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澳大利亚的堕胎服务:作为一个生物伦理问题的服务提供。

The provision of abortion in Australia: service delivery as a bioethical concern.

机构信息

School of Medicine and Psychology, Australian National University, Canberra, Australia.

出版信息

Monash Bioeth Rev. 2024 Dec;42(2):200-219. doi: 10.1007/s40592-024-00215-0. Epub 2024 Sep 9.

Abstract

Despite significant progress in the legalization and decriminalization of abortion in Australia over the past decade or more recent research and government reports have made it clear that problems with the provision of services remain. This essay examines such issues and sets forth the view that such issues can and should be seen as (bio)ethical concerns. Whilst conscientious objection-the right to opt-out of provision on the basis of clear ethical reservations-is a legally and morally permissible stance that healthcare professionals can adopt, this does not mean those working in healthcare can simply elect not to be providers absent a clear ethical rationale. Furthermore, simple non-provision would seem to contravene the basic tenants of medical professionalism as well as the oft raised claims of the healthcare professions to put the needs of patients first. Recognizing that much of the progress that has been made over the past three decades can be attributed to the efforts of dedicated healthcare professionals who have dedicated their careers to meeting the profession's collective responsibilities in this area of women's health and reproductive healthcare, this paper frames the matter as a collective ethical lapse on the part of healthcare professionals, the healthcare professions and those involved in the management of healthcare institutions. Whilst also acknowledging that a range of complex factors have led to the present situation, that a variety of steps need to be taken to ensure the proper delivery of services that are comprehensive, and that there has been an absence of critical commentary and analysis of this topic by bioethicists, I conclude that there is a need to (re)assess the provision of abortion in Australia at all levels of service delivery and for the healthcare professions and healthcare professionals to take lead in doing so. That this ought to be done is clearly implied by the healthcare profession's longstanding commitment to prioritizing the needs of patient over their own interests.

摘要

尽管在过去十年或更长时间里,澳大利亚在堕胎合法化和非刑罪化方面取得了重大进展,但最近的研究和政府报告清楚表明,服务提供方面仍然存在问题。本文探讨了这些问题,并认为这些问题可以而且应该被视为(生物)伦理问题。虽然出于明确的伦理保留意见而选择不提供服务的良心拒绝——即选择退出的权利——是医疗保健专业人员可以采取的合法和道德立场,但这并不意味着在没有明确伦理理由的情况下,从事医疗保健工作的人员可以简单地选择不提供服务。此外,简单地不提供服务似乎违反了医疗专业精神的基本原则,以及医疗保健专业人员经常提出的将患者的需求放在首位的主张。认识到过去三十年取得的大部分进展可以归因于那些致力于满足该领域女性健康和生殖健康方面的职业集体责任的敬业医疗保健专业人员的努力,本文将此事视为医疗保健专业人员、医疗保健专业和参与医疗机构管理的人员在集体上的伦理失误。尽管也承认一系列复杂因素导致了目前的情况,需要采取各种措施来确保提供全面的服务,并且生物伦理学家对这个话题缺乏批判性的评论和分析,但我得出的结论是,有必要在各级服务提供层面上重新评估澳大利亚的堕胎提供情况,并且医疗保健专业人员和医疗保健专业人员应该带头这样做。这是由医疗保健专业人员长期以来对将患者的需求置于自身利益之上的承诺所隐含的。

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