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J Med Ethics. 1996 Apr;22(2):115-20.

An obligation to provide abortion services: what happens when physicians refuse?

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  • 1Department of Philosophy and Religious Studies, California State University, Bakersfield, USA.


Access to abortion services in the United States continues to decline. It does so not because of significant changes in legislation or court rulings but because fewer and fewer physicians wish to perform abortions and because most states now have "conscientious objection" legislation that makes it easy for physicians to refuse to do so. We argue in this paper that physicians have an obligation to perform all socially sanctioned medical services, including abortions, and thus that the burden of justification lies upon those who wish to be excused from that obligation. That is, such persons should have to show how requiring them to perform abortions would represent a serious threat to their fundamental moral or religious beliefs. We use current California law as an example of legislation that does not take physicians' obligations into account and thus allows them too easily to declare conscientious objection.


In California, whereas the state mandates the obligation of counties to provide abortion services for incarcerated and for incompetent women, the state also has "conscience clause" legislation which allows health care workers to be excused from providing abortions simply by signing a written declaration. The existence of this legislation can create a situation whereby a county must provide abortions but has difficulty locating a physician to perform the procedures. Whereas individuals must have the right not to engage in activities they find morally repugnant, the California conscience clause is flawed because it fails to consider the moral obligations of physicians to provide services and because it trivializes the process of moral decision-making since no actual justification is needed. Rather than being at complete liberty to choose which services to offer, physicians have an obligation to provide services. Therefore, the burden of proof lies with those who wish to be excused from certain activities. This obligation arises from the debt physicians owe to society through the receipt of extraordinary social benefits (partially taxpayer-supported education; the privilege of professional licensure; the monopoly granted for most types of medical care through state licensing; large salaries and prestige; and, in some cases, employment at taxpayer-supported institutions) and because of the social harm which would occur if services were not provided. California's conscience clause legislation should be amended to establish review boards to evaluate claims of moral objection to providing abortion. Possible criteria which the Boards could follow would include determining: 1) if the applicant has a sincere scruple-based objection, 2) if the scruple fits an otherwise coherent system of beliefs, 3) if the scruple is consistent with other beliefs and actions, and 4) if the scruple is a key component of the petitioner's moral or religious framework. If an exception is granted, all reasonable alternatives should be explored to ensure that physicians fulfill their obligation to provide service, including having the petitioner provide only follow-up care or substituting some other form of public-benefiting service.

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