Refusal to Treat Patients Does Not Work in Any Country—Even If Misleadingly Labeled “Conscientious Objection”

We would like to point out some serious problems and contradictions in the study “Regulation of Conscientious Objection to Abortion: An International Comparative Multiple-Case Study,” by Wendy Chavkin, Laurel Swerdlow, and Jocelyn Fifield (Health and Human Rights Journal, vol. 19, no. 1, 2017). The study purports to show that it is possible to accommodate health care providers’ “conscientious objection” (CO) to legal abortion while assuring that women with an unwanted pregnancy have access to health care services. The researchers examined four countries—England, Italy, Portugal, and Norway—all Western democracies with laws that allow CO for abortion. They conclude that England, Norway, and Portugal are able to permit CO by law and still provide and fund abortion care. Italy is the major exception, where access to legal abortion is seriously compromised due to a very high number of objectors. However, significant information is omitted from the study, the choice of countries and interviewed stakeholders are selective and unrepresentative, and the findings are interpreted in a biased way. The study does not lend weight to the acceptance of CO for abortion in any country, including the four studied. Instead, the results confirm that refusing to provide basic health care cannot and should not be “accommodated” with patient needs—not even if the treatment refusal is misleadingly called “conscientious objection.” In the introduction, the authors explain that CO was introduced into law “out of political compromise or pragmatic necessity,” but they omit the obvious reasons for this unprecedented intrusion of personal beliefs into medical regulation. Individuals are allowed to boycott a democratically decided law because of society’s deference to religious beliefs and traditional views that assign women to a childbearing role. This points to an inappropriate and unethical basis for CO in reproductive health care—one that has little in common with the military CO it is dishonestly named after. Indeed, many people have argued against the exercise of CO in health care, but the authors never mention this opposing view.1 The study’s selection of four countries that allow CO is biased and rather puzzling. At least 22 countries allow CO through regulation, so why did the authors exclude most of them? They cite the four countries’ ratification of various international human rights agreements as one apparent reason. However, ratified agreements are no guarantee of compliance and have limited relevance to the utility of CO regulation. They also state that the four countries meeting their requirements are those with CO clauses in statute, legal abortion, and funded health care, and are “all high-income Western European countries with liberal