Conscience, Issue 2, 22 August 2016One of the themes of this issue of Conscience is “conscience and autonomy”. How did these concepts develop and what role have they played in determining our beliefs about abortion and other reproductive health issues? How do medical professionals weigh their personal beliefs against their responsibilities to patients? What about women who have no opportunities to exercise either conscience or autonomy in decisions about their reproductive health?Last winter, Catholics for Choice held a conference in New York and brought together providers, academics, advocates and journalists to talk about the meaning of conscience and autonomy. The articles featured in this issue were born from these conversations. Here are links to four of them.(1) Driving women around the bend: What’s really going on with abortion access in Italy? by Rosie Scammel“In Italy, the Council of Europe found doctors face a range of disadvantages for their choice to perform abortions, including a burdensome workload and missing career opportunities, amounting to discrimination in the workplace.”Irene Donadio, a senior adviser at International Planned Parenthood Federation, says non-objecting doctors face a “very hostile environment” and some young doctors are only able to get contracts if they claim to be anti-abortion…”Agatone says in some instances, objecting medical staff refuse to bring patients into the procedure room and won’t help clean medical equipment after the procedure, while non-objecting doctors often must travel to different hospitals to perform abortions… Agatone claims that in Rome, one doctor alone can perform 20 abortions a week or more, depending on how many appointments the hospital grants to the women who travel from all over the region… The Italian government, however, says non-objecting doctors perform an average of 1.6 abortions a week, according to 2013 figures, with the maximum found in Rome’s Lazio region (9.4) and Sicily (9.6)…”Daniela Colombo argues this vast range of difficulties associated with being a pro-choice doctor – including the heavy workload, being sidelined from promotions and surviving on short-term job contracts – pushes a disproportionate number of medics to claim they are conscientious objectors. The majority are not motivated by religious sentiment, but rather claim to hold strict Catholic views in order to progress in their careers and avoid being marginalized. “I do not think it’s because they’re all Catholic. They pretend. [Objecting] must be motivated by conscience, but no one goes to see if they are practicing or if they were married in church. I do not think the number of Catholics is on the rise”, whereas the number of doctors claiming to be conscientious objectors continues to increase.”(2) Personal Jesus, by Dr Willie Parker, Obstetrician-Gynecologist, Member of the Board, Physicians for Reproductive Choice, USA”It has not been easy watching the definition of conscience be oversimplified to mean refusal of vital health services for women on religious grounds. What is held as the sacred moral principle for “conscientious objection” is often the observance of patriarchal custom. This custom denies women the right to make decisions about their lives, thus reserving power and privilege for men and boys in an unquestioned manner. This is especially the case when the issue at hand involves preventing a woman from making reproductive decisions other than continuing a pregnancy.”(3) Opt in, opt out, and generation next, by Dr Uta Landy, National Director, Ryan Residency Training Program Fellowship in Family Planning, University of California, San Francisco Bixby Center for Global Reproductive Health, USA”…For example, in our national study on opting out of abortion training, we heard from a male resident whose religious belief was that life starts at the moment of conception. This informed his decision to neither perform nor participate in abortion. In fact, he was reluctant to enter the abortion clinic. He decided to help with post-abortion contraception counseling as a way to prevent the future need for an abortion. Learning more about a woman’s particular circumstances, he was forced to reflect on his premise of conscience, his judgment of the woman, of other physicians doing abortions and the physician’s role in meeting a patient’s needs and requests. His religious perspective took on a new dimension: his gender, when he considered that, as a man, he would never have to make a decision about terminating a pregnancy growing in his own body. Over time, the direction of this resident’s conscience changed. He would offer abortion as an option and refer the women to a colleague…”(4) Harmony, balance and rights: who pays the price, by Dr Suchitra Dalvie, Coordinator, Asia Safe Abortion Partnership, India”Around the world, women’s reproductive health care tends to tell the same story, a bit like Dickens’ A Tale of Two Cities. Right now it is the best of times (medical abortion pills, telemedicine, safe self-use) and the worst of times (increasing attempts to control women’s bodies, more and more absurd laws, reductions in public-sector expenditure on women’s health services).”Consider this quote from a study conducted by Samyak, an NGO working on gender equality based in Pune, India…. It is from a 29-year-old woman who was married at age 16 and had four daughters and two sons. This was her seventh pregnancy:Who thinks about poor people like us? Everyone thinks about money. Those who can spend money can get treatment. I was feeling very helpless. Private Doctor said no for abortion because I was not having money and doctor in public hospital treated me very badly. He said people like you are responsible for increasing population. Don’t you have any work rather than sleeping (having sex), you do these things and then come to us to sort it out. “She concluded that: ‘We poor people cannot do anything.’ ”PHOTO: © Bailey-Cooper Photography / Alamy Stock Photo