by Agustina Ramón Michel, Sonia Ariza Navarrete
This is the English version of a fact sheet that addresses strategies to deal with CO, based on empirical findings and the dynamics and forms that CO has taken among health professionals.
Based on a survey answered by more than 260 healthcare providers in Argentina and on what we know occurs at healthcare facilities, legal termination of pregnancy (LTP) is, by far, the most objected healthcare practice (Ariza Navarrete & Ramón Michel, 2018).
Conscientious objection (CO) is an exceptional legal concept. As a general principle, the legal system requires and seeks compliance with regulations by everyone who has the legal duty to do so. CO is a curious case where the State allows an individual to be exempted from a legal duty on moral grounds, provided they meet the requirements and the procedures set forth, and that they do not affect the rights of third parties. Originally, CO was meant to protect religious or cultural minorities, usually ignored by legal provisions. There are healthcare providers who, after weighing their moral principles and beliefs and their legal duties, request to be exempted from providing LTP services, as performing an LTP would severely damage their integrity. They somehow recognize their failure to resolve their moral conflict in a way that is more beneficial to their patients, their colleagues, and the health system. Thus framed, CO appears as an act of humility, not of pride or moral refusal (Maglio, 2009).
However, as we well know, many cases of CO to LTP distance themselves from this liberal use, from that ethical image embodied in bioethics and law, and appear more like reactionary acts, including religious fundamentalism and political pressure, which often translate into illicit acts that harm those whom they supposedly should accompany, assist, and care for. Some providers claim conscientious objection as part of activism against reproductive rights, particularly abortion rights. Other providers resort to CO for fear of being stigmatized in extremely hostile environments, for unfounded fears resulting from ignorance or lack of institutional support, or to avoid standing out from their superiors and paying the price for that distancing.
These are motivations and situations that are very different from each other, equivocally encompassed by the term CO but requiring different approaches and responses. Thus, there is currently immense dissonance between that set forth in legal instruments and practice: the version of CO as a thoughtful, sincere, and humble act by someone who is part of a minority has yielded to other uses that are much more problematic and much less ethical.