Protection of Conscience
Project
Circumstances Indicating Potential
for Conflict of Conscience
Abortion
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Protection of Conscience
Project |
Are State Doctors in the Western Cape
willing to implement
the Choice of Termination of Pregnancy Act of 1996?
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at least ensure that abortions and their complications are well known by all doctors and management of emergencies and complications will be appropriate. Combined meetings with the hospital management, the Department of Health representatives, and the health care providers to determine how to reduce the numbers of unwanted pregnancies in those communities and how to structure the TOP service in that area. Community resources, church and other interest groups should be included to become involved in not only the issue of abortion, but the attendant social pathology that so often accompanies it. Constructive engagement of pro-life and pro-choice forces in the region so that resources can be pooled to tackle the problem of exploited and hurting women who resort to abortion often with little care or support, whether they decide to go through with the TOP or not. Studies on the reasons why doctors are unwilling to do abortions would be helpful in understanding their expressed resistance. Further research into the attitudes of doctors and midwives towards the performance of abortion, and the psychological long term effects on both the mother and abortion provider will be important to undertake for the well being of both. Studies similar to this determining the willingness of nursing staff would be useful in the planning and execution of the dictates of the TOP Act. Studies on the follow up of women who have had terminations will provide a valuable audit of the effectiveness of the counselling given. A survey should determine the persistence of factors in her lifestyle or situation which contributed to the unwanted pregnancy in the first place (such as lack of contraceptive use or alcohol abuse). South Africa has a fragile network of medical services under financial siege and facing enormous obstacles in the face of an avalanche of diseases such as HIV, tuberculosis, and malaria. Abortion for many women is a desperate option in a desperate situation and because of its inherent moral problem - that of the sacrifice of fetal life in the interests of maternal health - threatens to polarize the medical profession in the employ of the State in the Western Cape who clearly have a wide spectrum of convictions. Conflict in this arena runs the risk of generating more heat than light and may ending up damaging the fabric of interpersonal relationships between colleagues as well as jeopardizing cooperation in other spheres of reproductive health service provision. The destructive engagement experienced in other countries should be avoided in South Africa as far as is possible. All personnel in this field can join forces to reduce the number of unwanted pregnancies - a laudable common goal. Our collective energies can be directed towards prevention while still maintaining a mutual respect for the strengths, capabilities and convictions of others in the field of Reproductive Health. The thoughtful advice and suggestions of Professor H.J.Odendaal are acknowledged with grateful thanks. Data processing and statistical comment was provided by Dr.C.J.Lombard of the Centre for Epidemiological Research (South Africa). Comments and criticism of study design were appreciated from pilot study participants and Drs.C.Parry and J.Volmink, and Ms. D. Bradshaw of the Medical Research Council. Ms. Marie Adamo from the Cape Town Dept of Health kindly supplied the relevant Government documents and information on designated institutions. 1. Government of South Africa. Choice on Termination of Pregnancy Act, 1996. No 92 of 1996. Government Gazette No.17602. 1996; 377:1-11. 2. Ward HRG. Major problems with new abortion law. Submission to South African parliament : Portfolio committee for health. 11 October 1996. 3. Sheehan MC, Munro JGC, Ryan JGP. Attitudes to medical practitioners towards abortion: a Queensland study. Austr Fam Phys 1980;9:565-570. 4. Hoyos MD, Walrond ER. National Survey of doctors, nurses and social workers on liberalisation of the Barbados abortion law. W I Med J 1977;26:2-11. 5. Agostino MB, De Marinis MG, Wahlberg V. Health professional opinions regarding abortion and the abortion law in samples from Italy and Sweden. Gynecol Obstet Invest 1991;31:125-129. 6. Communication department; Medical Association of South Africa. Doctors on abortion. Izindaba S Afr Med J 1995;85:31. 7. Castle MA, Hakim-Elahi E. Abortion education for residents. Obstet Gynecol 1996;87:626-629. 8. Frye A. Induced abortion in the United States: a 1994 update. J A M W A 1994;49:131-136. 9. Grimes DA. Clinicians who provide abortions, the thinning ranks. Obstet Gynecol 1992;80:719-723. 10. Westhoff C. Abortion training in residency programs. J A M W A 1994;49:150-152. 11. Lazarus ES. Politicizing abortion: Personal morality and professional responsibility of residents in the United States. Soc Sci Med 1997;44: 1417-1425. 12. CREOG. Educational objectives : “ Core Curriculum for residents in Gynaecology and Obstetrics.” Washington D.C. 1992:35-36. 13. Fishburne J. Proposed new special requirements for OB/GYN 1995. CREOG and Association of Professors in Gynaecology and Obstetrics Annual meeting Re-engineering Medical Education for Woman’s Health Care. 1995:111-112. 14. Marie Stopes Clinic. Promotional material - advertised costs of service. Marie Stopes Clinic, Cape Town 1997. 15. Argus reporter. “Hospitals faces closure.” News report: Cape Argus (city late) 1998; March 31: 3. 16. Wardle LD. Protecting the rights of conscience of health care providers. J Leg Med 1993;14:177-230. 17. Bartholome WG. Ethics and termination of pregnancy, the physician’s perspective; in “Ethical issues at the outset of life.” eds. Weil W, Benjamin M. Blackwell Science, London. 1987:103-120. 18. Information pamphlet handed to abortion applicants. Tygerberg Hospital 1997. 19. Meyers C, Woods RD. An obligation to provide abortion services: what happens when physicians refuse? J Med Eth 1996;22:115-120. 20. Childress JF. Civil disobedience, conscientious objection and evasive noncompliance: a framework for the analysis and assessment of illegal actions in health care. J Med Philos 1985;10:63-83. 21. Dooley D. Conscientious refusal to assist with abortion. (editorial) B M J 1994;309:622-623. |
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