Dilemmas of conscientious objection in the voluntary interruption of pregnancy: integrative literature review
Abstract
Introduction: Conscientious objection (CO) can generate a conflict for health professionals on issues such as voluntary interruption of pregnancy (IVE).
Objective: To analyze the arguments in the scientific evidence for CO in IVE.
Method: Integrative literary review in six stages, obtained from the MEDLINE/PUBMED, ISI Web of Science, LILACS, and SciELO databases published between 2018-2022 in English, Portuguese, and Spanish, adjusted to PRISMA requirements. Data were summarized using thematic analysis.
Results: From 55 texts, 25 were analyzed. 32% of the publications were made in 2020, 36% are critical analyses of the literature, 24% were made in Chile, and 32% were obtained from PUBMED. Three categories of work are accepted: 1. Characteristics of the CO. How does CO affect public health? 2. The advisability of proceeding to a regulation of the exercise of the CO.3. CO challenges.
Conclusions: The aspects that support professional attitudes are problematized, insisting that, although the law recognizes the exercise of CO in the health field, it is necessary to articulate bidirectional protection; in this way, CO is legitimized and acquires coherence, ensuring the right to health of women. Thus, his argument resides in the understanding that the main commitment of health teams is the well-being of women's sexual and reproductive health in all contexts.
Downloads
References
Fleming V, Frith L, Luyben A, Ramsayer B. Conscientious objection to participation in abortion by midwives and nurses: a systematic review of reasons. BMC Medical Ethics [Internet]. 2018 [citado 4 de marzo de 2023];19(1):1-13. Disponible en: https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-018-0268-3
Awoonor-Williams JK, Baffoe P, Ayivor PK, Fofie C, Desai S, Chavkin W. Prevalence of conscientious objection to legal abortion among clinicians in northern Ghana. International Journal of Gynecology & Obstetrics [Internet]. 2018;140(1):31-6. Disponible en: hoy
Marshall P, Zúñiga Y. The overprotection of conscientious objection in Chile’s abortion regulation. Developing World Bioethics [Internet]. 2021 [citado 4 de marzo de 2023];21(2):58-62. Disponible en: https://doi.org/10.1111/dewb.12303
Montero Vega A, Ramírez-Pereira M. Noción y argumentos sobre la objeción de conciencia al aborto en Chile. Revista de Bioética y Derecho [Internet]. 2020 [citado 4 de marzo de 2023];(49):59-75. Disponible en: https://scielo.isciii.es/scielo.php?pid=S1886-58872020000200005&script=sci_arttext&tlng=pt
Salas SP. La objeción de conciencia en la educación médica. Una propuesta para Chile. Revista médica de Chile [Internet]. 2019 [citado 4 de marzo de 2023];147(8):1067-72. Disponible en: http://dx.doi.org/10.4067/S0034-98872019000801067
Ministerio de Salud, Chile. Funcionarios objetores de conciencia por Servicio de Salud a marzo 2022 [Internet]. 2023 [citado 4 de marzo de 2023]. Disponible en: https://www.minsal.cl/funcionarios-objetores-de-conciencia-por-servicio-de-salud/
Montero A, Ramírez-Pereira M, Robledo P, Casas L, Vivaldi L, Molina T, et al. Prevalencia y características de objetores de conciencia a la Ley 21.030 en instituciones públicas. Revista chilena de obstetricia y ginecología [Internet]. 2021 [citado 4 de marzo de 2023];86(6):521-8. Disponible en: http://dx.doi.org/10.24875/rechog.21000006
Souza MT de, Silva MD da, Carvalho R de. Revisão integrativa: o que é e como fazer. Einstein (São Paulo) [Internet]. 2010 [citado 25 de septiembre de 2020];8(1):102-6. Disponible en: https://www.scielo.br/pdf/eins/v8n1/pt_1679-4508-eins-8-1-0102
Hutton B, Catala-Lopez F, Moher D. The PRISMA statement extension for systematic reviews incorporating network meta-analysis: PRISMA-NMA. Med Clin (Barc) [Internet]. 2016 [citado 4 de agosto de 2021];147(6):262-6. Disponible en: https://reader.elsevier.com/reader/sd/pii/S0025775316001512?token=E71AE17868A425C2D8A9022E24CAD60052828E602EC5C64896DA7474EF60CA1B80398F5672A5975906ED3AD8F177DB7E&originRegion=us-east-1&originCreation=20210804172956
Zaami S, Rinaldi R, Montanari Vergallo G. The highly complex issue of conscientious objection to abortion: can the recent European Court of Human Rights ruling Grimmark v. Sweden redefine the notions of care before freedom of conscience? The European Journal of Contraception & Reproductive Health Care [Internet]. 2021 [citado 4 de marzo de 2023];26(4):349-55. Disponible en: https://doi.org/10.1080/13625187.2021.1900564
Michel AR, Kung S, López-Salm A, Navarrete SA. Regulating conscientious objection to legal abortion in Argentina: Taking into consideration its uses and consequences. Health and Human Rights [Internet]. 2020 [citado 4 de marzo de 2023];22(2):271. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7762910/
Branco JG de O, Brilhante AVM, Vieira LJE de S, Manso AG. Objeção de consciência ou instrumentalização ideológica? Uma análise dos discursos de gestores e demais profissionais acerca do abortamento legal. Cadernos de Saúde Pública [Internet]. 2020 [citado 4 de marzo de 2023];36. Disponible en: https://doi.org/10.1590/0102-311X00038219
Harris LF, Halpern J, Prata N, Chavkin W, Gerdts C. Conscientious objection to abortion provision: why context matters. Global public health [Internet]. 2018 [citado 4 de marzo de 2023];13(5):556-66. Disponible en: https://doi.org/10.1080/17441692.2016.1229353
Fonseca SC, Domingues RMSM, Leal M do C, Aquino EM, Menezes G. Aborto legal no Brasil: revisão sistemática da produção científica, 2008-2018. Cadernos de Saúde Pública [Internet]. 2020 [citado 4 de marzo de 2023];36. Disponible en: https://doi.org/10.1590/0102-311X00189718
Watson K. The ethics of access: Reframing the need for abortion care as a health disparity. The American Journal of Bioethics [Internet]. 2022 [citado 4 de marzo de 2023];22(8):22-30. Disponible en: https://doi.org/10.1080/15265161.2022.2075976
Sawicki NN. The conscience defense to malpractice. Calif L Rev [Internet]. 2020 [citado 4 de marzo de 2023];108:1255. Disponible en: https://doi.org/10.15779/Z380P0WRG5
Fleming V, Robb Y. Potential conflicts in midwifery practice regarding conscientious objection to abortions in Scotland. Nursing ethics [Internet]. 2019 [citado 4 de marzo de 2023];26(2):564-75. Disponible en: https://doi.org/10.1177/096973301770833
Fritz KG. Unjustified asymmetry: Positive claims of conscience and heartbeat bills. The American Journal of Bioethics [Internet]. 2021 [citado 4 de marzo de 2023];21(8):46-59. Disponible en: https://doi.org/10.1080/15265161.2020.1863514
Ramsayer B, Fleming V. Conscience and conscientious objection: The midwife’s role in abortion services. Nursing ethics [Internet]. 2020 [citado 4 de marzo de 2023];27(8):1645-54. Disponible en: http://dx.doi.org/10.1177/0969733020928416
Maxwell C, Ramsayer B, Fleming V. It’s about finding a balance… exploring conscientious objection to abortion with UK midwives. Midwifery [Internet]. 2022 [citado 4 de marzo de 2023];112:103416. Disponible en: https://doi.org/10.1016/j.midw.2022.103416
Cuesta JDC. Objeción de conciencia de las personas organizacionales en Colombia. Ciencias Sociales y Educación [Internet]. 2018 [citado 4 de marzo de 2023];7(14):39-64. Disponible en: https://doi.org/10.22395/csye.v7n14a3
Del Risco JAC, Santana GF. La afectación al derecho a la vida y el tratamiento de la objeción de conciencia en el Perú. Revista General de Derecho Canónico y Derecho Eclesiástico del Estado. 2021;(57):15.
Fleming V, Ramsayer B, Zakšek TŠ. Freedom of conscience in Europe? An analysis of three cases of midwives with conscientious objection to abortion. Journal of medical ethics [Internet]. 2018 [citado 4 de marzo de 2023];44(2):104-8. Disponible en: http://dx.doi.org/10.1136/medethics-2016-103529
Botero SS, Cárdenas R, Zamberlin N. ¿De qué está hecha la objeción? Relatos de objetores de conciencia a servicios de aborto legal en Argentina, Uruguay y Colombia. Sexualidad, Salud y Sociedad (Rio de Janeiro) [Internet]. 2020 [citado 4 de marzo de 2023];137-57. Disponible en: https://doi.org/10.1590/1984-6487.sess.2019.33.08.a
Moure Soengas A, Cernadas Ramos A. Percepción del alumnado de medicina sobre la objeción de conciencia a la interrupción voluntaria del embarazo en Galicia. Gaceta Sanitaria [Internet]. 2020 [citado 4 de marzo de 2023];34:150-6. Disponible en: https://doi.org/10.1016/j.gaceta.2019.02.007
Martínez-Sánchez J, Trujillo-Numa L, Montoya-González L, Restrepo-Berna DP. Actitudes, conocimientos y prácticas de internos de medicina frente a la interrupción voluntaria del embarazo en Medellín, Colombia. Revista Médica de Risaralda [Internet]. 2019 [citado 4 de marzo de 2023];25(2):149-56. Disponible en: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0122-06672019000200149
Vicco MH, Zamora MAG. Objeción de conciencia como necesidad legal: una mirada desde el aborto. Revista Bioética [Internet]. 2019 [citado 4 de marzo de 2023];27(3):528-34. Disponible en: https://doi.org/10.1590/1983-80422019273337
Cabello-Robertson J, Núñez-Nova A. Objeción de conciencia institucional y regulación en salud: ¿existe una excusa legítima frente al aborto en Chile? Revista de Bioética y Derecho [Internet]. 2018 [citado 4 de marzo de 2023];(43):161-77. Disponible en: https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1886-58872018000200012
Gonzalez Velez AC. Conscientious Objection, Bioethics and Human Rights: A Perspective from Colombia. Rev Bioetica & Derecho. 2018;42:105.
Robledo P. Objeción de conciencia: entre libertades y derechos. Revista Chilena de Salud Pública [Internet]. 2018 [citado 4 de marzo de 2023];22(2):179-87. Disponible en: https://doi.org/10.5354/0719-5281.2018.53249
The works published in this magazine are subject to the following terms:
1. The Publications Service of the University of Murcia (the publisher) preserves the copyright of the published works, and encourages and allows the reuse of the works under the license for use stated in point 2.
© Servicio de Publicaciones, Universidad de Murcia, 2011 (© Publications Service, University of Murcia, 2011)
2. The works are published in the electronic edition of the journal under Creative Commons Reconocimiento-NoComercial-SinObraDerivada 3.0 España(texto legal) “ a Attribution-NonCommercial-NoDerivatives 3.0 Spain license (legal text)”. They can be copied, used, broadcasted, transmitted and publicly displayed, provided that: i) the authorship and original source of their publication (journal, publisher and URL) are cited; (ii) are not used for commercial purposes; iii) the existence and specifications of this license is mentioned.
3. Conditions of self-archiving. Authors are allowed and encouraged to electronically disseminate the pre-print (pre-reviewed ) and / or post-print (reviewed and accepted for publication) versions of their works prior to publication, as it ensures a wider circulation and dissemination which may lead to a possible increase in its mention and a higher scope among the academic community. RoMEO color: green.