February 28, 2024

Does American medicine need more Vera Drakes?

Are abortion doctors brave souls who defy “stigma, marginalization within medicine, harassment, and threat of physical harm” to act in accordance with their consciences?

Vera Drake, a highly praised 2004 film by British director Mike Leigh, painted a portrait of a back-street abortionist in 1950s England. Vera is a warm-hearted, generous charwoman who “helps out girls in trouble” out of the goodness of her heart. Unhappily, one of her girls nearly dies and the police come knocking. Stigmatised as an abortionist, her employers, friends and even her son let the poor woman twist in the wind. The court gives her a harsh sentence “as a deterrent to others”.

Eight years later the image of the saintly abortionist has moved from the cinema to the New England Journal of Medicine. In the September 13 issue, Dr Lisa Harris, of the University of Michigan, Ann Arbor, argues that abortion doctors are brave souls who defy “stigma, marginalization within medicine, harassment, and threat of physical harm” to act in accordance with their consciences.

Dr Harris laments the fact that the pro-life side of the US abortion debate has captured the moral high ground of conscience and conscientious objection.

“the equation of conscience with non-provision of abortion contributes to the stigmatization of abortion providers. If physicians who offer abortion care don’t have a legitimate claim to act in ‘good conscience,’ like their counterparts who oppose abortion, the implication is that they act in ‘bad conscience’ or lack conscience altogether. This understanding reinforces images of abortion providers as morally bankrupt.”

Surely, Dr Harris contends, if there is a place for conscientious objectors, there must also be a place for conscientious providers. “Moral integrity can be injured as much by not performing an action required by one’s core beliefs as by performing an action that contradicts those beliefs.”

Abortion is not completely legal in the US and in many jurisdictions there are limits. In Georgia and Arizona abortions are banned after 22 and 20 weeks. There are no exemptions in the law for abortionists who feel ethically obliged to perform abortions beyond these limits. Why not?

Dr Harris points out that there is great confusion about conscience and its limits. How can the claims of conscience be distinguished from political convictions or personal bias or sheer misinformation? She calls for fresh look at the idea of good conscientious objection. “Failure to recognize that conscience compels abortion provision, just as it compels refusals to offer abortion care, renders ‘conscience’ an empty concept and leaves us all with no moral ground (high or low) on which to stand.”

Michael Cook
Creative commons
conscientious objection