Conscientious objection and refusal to provide reproductive healthcare: a White Paper examining prevalence, health consequences, and policy responses.
Conscientious objection and refusal to provide reproductive healthcare: a White Paper examining prevalence, health consequences, and policy responses.
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DOI：
10.1016/s0020-7292(13)60002-8
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发表时间：
2013-12-01
期刊：
影响因子：
--
通讯作者：
Polin, Kate
中科院分区：
文献类型：
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作者：
Chavkin, Wendy;Leitman, Liddy;Polin, Kate
背景：全球医生选择-一个倡导生殖健康和权利的医生跨国网络-开始探索基于良心拒绝生殖保健的现象，因为世界范围内越来越多的危害报告。本白皮书审查了这种拒绝的普遍程度和影响，并审查了平衡个人良心、生殖决策自主、健康保障和专业医疗诚信的政策努力。目标和检索策略：本白皮书收录了1998年至2013年间以英语、法语、德语、意大利语、葡萄牙语和西班牙语出版的医学、公共卫生、法律、伦理和社会科学文献。由于对拒绝者身份的标准没有达成共识，也没有对这种做法的标准化定义，而且这些研究有抽样和其他方法上的限制，因此很难获得流行率的估计。白皮书审查了这些数据，并提供了逻辑框架，以说明基于良心拒绝提供堕胎可能对健康和卫生系统造成的后果；辅助生殖技术；避孕;在孕产妇健康面临风险和不可避免的流产的情况下进行治疗；产前诊断。最后对法律、监管和其他政策应对措施进行了分类。结论：经验证据对于不同的政治行为者来说是必不可少的，因为他们用政策或法规来应对利害攸关的竞争问题。需要在不同的地缘政治环境下进行进一步的研究和培训。提供者和专业医疗/公共卫生协会对自己的良心负有双重责任，对病人的健康和权利负有双重义务，必须带头努力应对基于良心的拒绝，并保护生殖健康、医疗诚信和妇女的生命。
BACKGROUND: Global Doctors for Choice-a transnational network of physician advocates for reproductive health and rights-began exploring the phenomenon of conscience-based refusal of reproductive healthcare as a result of increasing reports of harms worldwide. The present White Paper examines the prevalence and impact of such refusal and reviews policy efforts to balance individual conscience, autonomy in reproductive decision making, safeguards for health, and professional medical integrity.OBJECTIVES AND SEARCH STRATEGY: The White Paper draws on medical, public health, legal, ethical, and social science literature published between 1998 and 2013 in English, French, German, Italian, Portuguese, and Spanish. Estimates of prevalence are difficult to obtain, as there is no consensus about criteria for refuser status and no standardized definition of the practice, and the studies have sampling and other methodologic limitations. The White Paper reviews these data and offers logical frameworks to represent the possible health and health system consequences of conscience-based refusal to provide abortion; assisted reproductive technologies; contraception; treatment in cases of maternal health risk and inevitable pregnancy loss; and prenatal diagnosis. It concludes by categorizing legal, regulatory, and other policy responses to the practice.CONCLUSIONS: Empirical evidence is essential for varied political actors as they respond with policies or regulations to the competing concerns at stake. Further research and training in diverse geopolitical settings are required. With dual commitments toward their own conscience and their obligations to patients' health and rights, providers and professional medical/public health societies must lead attempts to respond to conscience-based refusal and to safeguard reproductive health, medical integrity, and women's lives.