Lisa Harris, M.D., wrote an interesting article for the September issue of the New England Journal of Medicine in which she flips the usual discusssion on conscientious objection and abortion. Harris argues that focusing on conscientious objections to performing abortions ignores the fact that many medical providers perform abortion services precisely because they feel compelled by their conscience:

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.”

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. However, doctors (and, in some states, advanced practice clinicians) continue to offer abortion care because deeply held, core ethical beliefs compel them to do so. They see 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 more than the potential life of a fetus, among other reasons. Abortion providers continue to describe their work in moral terms, as “right and good and important,” and articulate their sense that the failure to offer abortion care generates a crisis of conscience.

Yet we continue to hear only of medical providers who conscientiously object to performing certain services —  which, as Harris points out, has negative consequences:

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. Second, the equation of conscience with nonprovision of abortion contributes to the stigmatization of abortion providers. Finally, bioethicists have focused on defining conditions under which conscientious refusals are acceptable but, with rare exceptions, have neglected to make the moral case for protecting the conscientious provision of care.

This is more than just an interesting philosophical argument. It is also tool that should be used by reproductive rights activists in debates over conscientious objection to providing health care. The next time you hear a person argue for the right to not perform certain services, ask them whether they would also argue for the right to perform certain services. The answer will likely indicate whether the person simply opposes whatever service is being discussed (i.e., abortion), or whether the person actually has a logically consistent argument concerning conscience rights.

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