Fiala Christian, Arthur Joyce H
Obstetrics and Gynecology Gynmed Clinic, Vienna, Austria(1).
Abortion Rights Coalition of Canada, POB 2663, Station Main, Vancouver, BC, V6 B 3W3, Canada(2).
Eur J Obstet Gynecol Reprod Biol. 2017 Sep;216:254-258. doi: 10.1016/j.ejogrb.2017.07.023. Epub 2017 Jul 23.
A widespread assumption has taken hold in the field of medicine that we must allow health care professionals the right to refuse treatment under the guise of 'conscientious objection' (CO), in particular for women seeking abortions. At the same time, it is widely recognized that the refusal to treat creates harm and barriers for patients receiving reproductive health care. In response, many recommendations have been put forward as solutions to limit those harms. Further, some researchers make a distinction between true CO and 'obstructionist CO', based on the motivations or actions of various objectors. This paper argues that 'CO' in reproductive health care should not be considered a right, but an unethical refusal to treat. Supporters of CO have no real defence of their stance, other than the mistaken assumption that CO in reproductive health care is the same as CO in the military, when the two have nothing in common (for example, objecting doctors are rarely disciplined, while the patient pays the price). Refusals to treat are based on non-verifiable personal beliefs, usually religious beliefs, but introducing religion into medicine undermines best practices that depend on scientific evidence and medical ethics. CO therefore represents an abandonment of professional obligations to patients. Countries should strive to reduce the number of objectors in reproductive health care as much as possible until CO can feasibly be prohibited. Several Scandinavian countries already have a successful ban on CO.
医学领域普遍存在一种观点，即我们必须赋予医护人员以“良心拒斥”（CO）为由拒绝治疗的权利，尤其是对于寻求堕胎的女性。与此同时，人们也普遍认识到，拒绝治疗会给接受生殖健康护理的患者带来伤害并造成障碍。对此，人们提出了许多建议作为减少这些伤害的解决方案。此外，一些研究人员根据不同反对者的动机或行为，对真正的良心拒斥和“阻挠性良心拒斥”进行了区分。本文认为，生殖健康护理中的“良心拒斥”不应被视为一项权利，而是一种不道德的拒绝治疗行为。良心拒斥的支持者除了错误地认为生殖健康护理中的良心拒斥与军事领域的良心拒斥相同之外，没有真正为自己的立场辩护，而实际上两者毫无共同之处（例如，反对的医生很少受到纪律处分，而患者却要为此付出代价）。拒绝治疗基于无法证实的个人信仰，通常是宗教信仰，但将宗教引入医学则会破坏依赖科学证据和医学伦理的最佳实践。因此，良心拒斥代表着对患者职业义务的抛弃。各国应尽可能努力减少生殖健康护理中反对者的数量，直到能够切实禁止良心拒斥。几个斯堪的纳维亚国家已经成功地禁止了良心拒斥。
