Ramón Michel Agustina, Kung Stephanie, López-Salm Alyse, Ariza Navarrete Sonia
Associate Researcher at the Centro de Estudios de Estado y Sociedad and Professor of Law at Palermo University, Buenos Aires, Argentina.
Research, Monitoring, and Evaluation Advisor at Ipas, Chapel Hill, North Carolina, USA.
Health Hum Rights. 2020 Dec;22(2):271-283.
Claims of conscientious objection (CO) have expanded in the health care field, particularly in relation to abortion services. In practice, CO is being used in ways beyond those originally imagined by liberalism, creating a number of barriers to abortion access. In Argentina, current CO regulation is lacking and insufficient. This issue was especially evident in the country's 2018 legislative debate on abortion law reform, during which CO took center stage. This paper presents a mixed-method study conducted in Argentina on the uses of CO in health facilities providing legal abortion services, with the goal of proposing specific regulatory language to address CO based not only on legal standards but also on empirical findings regarding CO in everyday reproductive health services. The research includes a review of literature and comparative law, a survey answered by 269 health professionals, and 11 in-depth interviews with stakeholders. The results from our survey and interviews indicate that Argentine health professionals who use CO to deny abortion are motivated by a combination of political, social, and personal factors, including a fear of stigmatization and potential legal issues. Furthermore, we find that the preeminent consequences of CO are delays in abortion services and conflicts within the health care team. The findings of this research allowed us to propose specific regulatory recommendations on CO, including limits and obligations, and suggestions for government and health system leaders.
出于良心拒服(CO)的主张在医疗保健领域有所扩大,尤其是在堕胎服务方面。实际上,出于良心拒服正以超出自由主义最初设想的方式被使用,给堕胎服务设置了诸多障碍。在阿根廷,目前缺乏对出于良心拒服的规范且规范不足。这一问题在该国2018年关于堕胎法改革的立法辩论中尤为明显,在此期间,出于良心拒服成为焦点。本文介绍了在阿根廷进行的一项关于出于良心拒服在提供合法堕胎服务的医疗机构中的使用情况的混合方法研究,目的是不仅基于法律标准,还基于日常生殖健康服务中出于良心拒服的实证研究结果,提出针对出于良心拒服的具体监管措辞。该研究包括文献和比较法综述、269名医疗专业人员回答的一项调查,以及对利益相关者的11次深度访谈。我们的调查和访谈结果表明,阿根廷那些出于良心拒服而拒绝堕胎的医疗专业人员是受政治、社会和个人因素的综合影响,包括对污名化的恐惧和潜在的法律问题。此外,我们发现出于良心拒服最主要的后果是堕胎服务的延迟以及医疗团队内部的冲突。这项研究的结果使我们能够就出于良心拒服提出具体的监管建议,包括限制和义务,以及给政府和卫生系统领导人的建议。