Conscientious refusals to provide reproductive health care
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Conscientious refusals to provide reproductive health care Carolyn McLeod: Conscience in reproductive health care: prioritizing patient interests. Oxford: Oxford University Press, 2020, 224 pp, £40.00 HB Carolyn Mason1
© Springer Nature B.V. 2020
Carolyn McLeod argues that health professionals who conscientiously object to the provision of reproductive health care services have a duty to ensure that their patients and prospective patients can access standard care. The relevant health professionals are those with the discretionary authority to decide what services are relevant, or whether, when and how services ought to be provided, including midwives, nurses, pharmacists, and physicians. McLeod primarily discusses emergency contraception and abortion, but the arguments apply to other reproductive health care services. McLeod focuses on conscientious refusals: “refusals made by health care professionals, on grounds of conscience, to patients’ requests for services that make up the standard of care the professionals are meant to provide to patients” (6). There are three policy approaches to such moral conflicts: prioritizing the interests of conscientious objectors, compromising, or prioritizing the interests of those requesting a service. The first chapters examine the effects of prioritizing the interests of conscientious objectors and reject the possibility of compromise. These chapters include interesting discussions of moral integrity, harm, trust and compromises. Later chapters develop a fiduciary account of the role of health professionals and argue for prioritizing the interests of patients and the public. Chapter 1 investigates the personal value of acting according to conscience. McLeod criticises the view that acting according to conscience has value because it protects our inner moral unity. Rather, she argues that acting according to conscience has value when one’s conscience reflects one’s best moral judgements, because acting against one’s best moral judgements undermines a person’s ability to lead “an authentic moral life” (40). If being denied reproductive health care services were merely an inconvenience, McLeod might accept that this interest in leading an authentic moral life would make conscientious refusals morally permissible. However, she rejects this claim. * Carolyn Mason [email protected] 1
University of Canterbury, Christchurch, New Zealand
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In Chapter 2, “Harm or mere inconvenience?”, McLeod argues that being denied non-emergency reproductive health care services can be harmful. According to McLeod, “harms” are setbacks to our interests that affect our wellbeing. She argues that being refused standard care, such as emergency contraception or abortion services, can set back women’s interests and affect their wellbeing in several ways. First, conscientious refusals can make it difficult to obtain treatment in a timesensitive manner. For example, a refusal to provide emergency contraception can lead to pregnancy and an abortion. Secon
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