Tuesday, 26 August 2008

Abortion - Rights of Provider Refusal?

There's been a lot gnashing of teeth on US Feminist blogs about a regulation proposed by the U.S. Department of Health and Human Services that gives legal protection to doctors and health care providers who refuse to participate in abortions or refer women to others that might. Further confounding matters is that the regulations on what constitutes an abortion have been left vague enough that providers can opt out of offering the abortion pill RU-486 and emergency contraception.

This change, which has gotten Pro-Choice activists in the States so angry because of its attack on women's right to choose, has actually been on the statute books here in New Zealand for quite some time. Yep you read correctly. In New Zealand your doctor has a legally enshrined right not only refuse to not perform an abortion (which is a moot point as you have to find two 'certifying consultants' to ok the procedure in the first place) but also has the right to deny access and information to contraception if they object to doing so on grounds of conscience.

The law is very much a reflection of the era in which it was drafted, Doctors (who were almost exclusively male) were held in relatively high esteem and sex outside the confines of marriage were strongly frowned upon. However society has moved on, defacto relationships are commonplace and patients have had formal rights for well over 10 years. Why should we not have those same rights also extend to abortion and more importantly contraception in order to prevent unplanned pregnancies not mention STDs from happening in the first place?

Given that medicine in this country is largely funded by the taxpayer, we do need to start asking difficult questions about whether providers' views abortion and contraception should determine a patient has access to care. I think it is a question that we also need to start asking would-be doctors. If a prospective medical student finds that they are uncomfortable about discussing contraception, gay sexual health or performing medical procedures like abortion, then I believe that they need to find a different career. We expect our biology teachers to discuss evolution as part of the school curriculum even if they believe in Intelligent Design and we expect our Police Officers to enforce our laws even if they don't agree with all of them. It is about time that doctors no longer have the 'right' to put our sexual health in the 'too hard' basket because it makes them uncomfortable.

14 comments:

ms poinsettia said...

What I find interesting is that despite NZ having such a law it doesn't seem to have greatly impacted on women's access to contraception/abortion, yet without such a law in America, doctors and pharmacists are already refusing to write/fill contraception prescriptions and abortion referrals. Maybe because we are a much more secular nation?

I still think it's an important issue here because there seems to be a surge in conservative religious sentiment here, the same thing which has fuelled the vocal anti-abortion factions in the US. Even though the US anti-abortionists are out-of-step with public opinion, they seem to be slowly changing abortion access etc. So even though the religious right are a minority here too, we need to be wary.

artandmylife said...

"Dr Joseph Hassan, Nelson GP in October 2005 wrote to his female patients advising them that he would no longer be prescribing the oral contraceptive pill and they must obtain it elsewhere. He advised them that fertility was a gift that should not be medicated. Dunedin GP and Catholic Dr Astrid Windfuhr, spoke on TV3’s Campbell Live on 1 May 2006 about sending her female patients a similar letter five months previously. She conveniently linked this to a WHO report noting a small known risk of breast and cervical cancer in women taking combined oral contraceptive pills. "

weka said...

What I find interesting is that despite NZ having such a law it doesn't seem to have greatly impacted on women's access to contraception/abortion

Sorry, but that's not correct. Not only are there areas in NZ where all doctors refuse to do abortions there are Health Authorities that intentionally hire anti-abortion obstetric and gynecological doctors. There are a number of places in NZ where you can't get an abortion and have to travel to another province in order to access one. Southland and the West Coast come to mind*.

In the past that also meant that women had to find and pay for their own accomodation and travel, as well as lie to the hospital about their address so they appeared to live in that area. For women that were having to hide the abortion from their families that is a huge barrier. Or women in poverty, or single mothers with little access to child care. Etc.

The situation appears to be a bit better now (DHBs fund travel I think, and women don't have to lie). But some areas are still not hiring doctors willing to do abortions, or even certifying consultants.

*You can check on other areas here: http://www.abortion.gen.nz/index.html

btw, I'm not sure that the HDC gives legal rights. If a practitioner breaks the HDC code, a patient can make a complaint and if it's upheld by the commissioner the HDC will make recommendations but these aren't binding. I think any legally binding censure and action against practioners is down to their professional body. This essentially puts the onus on the patient to make a complaint, not always an easy thing for someone who may be ill or have a disability. It's better than what we had before the 90s, but it still doesn't offer that much protection to health service users.

weka said...

Here's Maia's post, which further details the difficulties for many women of accessing abortion services in NZ:

http://capitalismbad.blogspot.com/2006/05/abortion-access-in-new-zealand.html

Anna McM said...

I've felt conflicted about this in the past, but you've resolved my conflict!

I think there is a place in society for conscientious objective (from warfare for example), and that this should be protected. On the other hand, the right to conscientious objection shouldn't be used on dumb things, or used against particular members of society. For example, I can't stand it when MPs get conscience votes on issues to do with reproductive rights, homosexuality etc - these are political matters of rights and wellbeing.

Same should apply to doctors' right to withold treatment on non-medical grounds, I reckon.

Anna McM said...

And Drs Joseph Hassan and Astrid Windfuhr irk me too. Even if you accept the right of doctors not to prescribe, there's not need to go writing to women advising that their fertility is a bloody gift - that becomes an advertisement for the doctors' own religious beliefs. Unsurprising that they should deem the issue to involve only female patients.

The ex-expat said...

I think there is a place in society for conscientious objective (from warfare for example), and that this should be protected.

I agree. It isn't like we are forcing these people to become doctors and there sure as hell isn't a shortage of applicants for places in medical schools.

Hugh said...

Perhaps this discussion could be broadened by addressing the right of doctors who come from cultural traditions that are anti-abortion, i.e. Sikh doctors? Given the need to recruit more members of ethnic minorities into the medical profession, is it not necessary to allow them to fully practice their cultural beliefs, rather than having to choose between being a good Doctor or a good Sikh?

Anna McM said...

I could accept a pragmatic argument for the need to recruit doctors from different religious/ethnic backgrounds, but I don't much mind asking someone to choose between their religious beliefs and their professional ethics in a stark situation such as this where other people's wellbeing is at stake.

The ex-expat said...

Given the need to recruit more members of ethnic minorities into the medical profession, is it not necessary to allow them to fully practice their cultural beliefs, rather than having to choose between being a good Doctor or a good Sikh?

But that makes a huge assumption that all people of the culture don't engage in activities that are frowned upon that might need medical care.

When I lived in Korea, I was repeatedly told by Koreans that there are no homosexuals (foreign problem apparently) and since all Korean women are virgins I had to self-fund the smear because it wasn't included in my insurance medical.

Of course there were gays and lesbians in Korea and the virgin myth seems ridiculous given the large number of hymen reconstruction surgeries performed.

Which proves that doctors can and do work around taboos, and for those who don't think they can, there is a need to reassess career options.

Hugh said...

But that makes a huge assumption that all people of the culture don't engage in activities that are frowned upon that might need medical care.

Not at all, it simply assumes that some cultures teach that certain practices are not acceptable, and that while not all members of those cultures follow those teachings, some do and should not be penalised for it.

For instance, it's demonstrably clear that not all Maori follow the principles of utu, muru and whanau. That doesn't mean we should expect those who do to put aside these principles, let alone treat the principles as fake.

Anna McM said...

I don't think we'd be asking doctors to disregard any of their beliefs at all. I think we'd be asking them not to act on those beliefs when they contradicted the rights of individuals/groups in our secular state, or in other ways caused harm.

hungrymama said...

I can see an enormous moral difference between refusing to perform a particular procedure/prescribe a particular medicine and refusing to refer a patient on to someone who will.

Medicine's a pretty broad field though and not one that people tend to fall into through lack of choices so it seems to me that it shouldn't be too difficult to avoid ever being faced with such a quandry.

ms poinsettia said...

Thanks for the link Weka. I did catch the end of that interview on Campbell Live with Dr Windfuhr so was aware there were a few doctors around opting out but had the impression it was relatively uncommon, compared to the US. I'm so appalled that health authorities would purposely hire anti-abortion gynaecologists.

On one hand, if doctors are prepared to refer patients on it seems kindof reasonable (but still a big inconvenience and more expensive). But then, if we're talking about a doctor in a small town or rural area where there aren't other easily accessible medical professionals, they're forcing their patients to 'live' their beliefs. I think in the end if doctors are not willing to do all aspects of their job, they need a new job. Of course, this would be a more 'enforceable' approach, employment wise, if abortion was actually legal.