title: Yes we can! Successful examples of disallowing 'conscientious objection' in reproductive health care.
abstract: Reproductive health care is the only field in medicine where health care professionals (HCPs) are allowed to limit a patient's access to a legal medical treatment - usually abortion or contraception - by citing their 'freedom of conscience.' However, the authors' position is that 'conscientious objection' ('CO') in reproductive health care should be called dishonourable disobedience because it violates medical ethics and the right to lawful health care, and should therefore be disallowed. Three countries - Sweden, Finland, and Iceland - do not generally permit HCPs in the public health care system to refuse to perform a legal medical service for reasons of 'CO' when the service is part of their professional duties. The purpose of investigating the laws and experiences of these countries was to show that disallowing 'CO' is workable and beneficial. It facilitates good access to reproductive health services because it reduces barriers and delays. Other benefits include the prioritisation of evidence-based medicine, rational arguments, and democratic laws over faith-based refusals. Most notably, disallowing 'CO' protects women's basic human rights, avoiding both discrimination and harms to health. Finally, holding HCPs accountable for their professional obligations to patients does not result in negative impacts. Almost all HCPs and medical students in Sweden, Finland, and Iceland who object to abortion or contraception are able to find work in another field of medicine. The key to successfully disallowing 'CO' is a country's strong prior acceptance of women's civil rights, including their right to health care.
authors.affiliation: a Gynmed Clinic for Abortion and Family Planning , Vienna , Austria ;|b Division of Obstetrics and Gynaecology, Department of Women's and Children's Health , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden ;
authors.forename: Christian
authors.initials: C
authors.lastname: Fiala
authors.affiliation: b Division of Obstetrics and Gynaecology, Department of Women's and Children's Health , Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden ;
authors.forename: Kristina
authors.initials: K
authors.lastname: Gemzell Danielsson
authors.affiliation: c Department of Obstetrics and Gynecology , University of Helsinki and Helsinki University Central Hospital , Helsinki , Finland ;
authors.forename: Oskari
authors.initials: O
authors.lastname: Heikinheimo
authors.affiliation: d Department of Obstetrics and Gynecology , Women's Clinic, University of Iceland and Landspitali University Hospital , Reykjavík , Iceland ;
authors.forename: Jens A
authors.initials: JA
authors.lastname: Guðmundsson
authors.affiliation: e Abortion Rights Coalition of Canada , Vancouver , Canada.
authors.forename: Joyce
authors.initials: J
authors.lastname: Arthur
mesh_terms: D000028:Abortion, Induced / Q000331:legislation & jurisprudence / Q000523:psychology*; D000029:Abortion, Legal / Q000523:psychology*; D001291:Attitude of Health Personnel; D003242:Conscience; D003267:Contraception / Q000523:psychology*; D005260:Female; D005387:Finland; D006801:Humans; D007055:Iceland; D009774:Obstetrics; D010820:Physicians / Q000331:legislation & jurisprudence / Q000523:psychology*; D011247:Pregnancy; D016079:Refusal to Treat; D060728:Reproductive Health; D034121:Reproductive Health Services; D013548:Sweden; D014933:Women's Rights
keywords: Abortion; Finland; Iceland; Sweden; conscientious objection; dishonourable disobedience; refusal to treat; reproductive health care