Springer US
      Conscientious objection, abortion, rights, quotas, professional obligations, pregnancy

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          Abstract

          The debate regarding the role of conscientious objection in healthcare has been protracted, with increasing demands for curbs on conscientious objection. There is a growing body of evidence that indicates that in some cases, high rates of conscientious objection can affect access to legal medical services such as abortion—a major concern of critics of conscientious objection. Moreover, few solutions have been put forward that aim to satisfy both this concern and that of defenders of conscientious objection—being expected to participate in the provision of services that compromise their moral integrity. Here we attempt to bring some resolution to the debate by proposing a pragmatic, long-term solution offering what we believe to be an acceptable compromise—a quota system for medical trainees in specialties where a conscientious objection can be exercised, and is known to cause conflict. We envisage two main objectives of the quota system we propose. First, as a means to introduce conscientious objection into countries where this is not presently permitted. Second, to minimise or eliminate the effects of high rates of conscientious objection in countries such as Italy, where access to legal abortion provision can be negatively affected.

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          Conscientious objection in medicine.

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            Religion, conscience, and controversial clinical practices.

            There is a heated debate about whether health professionals may refuse to provide treatments to which they object on moral grounds. It is important to understand how physicians think about their ethical rights and obligations when such conflicts emerge in clinical practice. We conducted a cross-sectional survey of a stratified, random sample of 2000 practicing U.S. physicians from all specialties by mail. The primary criterion variables were physicians' judgments about their ethical rights and obligations when patients request a legal medical procedure to which the physician objects for religious or moral reasons. These procedures included administering terminal sedation in dying patients, providing abortion for failed contraception, and prescribing birth control to adolescents without parental approval. A total of 1144 of 1820 physicians (63%) responded to our survey. On the basis of our results, we estimate that most physicians believe that it is ethically permissible for doctors to explain their moral objections to patients (63%). Most also believe that physicians are obligated to present all options (86%) and to refer the patient to another clinician who does not object to the requested procedure (71%). Physicians who were male, those who were religious, and those who had personal objections to morally controversial clinical practices were less likely to report that doctors must disclose information about or refer patients for medical procedures to which the physician objected on moral grounds (multivariate odds ratios, 0.3 to 0.5). Many physicians do not consider themselves obligated to disclose information about or refer patients for legal but morally controversial medical procedures. Patients who want information about and access to such procedures may need to inquire proactively to determine whether their physicians would accommodate such requests. Copyright 2007 Massachusetts Medical Society.
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              Conscientious objection and induced abortion in Europe.

              The issue of conscientious objection (CO) arises in healthcare when doctors and nurses refuse to have any involvement in the provision of treatment of certain patients due to their religious or moral beliefs. Most commonly CO is invoked when it comes to induced abortion. Of the EU member states where induced abortion is legal, invoking CO is granted by law in 21 countries. The same applies to the non-EU countries Norway and Switzerland. CO is not legally granted in the EU member states Sweden, Finland, Bulgaria and the Czech Republic. The Icelandic legislation provides no right to CO either. European examples prove that the recommendation that CO should not prevent women from accessing services fails in a number of cases. CO puts women in an unequal position depending on their place of residence, socio-economic status and income. CO should not be presented as a question that relates only to health professionals and their rights. CO mainly concerns women as it has very real consequences for their reproductive health and rights. European countries should assess the laws governing CO and its effects on women's rights. CO should not be used as a subtle method for limiting the legal right to healthcare.
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                Author and article information

                Contributors
                daniel.rodger@lsbu.ac.uk
                Journal
                Health Care Anal
                Health Care Anal
                Health Care Analysis
                Springer US (New York )
                1065-3058
                1573-3394
                19 November 2020
                19 November 2020
                2021
                : 29
                : 2
                : 154-169
                Affiliations
                [1 ]GRID grid.4756.0, ISNI 0000 0001 2112 2291, School of Health and Social Care, Allied Health Sciences, , London South Bank University, ; 103 Borough Rd, London, SE1 0AA UK
                [2 ]GRID grid.6572.6, ISNI 0000 0004 1936 7486, Department of Philosophy, , University of Birmingham, ; Birmingham, B15 2TT UK
                Author information
                http://orcid.org/0000-0002-2121-7167
                Article
                419
                10.1007/s10728-020-00419-5
                8106580
                33211218
                a0fec28e-e421-435b-84e3-331e79669141
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 11 November 2020
                Funding
                Funded by: London South Bank University
                Categories
                Original Article
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                © Springer Science+Business Media, LLC, part of Springer Nature 2021

                Medicine
                conscientious objection,abortion,rights,quotas,professional obligations,pregnancy
                Medicine
                conscientious objection, abortion, rights, quotas, professional obligations, pregnancy

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