When a woman walks into a clinic and asks a doctor for a legal termination of her pregnancy, can the doctor refuse to perform the procedure on grounds of religion and personal beliefs? This was one of the most compelling questions raised at IWAC 2013, and one of the greatest dilemmas of our times.
Abortion, unlike other simple and safe medical procedures, it besieged by controversy. And hospitals, which are vital to abortions, are fertile grounds for debates on the morality of termination. Like other people, doctors can be pro-choice or not. But unlike everyone else, the onus of performing this procedures rests on doctors. And what happens if he or she is authorized by the state to perform an abortion, but was brought up to believe that the procedure is wrong?
Dr. SP Choong, ASAP’s Steering Committee chair raised this vital question in the plenary held on the second day of IWAC. He appealed to doctors not to question a woman’s motives, but perform the procedure simply because she asks for it. He then went on to talk about how this divisive politics within the medical community was in fact stigmatizing those who provided abortion, and even putting their lives at risk in some countries like the United States. He said that the only way this could be stopped was by educating the younger generation of doctors, and teaching them to respect what women wanted.
Speaking immediately after Dr. Choong, Dr. Christian Fiala, an advocate and provider from Austria, echoed this belief in his talk on “conscientious objection,” a word that has been appropriated into the abortion debate from talks on war. Conscientious objection is a right given to a conscripted soldier who might not want to participate in the war on religious, cultural or moral grounds. But abortion, he pointed out was not war, but a safe and basic medical procedure that helps women. “If you do not want to perform an abortion, you cannot choose this field of medicine,” he said. “You cannot become a Gynecologist without being prepared to deal with the question of unwanted pregnancy.”
Prof. Uta Landy of California, USA, who spoke in the Plenary session on the last day of IWAC talked about an option that ObGyn residents are given in the United States. They can choose to “opt-out” of abortion training, but have the opportunity to watch other residents perform this procedure. Additionally they can listen to counseling sessions before and after the procedure. These residents often understood the complex circumstances that make abortion a vital procedure, even if they still refused to perform it themselves. Some of them had decided that they would offer it as an option and refer the woman to a colleague who would provide a safe abortion.
But as a delegate from Ethiopia pointed out in one of the Q&A sessions, this is not really an option in poor African countries, where there is a shortage of trained providers. His concern rings true in several countries in Asia, where conscientious objection — accompanied sometimes by the refusal for a referral — forces women to risk an unsafe abortion or to continue an unwanted pregnancy.
Prof. David Grimes who has been teaching obstetrics in the United States for over three decades thinks that senior doctors can motivate their students to perform abortions by setting an example. “Actions do speak louder than words,” he said in a conversation we had after his enlightening talk on misogyny, “When senior, respected faculty show up in the abortion clinic on a regular basis and provide compassionate, skilled care as a routine part of their practice, it sends a powerful message to the students and residents.”
While the sessions at IWAC were not meant to provide a specific answer to these problems, they did provide a compromise. All doctors must think of it as their moral obligation to refer a woman to a provider even if they do not want to perform the procedure themselves. It is unfortunate if a woman should lose her life over a moral dilemma that takes root in a person’s religious beliefs.