BackgroundFreedom of conscience is a core element of human rights respected by most European countries. It allows abortion through the inclusion of a conscience clause, which permits opting out of providing such services. However, the grounds for invoking conscientious objection lack clarity. Our aim in this paper is to take a step in this direction by carrying out a systematic review of reasons by midwives and nurses for declining, on conscience grounds, to participate in abortion.MethodWe conducted a systematic review of ethical arguments asking, “What reasons have been reported in the argument based literature for or against conscientious objection to abortion provision by nurses or midwives?” We particularly wanted to identify any discussion of the responsibilities of midwives and nurses in this area. Search terms were conscientious objection and abortion or termination and nurse or midwife or midwives or physicians or doctors or medics within the dates 2000–2016 on: HEIN legal, Medline, CINAHL, Psychinfo, Academic Search Complete, Web of Science including publications in English, German and Dutch. Final articles were subjected to a rigorous analysis, coding and classifying each line into reason mentions, narrow and broad reasons for or against conscientious objection.ResultsOf an initial 1085 articles, 10 were included. We identified 23 broad reasons, containing 116narrow reasons and 269 reason mentions. Eighty one (81) narrow reasons argued in favour of and 35 against conscientious objection. Using predetermined categories of moral, practical, religious or legal reasons, “moral reasons” contained the largest number of narrow reasons (n = 58). The reasons and their associated mentions in this category outnumber those in the sum of the other three categories.ConclusionsWe identified no absolute argument either for or against conscientious objection by midwives or nurses. An invisibility of midwives and nurses exists in the whole debate concerning conscientious objection reflecting a gap between literature and practice, as it is they whom WHO recommend as providers of this service. While the arguments in the literature emphasize the need for provision of conscientious objection, a balanced debate is necessary in this field, which includes all relevant health professionals.
Freedom of conscience in Europe? An analysis of three cases of midwives with conscientious objection to abortion http://researchonline.ljmu.ac.uk/8578/ Article LJMU has developed LJMU Research Online for users to access the research output of the University more effectively. Copyright © and Moral Rights for the papers on this site are retained by the individual authors and/or other copyright owners. Users may download and/or print one copy of any article(s) in LJMU Research Online to facilitate their private study or for non-commercial research. You may not engage in further distribution of the material or use it for any profit-making activities or any commercial gain.The version presented here may differ from the published version or from the version of the record. Please see the repository URL above for details on accessing the published version and note that access may require a subscription. However, support from both professional and religious sources was inconsistent both within and between the examples. The authors conclude that there is a need for clear guidelines at both local and pan-European level for health professionals and recommends a European wide forum to develop and test them.
This article considers one of the philosophical sources of reflexivity, the concept of “pre-understandings” as envisaged by the German philosopher, Hans Georg Gadamer. There are a number of empirical research studies employing a Gadamerian approach, and while some authors may describe methods of examining pre-understandings and applying findings reflexively to hermeneutic enquiry, there remains a general lack of sufficient detail given over to the “how” in relation to this process. Furthermore, Gadamer describes how the “provoking” of one’s pre-understandings is required in order to make them realizable and this is rarely evident within authors’ work. As part of a hermeneutic research project exploring health professionals’ views of conscientious objection to abortion, we as a research team undertook a process of “provoking” our pre-understandings surrounding conscientious objection to abortion. This was undertaken by a preliminary discussion to examine our preunderstandings. A second discussion followed to examine if and how our pre-understandings had altered, and was conducted after the research team had read five transcribed interviews from a study on health care professionals’ perspectives of conscientious objection to abortion. By reviewing our pre-understandings, we were able to begin to make conscious what was unconscious, widening some of our initial views, being more definitive in others and in some cases endorsing our original pre-understandings. Using a reflexive process, we assimilated these findings with our research project and used it to inform our data collection, analysis and interpretation, demonstrating the application of rigor to our hermeneutic study.
Maternal emotions during the first three postnatal months: Gaining an hermeneutic understanding.
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