Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia.
Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, Brisbane, QLD, Australia.
Womens Health (Lond). 2023 Jan-Dec;19:17455057231152373. doi: 10.1177/17455057231152373.
Institutional objection (IO) occurs when institutions providing health care claim objector status and refuse to provide legally permissible health services such as abortion. IO may be regulated by sources including law, ethical codes and policies (including State and local/institutional policies). We conducted a mixed-methods narrative review of the empirical evidence exploring IO to abortion provision globally, to inform areas for further research. MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), Global Health (CAB Abstracts), ScienceDirect and Scopus were searched in August 2021 using keywords including 'conscientious objection', 'faith-based organizations', 'religious hospitals' and 'abortion'. Eligible research focused on clinicians' attitudes and experiences of IO to abortion. The 28 studies included in the review were from nine countries: United States (19), Chile (2), Turkey (1), Argentina (1), Australia (1), Colombia (1), Ghana (1), Poland (1) and South Africa (1). The analysis demonstrated that IO was claimed in a range of countries, despite different legislative and policy frameworks. There was strong evidence from the United States that clinicians in religious healthcare institutions were less likely to provide abortions and abortion referrals, and that training of future abortion providers was negatively affected by IO. Qualitative evidence from other countries showed that IO was claimed by secular as well as religious institutions, and individual conscientious objection could be used as a mechanism for imposing IO. Further research is needed to explore whether IO is morally justified, how decisions are made to claim IO, and on what grounds. Finally, appropriate models for regulating IO are needed to ensure the protection of women's access to abortion. Such models could be informed by those used to regulate IO in other contexts, such as voluntary assisted dying.
当提供医疗保健的机构声称反对者身份并拒绝提供合法允许的医疗服务（如堕胎）时，就会出现机构反对（IO）。IO 可能受到法律、道德准则和政策（包括州和地方/机构政策）等来源的监管。我们对全球范围内关于堕胎提供的 IO 的经验证据进行了混合方法叙述性综述，以确定进一步研究的领域。我们于 2021 年 8 月使用包括“凭良心反对”、“信仰组织”、“宗教医院”和“堕胎”在内的关键词，在 MEDLINE（Ovid）、Embase（Ovid）、CINAHL（EBSCO）、全球健康（CAB 摘要）、ScienceDirect 和 Scopus 上进行了搜索。合格的研究重点是临床医生对堕胎的 IO 的态度和经验。综述中包括的 28 项研究来自九个国家：美国（19 项）、智利（2 项）、土耳其（1 项）、阿根廷（1 项）、澳大利亚（1 项）、哥伦比亚（1 项）、加纳（1 项）、波兰（1 项）和南非（1 项）。分析表明，尽管立法和政策框架不同，但在许多国家都提出了 IO。来自美国的强有力证据表明，宗教医疗机构的临床医生提供堕胎和堕胎转介的可能性较低，而对未来堕胎提供者的培训也受到 IO 的负面影响。来自其他国家的定性证据表明，IO 不仅由宗教机构提出，而且还由世俗机构提出，并且个人凭良心反对可以作为实施 IO 的机制。需要进一步研究以探讨 IO 是否在道德上是合理的，如何做出 IO 的决定以及基于什么理由。最后，需要有适当的模型来监管 IO，以确保妇女获得堕胎的机会。这些模型可以借鉴在其他情况下用于监管 IO 的模型，例如自愿协助死亡。
