“…the conscientious objection of a healthcare service provider based on his/her ethical or religious beliefs shall be respected; however, the conscientious objector shall immediately refer the person seeking such care and services to another healthcare service provider within the same facility or one which is conveniently accessible who is willing to provide the requisite information and services…" – HB 4244
The passage stated above is one of the most debatable parts
in the Reproductive health bill among health professionals. It requires every
medical professional (doctors, nurses, etc.) to refer a pregnant woman to
another professional if one cannot perform an act due to conflicting ethical
views. So to speak, medical professionals
can refuse, but they should provide a contact person to do it.
Some people argue that this is unethical especially when the
client asks the professional to do abortion. That by referring the patient,
you are already acting as an accomplice to the morally disturbing situation.
However, I believe that patient’s right to information should also be upheld
and health care services be extended to all, even those who choose to undergo
abortion.
For example, a patient asks about abortion, you as a health care professional can’t just
deny them of all information that they deserve as patients. Therefore, the responsibility
then of a doctor/nurse who is under ethical distress is to explain the risks, harm, and other ethico-legal issues to the patient.
When it comes to performing an abortion, the medical
professionals must set clear their values to determine what they would do in
such morally distressing circumstances and refuse to participate if it does not
conform with their beliefs. Medical professionals know what is good for their
patients however they should not impose their beliefs on them and not step on
their right to autonomy. It is the body of the patient thus they have the
authority to decide for themselves.
Should the patient
still persist to have abortion be done, referral to another medical professional is one good
way of ensuring that the abortion will at least be safe. Unsafe abortion as
defined by the WHO as ”a procedure for terminating
an unintended pregnancy either by individuals without the necessary skills or
in an environment that does not conform to minimum medical standards, or both.”
These women usually resort to self-induced abortions or receive it
from traditional healers whose credibility is questionable due to inadequate
medical training. (WHO, 2004) I am not saying that abortion is moral and that there is absolutely
no wrong with it since it has its own ethical issues and legal implications which are also conficting with my values. Although when you consider that an estimated
68,000 women die every year (eight women per hour) due to unsafe abortion (WHO, 2004),
you will realize how salient it is for them to receive adequate health care. This is also supported by the study of Juarez,
Cabigon, Singh, and Hussain (2005) where they recognized that policies and programs
on postabortion care in the Philippines needs improvement.
In a nutshell, patient’s decisions must be respected with
their autonomy valued. Nurses/doctors must assist the patient in coming up with an
ethical decision but should not force their beliefs on the patient. Should
client still pursue abortion, referral is needed to ensure that the procedure
will at least, be safe and free from complications.
Sources:
- Unsafe abortion: global and regional estimates of the incidence of unsafe abortion and associate mortality in 2000. 4th edition, Geneva, Switzerland: World Health Organization, 2004
- Grimes DA, Benson J, Singh S, Romero M, Ganatra B, Okonofua FE, Shah Iqbal Unsafe abortion: the preventable pandemic. The Lancet Sexual and Reproductive Health Series, 2006
- Juarez F, Cabigon J, Singh S, and Hussain R The Incidence of Induced Abortion in the Philippines: Current Level and Recent Trends. International Family Planning Perspectives Volume 31, Number 3, September 2005
- https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhReAVkEFrhEBSQZVesAmZXBiiJ8h0twStwBjVV38dCxbES__oEsGsbjSmsPLARC8jeMbU-z99nVaCnB38GL7Z9L1BD08r_tyDzUqzZXziwTlLdWz3bDeuUz_sNFROCZjVEG3RWSsh3z4Yz/s1600/tb36injectables.jpg
if a medical professional does not want to perform a medical procedure that is permitted by law and approved by the profession, they have an obligation as a professional to make the referral or resign their license. abortion is illegal in the Philippines so your example is not relevant to the debate except as a scare tactic.
ReplyDeleteThat is exactly my point. Should RH Bill be passed, referral to other professionals would be permitted by the law, leaving the issue on the hands of the patient. Of course, adequate health teachings must also be given prior to referring.
ReplyDeleteMy point is that should the RH Bill be passed, abortion would still be illegal.
ReplyDeleteWith respect to referrals, a medical professional is always under an obligation to refer a patient to another practitioner (whether or not Congress passes a law). It is an obligation imposed upon all professionals. The withholding of such a referral whatever the reason is an abuse of power. If someone with a license cannot discharge their professional duties, they are always entitled to resign their license. Regardless of personal beliefs, a professional is not entitled to hold a license and fail to maintain the standards of all professions (medical or otherwise). Maybe we're saying the same thing?
In some points,we are. :)
ReplyDeleteIn bioethics, we follow the principle of primum non nocere or "first do no harm". That is why if the health care professional believes that the procedure is not for the best interest of the patient, he could refuse to perform the act. It's not really failing to act professionally due of personal beliefs but more of not wanting to take responsibility for the possible harmful outcome.
The principle of beneficence should also be considered since abortion does not technically benefit the patient unless it is for a therapeutic purpose. That's is why I'm proposing that if one doesn't want to perform an act that is against what he thinks is right, he should at least refer them to another professional who consents to it so that the abortion would at least be free from complications.
if we're talking about abortion, which is and, after the passage of the RH bill, will be illegal, i don't think there is an issue in denying the procedure and refusing to refer -- from a professional stand-point.
ReplyDeleteif we're talking about complications after the abortion (postabortion), any professional who refuses to treat someone for postabortion problems should have their licensed revoked (now or after the RH passes). it would be as unprofessional or unethical to deny treatment to the victim of a gun shot wound simply because we object to the circumstances in which the wound occurred.
the RH bill is really a rational irrelevance to the primary issue here.
But we cannot deny the fact that being a professional, we should also act on what is best for our patients.
ReplyDeleteI agree completely with your second sentence on the treatment of postabortion problems.
The patient's wishes, whatever they may be, should be followed. This goes not just for birth and abortion, but also for hospice services and non-resuscitate orders.
ReplyDelete