Focus on Public Sector’s Responsibility

In his article “Doctoring Conscience,” Dick van der Tak recounts some of the experiences of members of Global Doctors for Choice (GDC), who consider it a matter of conscience to provide abortions for women in legally restrictive settings. Some of these physicians, in turn, have suffered harsh consequences. Van der Tak explains that, consequently, there are also physicians who are deterred from providing abortions by fear of such retaliation, some of whom claim conscientious objec­tion as a shield.

GDC has been engaged in exploring the question of conscientious objection to the provision of abortion ever since members reported that, in some settings, it aggra­vated a dearth of providers and thus constituted a barrier to desperately needed care. Is it possible to respect the convictions of women who decide they need an abortion, physicians who consider it a moral imperative to provide them and clinicians whose beliefs preclude them from doing so?

Having been immersed in research and policy discus­sions on several continents on this topic, I now think that the most useful way to honor individual integrity is to shift focus to the institutional and state obligation to provide care. If we center our atten­tion on the public sector’s responsibility to honor human rights commitments to health, gender equity and tolerance of multiple belief systems, then we may find the space to respectfully allow for indi­vidual decisions while ensuring that women obtain necessary care.

WENDY CHAVKIN MD, MPH
Professor of Population and Family Health and Obstetrics-Gynecology
Mailman School of Public Health and College of Physicians and Surgeons
Columbia University, New York, NY