Abstract
This paper advances a normative framework to understand conscientious objection in the area of sexual and reproductive health services. Here, the objection of health professionals, unlike traditional cases of objection (such as the refusal of mandatory military service), directly affects the rights of other people. For this and other reasons I detail, the permissive strategies of the model I call “libertarian” (in which the scope of objection is limitless) and the model I call “conciliatory” (in which the referral of patients to non-objecting professionals is the condition for access to the right to conscientious objection) run into serious problems. I argue in favor of a third model inspired by the ideal of equality. From this perspective, it is unlikely that conscientious objection can be acceptable for sexual and reproductive health professionals. For this to be so, the limits on its exercise would have to be much stricter than those established by the conciliatory model and, in any case, the acceptance of any objections would have to be subordinated to the prior existence of non-discriminatory, universal access to sexual and reproductive health services.
Keywords
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- 1.
Among the works consulted for this piece, some that stand out are: Casas (2006), Dickens (2006), White (1999), Dresser (2005), Cantor and Baum (2004), Cook (2007), Cook and Dickens (2003, 2006), Charo (2005). Regarding considerations which are relevant in the developing world, see Van Bogaert (2002).
- 2.
“Le practicaron el aborto a la chica discapacitada de Entre Ríos que fue violada” Clarín, 24/9/2007. Cantor and Baum inform us that in Texas, a pharmacist refused to dispense emergency contraception to a rape victim who had a doctor’s prescription (Cantor and Baum 2004, note 9). Allison Grady describes the case of a married mother of four who tried to buy the morning-after pill in a pharmacy in Wisconsin. The pharmacist denied her the product and refused to return the prescription to her (Grady 2006).
- 3.
- 4.
Ascensio, José H. s/Amparo, Fallos 304:1293.
- 5.
Lopardo, Gabriel Fernando (Fallos 304:1524).
- 6.
Fallos 304:1533.
- 7.
Portillo, Alfredo s/infracción art. 44 ley 17531 (JA 1989-II-658, Fallos 312:496).
- 8.
See Cárdenas and Tandeter (2008).
- 9.
Human right treatises, which are constitutional norms in Argentina, guarantee women’s right to “medical care without discrimination” including “family planning”.
- 10.
Charo (2005, p. 2473).
- 11.
In the United States, courts extend the duty of care to pharmacists. Hooks Super X, Inc. V. Mc Laughlin, 642 N.E. 2d 514 (Ind. 1994).
- 12.
- 13.
As of June 2018, a bill establishing free abortion in the first 14 weeks of pregnancy passed in the lower chamber and is under consideration in the Senate.
- 14.
CEDAW, Sexual Health and Responsible Procreation Act, N. 25.673, Law 26.130 regulating contraceptive surgery, Law 26.150 establishing a National Program of Sexual Education, etc.
- 15.
CELS, 2008 HHRR Report, “El acceso al aborto permitido por la ley: un tema pendiente de la política de derechos humanos en la Argentina” by CEDES researchers Silvina Ramos, Paola Bergallo, Mariana Romero, and Jimena Arias Feijoó.
- 16.
“Portal de Belén—Asociación Civil sin Fines de Lucro c/ Ministerio de Salud y Acción Social de la Nación s/ amparo,” CSJN, March 5, 2002 (citing a fictitious Nobel Prize and the opinions of a geneticist from a decision by the Tennessee Supreme Court, hiding the fact that said Court dismissed his opinions because of his lack of expertise in the issues discussed, and for showing a deep confusion between science and religion). Investigation by Virginia Menéndez, included in the appeals procedure before the courts of Córdoba province: “Mujeres por la vida Asoc. sin fines de lucro c. Superior Gobierno de la Provincia de Córdoba—amparo—Recurso de Apelación” file no. 1270503/36, in file with author).
- 17.
See the 2002 Report by the National Ministry of Health and CEDES on maternal mortality in Argentina, available at http://www.msal.gov.ar/htm/site/pdf/Resumen%20ejecutivo.pdf.
- 18.
This strategy is similar to what Rebecca Dresser calls a “contract model,” in which the doctor informs the patient at the outset about the limits of her or his services (Dresser 2005, p. 9). The libertarian strategy allows even more leeway to the doctor.
- 19.
Adrienne Asch claims that the objector “exercises his right of conscientious refusal only by honest conversation followed by referral if the patient persist in her desires” (2006, p. 11). The scope of this “conversations” remains as a valid concern.
- 20.
Cantor and Baum defend this model (Cantor and Baum 2004, p. 2011).
- 21.
See Dresser (2005, p. 9).
- 22.
See Shue (1980).
- 23.
In the Province of Santa Fe, Sexual Health Law 11888 of 2001 in its Article 4 recognizes the right to conscientious objection but mandates the government to ensure “access to the services”. The decree regulating the Law creates a registry of objectors, not yet implemented. A similar norm in La Pampa was vetoed by the governor in 2007.
- 24.
I would like to thank Bo Burt for an illuminating conversation on this point.
- 25.
This requirement would rule out an objection to prescribing or selling the morning-after pill on the grounds of its abortive effects.
- 26.
I am grateful to Florencia Luna for conversations on this question.
- 27.
Like that of Rawls, for example, in Rawls (1971).
- 28.
See Markovits (2005).
- 29.
MacLucas (2007).
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Acknowledgements
I wish to express my thanks to Gloria Orrego for her very valuable research assistance and to Paola Bergallo for illuminating discussions. This work was supported by the Centro de Estudios de Estado y Sociedad and was developed during my stay at Yale Law School during February–March 2009. I thank Owen Fiss, Bo Burt, George Priest, Daniel Markovits, Reva Siegel, Robert Post, and Bradley Hayes for the warmest winter for me and my family.
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Alegre, M. (2019). Conscious Oppression: Conscientious Objection in the Sphere of Sexual and Reproductive Health. In: Rivera-López, E., Hevia, M. (eds) Controversies in Latin American Bioethics. International Library of Ethics, Law, and the New Medicine, vol 79. Springer, Cham. https://doi.org/10.1007/978-3-030-17963-2_3
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