Conscientious Refusals in
Reproductive Health Care
Many bioethicists and health-policy makers are currently struggling with what to do about conscientious refusals by health care professionals to provide health care services such as abortions. Our research addresses this complex moral and legal issue. The goal is to conduct rigorous analyses of when conscientious refusals—in particular those that occur in reproductive health care—are morally and legally permissible, and of which policies and educational initiatives we need in Canada with respect to these refusals. Our practical aim is to encourage delivery of reproductive health care services that is appropriately respectful of conscience and that safeguards women’s reproductive health.
Many bioethicists and health-policy makers are currently struggling with what to do about conscientious refusals by health care professionals to provide health care services such as abortions. Our research addresses this complex moral and legal issue. The problem of conscientious refusals will worsen as our society becomes more ethnically and religiously diverse and as medical science develops new health interventions. Consequently, a solution to this problem, issuing in morally and legally sound policies about the rights of health care professionals to refuse care on grounds of conscience, is urgently needed.
Reproductive health care, in particular, is ripe for an increasing number of refusals because of rapid advances in assisted reproductive technologies. Abortion is not the only source of controversy in reproductive health care. Among others are infertility treatments for lesbian, gay, bisexual, or transsexual (LGBT) people, the use of pre-implantation or prenatal testing to select against disability, and more recently, egg freezing as insurance against age-related fertility. We focus on refusals that occur in reproductive health care.
In addition, we take a feminist perspective on our topic and emphasize that a blanket ban on refusals in reproductive health care is inappropriate from this perspective. One reason is that some refusals will promote social justice for women or for other marginalized groups, and are therefore valuable. Although more often than not conscientious refusals will interfere with social justice, sometimes they do the very opposite.
The objectives are first, to determine when, if ever, conscientious refusals in reproductive health care ought to be permitted; second, to develop morally and legally sound model policies for governing these refusals in different professions that provide reproductive health care; and third, to devise for one of these professions (medicine) model curricula for discussing morally and legally appropriate limits on conscientious refusals with students, preferably before they decide on a specialty.
The research involves five projects, each with their own distinct research questions. Two of the projects (1, 2) will provide the necessary background for the other three projects (3, 4, 5), which focus squarely on our research objectives.
1. The nature and value of conscience: what is morally at stake in denying health care professionals the ability to make conscientious refusals in reproductive health care? What does it even mean for a refusal to be conscientious (i.e., to issue from conscience)?
2. The impact on others: what is morally at stake in granting health care professionals the ability to make conscientious refusals in reproductive health care? What is at stake in particular for the women who are denied care?
3. Moral and legal limits on permissible refusals: given what is at stake in denying or granting these refusals, when, if ever, are they morally permissible? When are they legally permissible? Is there a demarcation line between permissible and impermissible refusals that we could legitimately draw for the sake of public policy?
4. Model policy documents for different health professions: which policies about conscientious refusals ought to be in place, in medicine, nursing, midwifery, and pharmacy in particular?
5. Model curricula for physicians: which model curricula can we recommend, for medical students in particular?
Our core objective with projects 4 and 5 is to transfer the knowledge we gain from projects 1-3 to health policy-makers and health professional educators.
Funded by the Canadian Institutes of Health Research (2010-13.
Carolyn McLeod, Philosophy, Western University (Principal Applicant)
Françoise Baylis, Bioethics, Dalhousie University (Co-applicant)
Jocelyn Downie, Law, Dalhousie University (Co-applicant)
Michael Hickson, Philosophy, Santa Clara University (Co-applicant)
Daniel Weinstock, Director, CREUM—Centre de Recherche en Ethique de l’Universite de Montreal (Co-applicant)
Chloë Fitzgerald, Philosophy, The University of Western Ontario as of Oct. 1, 2011 (Postdoctoral fellow)
Reuven Brandt (Graduate student trainee, Western University)
Patrick Clipsham (Graduate student trainee, Western University)
Lori Kantymir (Graduate student trainee, Western University)
Jason Marsh (Graduate student trainee, Western University)
Meghan Winsby (Graduate student trainee, Western University)
Special issue of Bioethics on conscientious refusals, 2013.
Hickson, M. W. “Conscientious Refusals Without Conscience: Why Not?” Philo: A Journal of Philosophy 13(2), Fall/Winter 2010.
Downie, J. “Resistance Is Essential: Relational Responses to Recent Law and Policy
Initiatives Involving Reproduction.” In Being Relational: Reflections on Relational Theory and Health Law and Policy. Ed. J. Downie and J. Lewellyn. Vancouver: University of British Columbia Press.
McLeod, C. “A Feminist Relational Perspective on Conscience.” In Being Relational: Reflections on Relational Theory and Health Law and Policy. Ed. J. Downie and J. Lewellyn. Vancouver: University of British Columbia Press.
McLeod, C. “Harm or Mere Inconvenience? Denying Women Emergency Contraception,” Hypatia 25(1), 2010: 11-30.
McLeod, C. “An Institutional Solution to Conflicts of Conscience in Medicine.” Review of Conflicts of Conscience in Health Care: An Institutional Compromise, by Holly Fernandez Lynch, Hastings Center Report 40(6), 2010: 41-42.
McLeod, C. “Morally Justifying Oncofertility Research.” In Oncofertility: Reflections from the Humanities and Social Sciences. Ed. T. K. Woodruff, L. Zoloth, L. Campo-Engelstein, and S. Rodriguez. New York: Springer, 2010. pp. 187-194.
Santa Clara Workshop on Conscientious Refusals in Health Care, Santa Clara CA, November 3, 4. Funded by a CIHR Meetings, Planning and Dissemination Grant (L. Kantymir, principal applicant).
Café Scientifique, “The Spark of Conscience Inflames Debate: Conflicts of Conscience in Medicine,” London ON, November 16. Funded by a CIHR Café Scientifique grant (C. McLeod, principal applicant).
Kantymir, L. and C. McLeod. “Justification for Conscientious Objection in Health Care,” North American Society for Social Philosophy annual conference, Milwaukee WI, July 2011.
McLeod, C. “Ethics of Oncofertility Research,” The Tarrytown Meetings, Tarrytown NY, 2011.
Clipsham, P. “Reasons and Refusals: What is the Morally Relevant Content of a Conscientious Refusal?” The Canadian Society for the Study of Practical Ethics, Fredericton NB, May 2011.
McLeod, C. “A Global Perspective on Conscientious Refusals in Reproductive Health Care,” Workshop on Feminism and Global Justice, Canadian Philosophical Association annual meeting, Concordia University, Montreal PQ, June 2010.
McLeod, C. “Conscientious Refusals and Patient-Centred Bioethics,” Patient-Centred Health Law and Ethics, Wake Forest University Law School, Winston-Salem NC, April 2010.
McLeod, C. “A Relational Theory of Conscience for Bioethics,” Program on Values and Society, Department of Philosophy, University of Washington, Seattle WA, February 2010.