Friday, October 29, 2010

A great article on abortion and conscience clauses

  • Abortion, Conscience, and Doctors, by Christopher Kaczor:

    Now, no one believes that all doctors have a duty to provide all possible legal and beneficial services (bracketing for the moment the disputed question about whether abortion is really beneficial care). .... For example, a particular doctor may choose not to perform cosmetic surgery, though legal and in some cases beneficial, even though this means that a patient must visit another doctor to get the requested service. If a mere lack of personal interest (in learning the required procedure) justifies not offering a service (despite the inefficiency for the patient), then a more weighty interest like personal integrity certainly justifies not providing the procedure.


    It is theoretically possible that some patients denied abortion by their doctors will end up not getting abortions at all. However, practically speaking, given that there are 1.2 million abortions performed per year in the U.S. alone, it is apparent that the current law protecting the right of conscientious refusal is not generally impeding the availability of abortion, which remains one of the most common medical procedures worldwide.

    However, let’s suppose that in a given situation a doctor’s refusal to perform an abortion did in fact lead to a particular woman’s not getting an abortion. Has this woman been denied what she is entitled to or what she should have received?

    Um, I thought that any woman who requests an abortion and is denied an abortion will reflexively reach for a coathanger and ream herself out. It turns out that no, she won't. She'll get past the normal ambivalence of early pregnancy and, if Dr. Alec Bourne is to be believed, will be likely to thank the doctor who spared her baby's life:

    Those who plead for an extensive relaxation of the law [against abortion] have no idea of the very many cases where a woman who, during the first three months, makes a most impassioned appeal for her pregnancy to be 'finished,' later, when the baby is born, is thankful indeed that it was not killed while still an embryo. During my long years in practice I have had many a letter of the deepest gratitude for refusing to accede to an early appeal.

    Back to Kaczor:

    Even supposing that abortion is morally permissible, we would then need to identify whether the right to abortion is a liberty right or a claim right. A liberty right allows a person to do a certain action, but implies no duty for others to assist in that action. The right to free speech, an important liberty right, means that an agent may speak, but there is no duty for others to help the agent to speak, say by giving the agent air time on television.

    Mull over that one a while, those of you who hold that abortion is something other people are obligated to provide the woman with, not merely something you want us to stay out of the way of.

    Finally, Savulescu offers what can be called the “commitments of the doctor” argument against conscientious objection. Doctors take on commitments to patient well-being. “To be a doctor is to be willing and able to offer appropriate medical interventions that are legal, beneficial, desired by the patient, and a part of a just health care system.” ....

    At issue, ultimately, is whether abortion really is an appropriate medical intervention compatible with the medical commitment to preserving life and health rather than taking them, whether abortion really is beneficial to women, and whether there is only one or really two patients involved in pregnancy.

    In other words, doctors who are opposed to abortion do not see abortion as an appropriate treatment, but as a harm done to both the mother and child. Why would anybody want to compel a physician to do something he considers harmful to his patient? Should a patient have a presumed right to demand a treatment that the doctor, in his medical judgment, sees as contraindicated? For example, if a doctor refused to prescribe narcotic pain medications to a patient with a history of addiction, instead sending that patient to physical therapy, would the patient's demand for the drugs trump the doctor's medical judgment that this would place the patient at an unacceptable risk of becoming addicted to the painkillers in question?
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