Conscience reconsidered: The moral work of navigating participation in abortion care on labor and delivery

Czarnecki, Danielle; Anspach, Renée R.; Vries, Raymond De; Dunn, Mercedez D.; Hauschildt, Katrina; Harris, Lisa H.

doi:10.1016/j.socscimed.2019.03.034

Cited by 23 publications

(27 citation statements)

References 26 publications

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“…Moving the boundaries of their involvement and categorising their role as being instrumental in the act of the abortion or reframing their role as supportive care after the event helped staff to create moral distance and reduce their sense of participation. In the same paper when staff had competing imperatives they prioritised professional obligations to patients [34], as did our respondents.…”

Section: Practical Resourcefulnessmentioning

confidence: 71%

“…Other HCPs working in genetics, clinical and laboratory, and foetal medicine units may well avoid situations as has been discussed in other areas of abortion care. One research group, for example, discuss how staff involved in abortions made distinctions about technical, material, temporal and occupational aspects of the work to demarcate a caregiver's role in an abortion [34]. Moving the boundaries of their involvement and categorising their role as being instrumental in the act of the abortion or reframing their role as supportive care after the event helped staff to create moral distance and reduce their sense of participation.…”

Section: Practical Resourcefulnessmentioning

confidence: 99%

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Professionals’ Views on Offering Pre-Natal Testing for Adult Onset Cancer Susceptibility. Reconciling Personal and Professional Ethical Conflicts, Coping Strategies and Need for Policy Transparency

Cowley¹,

Jones²

2020

OBM Genetics

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This paper explores views of healthcare professionals (HCPs) in genetics and foetal medicine settings on offering pre-natal diagnosis (PND) for adult onset cancer susceptibility (AOCS) genes. Study participants came from different disciplinary backgrounds and all had considered implications of offering PND for AOCS, directly or indirectly, from professional and personal perspectives. Foetal medicine and genetics teams are accustomed to offering PND with the possibility of terminating an affected foetus on the basis of preventing severe physical or mental handicap to the child [1, 2]. In this qualitative study, participants were invited to semi-structured interviews. Using a narrative approach, participants had space to follow their thought processes. Narratives were thematically analysed. Whilst participants

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Section: Practical Resourcefulnessmentioning

confidence: 71%

Section: Practical Resourcefulnessmentioning

confidence: 99%

Professionals’ Views on Offering Pre-Natal Testing for Adult Onset Cancer Susceptibility. Reconciling Personal and Professional Ethical Conflicts, Coping Strategies and Need for Policy Transparency

Cowley¹,

Jones²

2020

OBM Genetics

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“…In a qualitative study, McLemore et al found that in deciding whether to participate in abortion care, nurses in California managed tensions between personal values and professional duties, considered the beliefs of those around them and assessed the urgency of a patient's needs 32 . Similarly, in a study among hospital labor and delivery staff, Czarnecki et al found that nurses and staff viewed abortion care as a spectrum of tasks, and had varied and flexible understandings of what they considered “participating” in abortion care 33 . For instance, despite not wanting to participate in an abortion, some nurses were comfortable with preparatory care or with managing postprocedure bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…32 Similarly, in a study among hospital labor and delivery staff , Czarnecki et al found that nurses and staff viewed abortion care as a spectrum of tasks, and had varied and fl exible understandings of what they considered "participating" in abortion care. 33 For instance, despite not wanting to participate in an abortion, some nurses were comfortable with preparatory care or with managing postprocedure bleeding. Illustrating the complexity of decision making, a 2004 study found that labor and delivery nurses in California hospitals felt they received criticism from colleagues whether they participated or refused to participate in abortion care.…”

Section: Discussionmentioning

confidence: 99%

Interprofessional Abortion Opposition: A National Survey and Qualitative Interviews with Abortion Training Program Directors at U.S. Teaching Hospitals

Bennett

Freedman²,

Langton

et al. 2020

Perspect Sexual Reproductive

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Hospital policies and culture aff ect abortion provision. The prevalence and nature of colleague opposition to abortion and how this opposition limits abortion care in U.S. teaching hospitals have not been investigated. METHODS : As part of a mixed-methods study, a nationwide survey of residency and site directors at 169 accredited obstetrics-gynecology training programs was conducted in 2015-2016, and 18 in-depth interviews with program directors were conducted in 2014 and 2017. The prevalence and nature of interprofessional opposition were examined using descriptive statistics, and regional diff erences were investigated using logistic regression. A modifi ed grounded theoretical approach was used to analyze interview data. RESULTS : Among the 91% of survey respondents who reported that they or their colleagues had wanted or needed to provide abortions in the prior year, 69% faced opposition from colleagues. Most commonly, opposition came from nurses (58%), nursing administration (30%) and anesthesiologists (30%), manifesting as resistance to participating in or cooperating with procedures (51% and 38%, respectively). Fifty-nine percent of respondents had denied care to patients in the prior year because of colleagues' opposition. Respondents in the Midwest and South were more likely than those in the Northeast to deny abortion care to patients because of such opposition (odds ratios, 3.2 and 4.4, respectively). Interviews revealed how participants had to circumvent opposing colleagues, making abortion provision diffi cult and leading to delays in and, infrequently, denial of abortion care. CONCLUSIONS : Interprofessional opposition to abortion is widespread in U.S. teaching hospitals. Interventions are needed that prioritize patients' needs while recognizing the challenges hospital colleagues face in their abortion participation decisions.

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“…Additionally, some providers will assist in abortion for some reasons (maternal life, lethal fetal anomaly, etc) but not for others. Some providers will assist with only some aspects of care, 18 and some providers, including midwives, consider follow‐up care to fall under the umbrella of objectionable participation. Finally, it is important to note that, as discussed below, referral for abortion care is always within midwifery scope of practice, 19 although providers do not always provide appropriate or timely referral 20 …”

Section: Review Of Ethical Foundationsmentioning

confidence: 99%

The Ethical Justification for Conscience Clauses in Nurse‐Midwifery Practice: Context, Power, and a Changing Landscape

Eagen-Torkko

Levi

2020

J Midwife Womens Health

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In the last century, conscientious objection has moved from objection to conscripted military service to include health care providers who have moral concerns about participation in specific aspects of health care. Although guidance for the use of conscientious objection has developed in both nursing and midwifery, changes in the political landscape may be creating a source of conflict between providers and the use of conscientious objection. Particularly in aspects of sexual and reproductive care like abortion, contraception, and lesbian, gay, bisexual, transgender, or queer health care, the ethical requirement for prompt referral is becoming increasingly difficult to meet in many contexts. Changes to federal regulations protecting conscience clauses have tilted strongly in favor of the rights of providers in recent years; this challenges the delicate balance of patient and provider rights that has developed over the years. These may now represent an unavoidable conflict between different aspects of the ethical obligations of providers, in particular the obligation to seek justice, and bring into question whether the current status of conscientious objection is sustainable. In this article, we examine these conflicts in the context of the current political climate.

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Conscience reconsidered: The moral work of navigating participation in abortion care on labor and delivery

Cited by 23 publications

References 26 publications

Professionals’ Views on Offering Pre-Natal Testing for Adult Onset Cancer Susceptibility. Reconciling Personal and Professional Ethical Conflicts, Coping Strategies and Need for Policy Transparency

Professionals’ Views on Offering Pre-Natal Testing for Adult Onset Cancer Susceptibility. Reconciling Personal and Professional Ethical Conflicts, Coping Strategies and Need for Policy Transparency

Interprofessional Abortion Opposition: A National Survey and Qualitative Interviews with Abortion Training Program Directors at U.S. Teaching Hospitals

The Ethical Justification for Conscience Clauses in Nurse‐Midwifery Practice: Context, Power, and a Changing Landscape

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