Providing accessible healthcare to all citizens is just the
tip of the iceberg when it comes to reforming access to affordable and
comprehensive health services in the United States. Currently, “conscientious
objection” is a contentious protected right for doctors that put them at odds
with their patients. This right in health care protects a physician’s decision
to refuse referrals, information, and health services to a patient based on
their own personal or moral beliefs. In other words, if a patient is in need of
a service that is medically sound, the doctor can refuse to treat them (or
inform them of options available to them) based off of their personal beliefs.
More often than not, conscientious objection negatively impacts women’s access
to reproductive care and life saving operations, and perpetuates a cycle of
victimization and shaming for women.
Following the passing
of Roe V. Wade in 1973, Congress supported conscientious objection in
health care with the passing of the Church Amendment. Conscientious objection
has taken various forms in different states ranging from abortion refusal
clauses to protecting withholding information from a patient. In fact,
forty-six states have refused to provide abortion services to patients, most
states permit parents to refuse immunizations because of religious beliefs,
twenty states allow parents to refuse immunizations because of moral beliefs, sixteen
states allow doctors the right to refuse to perform sterilizations, eight
states allow doctors to refuse the prescription of contraception, and fours
states are considering allowing health care providers to refuse practically
anything on moral grounds.
The American Medical Association, American College of
Obstetricians and Gynecologists, American College of Surgeons, American Academy
of Pediatrics, and American College of Emergency Physicians, all universally
accept that a physician’s primary responsibility is serving the needs of
their patients in balance with their personal belief, but providers
are still asserting their right to deny patients services based on their own
personal, often religiously motivated, beliefs. This not only violates a
patient’s right to adequate health care, but it also is a transgression of
physician responsibility because it places personal beliefs over patient’s health
needs and medically accepted standards of care.
Even more troubling is how conscientious objection has
negatively impacted women’s access to reliable and adequate health care, and
does not help women who have been victimize regain control of their body. According
to a state-level analysis by the Guttmacher Institute: “Currently, about
half (51%) of the 6.6 million pregnancies in the United States each year (3.4
million) are unintended” and 3 in 10 women have an abortion by the age of 45. Additionally,
the Rape, Abuse and Incest National Network reports “1 out of every 6
American women has been a victim of an attempted or completed rape in her lifetime,”
which doesn’t account for the high percentage of people who do not report their
rape, and:
In 2012, 345,830 women were raped.
According to medical reports, the incidence of pregnancy for one time
unprotected sexual intercourse is 5%. By applying the pregnancy rate to 346,830
female survivors, RAINN estimates that there were 17,342 pregnancies as a
result of rape in 2012.
Taking into consideration the high rate of violence against
women, let’s take a look at what conscientious objection actually means for
women. Doctors are allowed to withhold information on Emergency Contraception
(EC) when victims come in for their rape kits, and if the victim is the one in
three women who doesn’t know about EC to request it at the time of service,
this can be a life altering decision forced by a doctor upon their patient. It
is a doctor’s obligation to provide their patient with all the information
necessary for them to make an informed decision. Emergency contraceptive is a
time sensitive medication, and forcing a patient to seek it elsewhere by
refusing to administer it puts them at higher risk of unintended pregnancy or
abortion.
Rape is inherently about control, and by not providing women
with all the possible options to help her make the best medical decision for
herself, or denying her access to EC that she has personally requested, only
serves to further remove her personal control over her body as well as compounds
the feelings of victimization. Doctors should not be victimizing their
patients, but empowering them and helping them recover. Withholding information
or not prescribing EC is not only a violation of a women’s right to health care
services and a violation of the Hippocratic Oath, but puts women at a greater
risk of poor health and morbidity. Rape victims are 4
times more likely to commit suicide, and 24 times more likely to abuse drugs
and alcohol.
Considering that 3 in 10 women have an abortion by age 45
for many different personal and health reasons, and the large number of
unintended pregnancy in the US, women are in need of access to abortion
services and contraception. Doctors who conscientiously object to prescribing
birth control puts women at risk who are in need of hormonal contraception to
help with their menstrual cycles, or prevent pregnancy for medical conditions
that could place their life in danger. For women whose life can be endangered
by pregnancy, sterilization can be refused as well.
Some hospitals and physicians, based on their religious
affiliations and beliefs, can refuse to perform an abortion even if it means
saving the life of the mother and can even withhold information about the
possibility of abortion as a health option. Physicians can refuse to treat a
woman with an ectopic pregnancy (which is almost never viable) until there is
no longer a heartbeat because of a religious or moral objection to abortion,
putting a woman at a higher risk of infection and emotional trauma. Essentially,
doctors are disregarding the life, choices, and care of a woman based off of
their own personal moral beliefs. Once again, women face moral judgment and
shaming by their healthcare provider, not to mention that there are already
societal pressures discouraging women from seeking an abortion and chastising
them for having an abortion.
It is not just a small percentage of doctors who can, and
will, refuse medical services to women because of religious or moral beliefs.
According to The New England Journal of Medicine, “63%
of doctors said it is acceptable to tell patients they have moral objections to
treatments, and 18% felt no obligation to refer patients elsewhere.”
Conscientious objection in the health field ultimately creates a system that breaks
the bond of trust between a woman and her doctor. No woman should be left
wondering if her doctor withheld essential information because of
religious or moral beliefs. Then again, if they don’t ask, will they ever know?
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