Reproductive justice: Improving access to abortion services in Aotearoa New Zealand

<p>With the recently introduced Abortion Legislation Bill 2019, 2020 could be the year that Aotearoa decriminalises abortion. The Bill, if passed, would remove abortion from the Crimes Act 1961 and treat it, instead, as a health issue. Current legislation has been heavily critiqued for undermining patients’ human rights to healthcare and bodily autonomy, causing lengthy delays in treatment, and contributing to stress. Access to abortion is unequal for different members of society, particularly for those who face socioeconomic disadvantages, are marginalised, rural, Māori, religious, migrant, or a combination thereof. Factors that obstruct access may be legal, geographical, socioeconomic, cultural and societal. Additionally, stigma, the lack of availability of willing abortion practitioners, and conscientious objection represent significant barriers. Improving access to abortion would assist in the achievement of reproductive justice and Aotearoa’s national and international agreements, such as Te Tiriti o Waitangi and the United Nation’s Sustainable Development Goals. This study explores how access to abortion can be improved, particularly for the most disadvantaged, whether or not the law changes. It aims to contribute to improved and more equitable access to abortion services. Undertaken from a social constructivist and transformative epistemology, semi-structured interviews were conducted with 13 abortion providers, academics and advocates, as they are the knowledge-holders of abortion access. The research is guided by the framework of reproductive justice, which recognises every aspect which may hinder or empower a person’s right to control their fertility. The study found that decriminalisation and telemedicine have the greatest potential to improve access to abortion in Aotearoa, particularly for the most disadvantaged. Other ways to improve access, regardless of law change, include improved cultural competency, efforts to reduce stigma, changes to conscientious objection, and integrated services. Decriminalisation would assist in improving access to abortion and making advancements towards reproductive justice and human rights. However, questions remain over the future of funding, training and access.</p>

Reproductive justice: Improving access to abortion services in Aotearoa New Zealand

<p>With the recently introduced Abortion Legislation Bill 2019, 2020 could be the year that Aotearoa decriminalises abortion. The Bill, if passed, would remove abortion from the Crimes Act 1961 and treat it, instead, as a health issue. Current legislation has been heavily critiqued for undermining patients’ human rights to healthcare and bodily autonomy, causing lengthy delays in treatment, and contributing to stress. Access to abortion is unequal for different members of society, particularly for those who face socioeconomic disadvantages, are marginalised, rural, Māori, religious, migrant, or a combination thereof. Factors that obstruct access may be legal, geographical, socioeconomic, cultural and societal. Additionally, stigma, the lack of availability of willing abortion practitioners, and conscientious objection represent significant barriers. Improving access to abortion would assist in the achievement of reproductive justice and Aotearoa’s national and international agreements, such as Te Tiriti o Waitangi and the United Nation’s Sustainable Development Goals. This study explores how access to abortion can be improved, particularly for the most disadvantaged, whether or not the law changes. It aims to contribute to improved and more equitable access to abortion services. Undertaken from a social constructivist and transformative epistemology, semi-structured interviews were conducted with 13 abortion providers, academics and advocates, as they are the knowledge-holders of abortion access. The research is guided by the framework of reproductive justice, which recognises every aspect which may hinder or empower a person’s right to control their fertility. The study found that decriminalisation and telemedicine have the greatest potential to improve access to abortion in Aotearoa, particularly for the most disadvantaged. Other ways to improve access, regardless of law change, include improved cultural competency, efforts to reduce stigma, changes to conscientious objection, and integrated services. Decriminalisation would assist in improving access to abortion and making advancements towards reproductive justice and human rights. However, questions remain over the future of funding, training and access.</p>

Framing Civil Defence Critique: Swiss Physicians’ Resistance to the Coordinated Medical Services in the 1980s

The Coordinated Medical Services, an emblematic organisation of Switzerland’s total national defence system, were operational at the beginning of the 1980s. Through the Coordinated Medical Services, Swiss authorities propagated a sociotechnical imaginary the core of which was that Switzerland was able to survive a nuclear war through a huge collective effort. This vision faced severe criticism, in particular, from members of the Physicians for Social Responsibility and the International Physicians for the Prevention of Nuclear War (PSR/IPPNW Switzerland). The chapter sheds light on their resistive actions, including conscientious objection, as well as on their effective discursive strategy of subjectivisation centring around the figure of the conscientious physician. This resistance contributed to a growing civil defence criticism that challenged the Swiss total national defence imaginary.

Referral vs Transfer of Care: Ethical Options When Values Differ

Conscientious objection (CO) in medicine is where a healthcare professional (HCP) firmly opposes, with an expression of reasoned disapproval, a legally available procedure or treatment that is proscribed by one’s conscience. While there remains controversy regarding whether conscientious objection should be a part of medicine, even among those who support CO state that if the HCP does not provide the requested service such as abortion, physician assisted suicide, etc., there is an obligation on the part of the objecting HCP to refer to someone who will provide it. However, referral makes the referring HCP complicit in the act the referrer believes to be immoral since the referrer has a duty to know that the HCP who will accept the patient is not only able to do the procedure but is competent in its performance as well. The referrer thus facilitates the process. Since one has a moral obligation to limit complicity with immoral actions when it cannot be avoided, the alternative is to allow the patient to transfer care to another when the patient has made the autonomous decision to reject the advice of the HCP.

Conscience absolutism via legislative amendment

On 30 June 2021, Ohio state Governor, Mike DeWine, signed a Bill which would enact the state's budget for the next two years. In addition to its core funding imperatives, the Bill also contained an amendment significantly expanding entitlements of health care providers to conscientiously object to professional duties to provide controversial health care services. This amendment has been heavily criticised as providing the means to allow health care providers to discriminate against a wide range of persons by denying them access to often contested services such as abortion and contraception. In this paper, we examine the implications of this amendment and situate it in relation to other legislative actions intended to guarantee absolute rights to conscientious objection. In doing so, we argue that the entitlements extended to health care providers by these Bills are overly broad and ignore their potential to allow significant harm to be caused to clients. We then argue that if health care providers should have rights to conscientiously object (a question we do not try an answer here), then any legislation intended to protect such rights should be limited, specific, and parsimonious. Where it is not, the ideological liberty of HCPs treads dangerously on the physical freedom of their clients.

“I haven’t had to bare my soul but now I kind of have to”: describing how voluntary assisted dying conscientious objectors anticipated approaching conversations with patients in Victoria, Australia

Background Dealing with end of life is challenging for patients and health professionals alike. The situation becomes even more challenging when a patient requests a legally permitted medical service that a health professional is unable to provide due to a conflict of conscience. Such a scenario arises when Victorian health professionals, with a conscientious objection (CO) to voluntary assisted dying (VAD), are presented with patients who request VAD or merely ask about VAD. The Voluntary Assisted Dying Act 2017 (Vic) recognizes the inherent conflict of conscience that may arise for some health professionals when asked to provide VAD and responds by affording broad protection to conscientious objectors who wish to refuse to take part in the VAD process. Methods Seventeen semi-structured qualitative interviews were conducted with Victorian health professionals with a self-identified CO to VAD in the lead-up to the implementation of VAD in Victoria. Interviews explored how participants anticipated they would manage their CO in practice. Interviews were transcribed verbatim and analyzed thematically. Results Our results reveal that the way in which health professionals claimed they would approach CO conversations is variable and was dependant on the strength of their opposition to VAD. We categorized conscientious objectors according to their approach as either dissuasive non-referrers, passive non-referrers, facilitators or negotiators. Our study also explores the perceived difficulties of exercising one’s CO as identified by our participants. Conclusion The broad protection offered by the Voluntary Assisted Dying Act 2017 (Vic) encourages a range of behaviors from conscientious objectors, due to the minimal obligations imposed. In order to assist conscientious objectors, more policy, institutional guidance, and education needs to be available to conscientious objectors explicitly addressing how to effectively manage one’s CO. Such guidance is imperative to ensuring that their moral integrity is preserved and that they are exercising their CO appropriately.