Conscientious objection in medicine: Experience in Chile

Abstract

The last war Chile was engaged in was the War of the Pacific (Salpeter War 1879-1884); since then and up to the reinstatement of democracy in 1988 compulsory military conscription of males at the age of 18 years old was strictly enforced. Exceptions were only granted for medical reasons, to students engaged in higher education, and in response to pressure of influential connections. Nowadays conscription is voluntary and, when necessary to fill the annual quota, a lottery system is used. Consequently, Chileans have no experience with conscientious objection (CO) for military reasons, nor have they needed to be aware of its widespread and rigorous use in such countries as Germany and the U.S.A.The country emerged from a brutal dictatorship (1973)(1974)(1975)(1976)(1977)(1978)(1979)(1980)(1981)(1982)(1983)(1984)(1985)(1986)(1987)(1988) with a strongly neoliberal economy, a dismantled social network, and an impoverished public healthcare system. International loans imposed a subsidiary State supplemented with privatization schemes for social security, education and healthcare services. At present, public hospitals are understaffed and underfunded although expected to cover the healthcare needs of 75% of the population, while private medicine operating with a similar expenditure covers the better off.Scarcity in public healthcare funds has made it necessary to buy services from the private sector to cover needs of their beneficiaries. In a country with a high inequality Gini index of 0.45 where the richest 1% accumulates 26.5% of the national income, politics is slow to abandon tradition and conservatism protected by Church custody.The constitutional separation of State and Church, adopted in 1925, has not eroded the social and political influence of the Catholic Church, to which 45-56% of Chileans declare their allegiance though with dwindling observance.Investing in elite schools, as well as creating and supporting a number of high-quality private universities, including medical schools with excellent teaching hospitals, has been instrumental in educating a conservative elite of healthcare professionals, lawyers and politicians loyal and committed to the Vatican's teachings. Church supported universities have created active bioethics centres and observatories; debates in academic forums on abortion are often closed with the blunt statement that "abortion is

La objeción de conciencia en el ámbito sanitario: un equilibrio entre derechos y deberes

“…En Chile esta forma de objeción se ha utilizado en relación con el aborto y la educación sexual (Kottow, 2021). Defensores de la objeción de conciencia institucional se basan en que es necesaria para proteger las creencias y valores de las organizaciones religiosas y otras organizaciones con fines específicos.…”

Balancing personal beliefs against access to legal abortion: An uneven negotiation

“…Kottow describes how fetal rights in Chile trump the reproductive rights of women when rights to legal abortion have been weakened by strong rights to CO by individuals and on broad institutional bases, even when this results in women being referred to health facilities that are far from the referring institution with the associated burdens of costs and delays. 10 Magelssen and Ewnetu explore, by means of an interview study, the views of health professionals on CO in Ethiopia. This country, as in Sweden, Iceland and Finland, does not allow CO by health professionals.…”