Conscientious Objection: A Front-Row Perspective from the Theater

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Dr. Philip D. Darney

Five months after the Roe v. Wade decision, I started my ob/gyn residency training at a big city hospital. The hospital had not provided abortions before, but the chief had long believed they were a critical component of women’s health and rights. To the dismay of many of the Catholic nursing staff, he organized an abortion service. That service was my first rotation as a new resident. I’d never done an abortion, and I could tell that most of my teachers hadn’t either, but the chief allowed no objections, conscientious or otherwise, and we all learned quickly. I spent the rest of my career in big city hospitals outside the Bible Belt as an obstetrician, gynecologist and abortion provider.

At all of these hospitals the chiefs, who were determined to provide abortions, hired me, in part, because of my training at that first hospital. By then at least two things had happened that changed hospital-based abortion services: Chiefs no longer had unquestioned authority in their hospitals, and opposition to the Roe decision had intensified. The first development meant that nurses, residents and faculty felt less compelled to comply with their chiefs’ plans, and the second meant that government authorities would support these health professionals if they objected to abortion.

For example, the 1976 Hyde Amendment ended federal support for abortion care, training and research. Poelker v. Doe (1977) ruled that “a city hospital does not have a constitutional obligation to provide abortions or even permit therapeutic abortions.” Based on these developments, conscientious objection became formalized in all three aspects of academic hospitals’ roles: patient care, teaching and research. Neither faculty nor residents could be appointed on the basis of their willingness to do abortions, required to do them or dismissed if they didn’t do them.

At another of the big city hospitals where I worked, the chief had recruited me to run and expand the abortion service to include surgical terminations through the second trimester. He subsequently hired two staunchly Catholic faculty members—one to run residency training and the other medical student instruction. All of us also worked as obstetricians and did gynecologic surgery.

The first of my Catholic colleagues, who organized residency training, was careful that any residents who “opted out” of the six-week abortion provision were interviewed about their conscientious objections. They were also required to work all day in the prenatal clinic rather than operating in the abortion clinic, so that the abortion service was never left without an eager substitute for the objecting resident. In addition, if a patient of his needed an abortion, he always came to the clinic with her and was often in the operating room to support her in the loss of a wanted pregnancy. I could tell that it distressed him to witness the abortion, but he considered compassionate support for his patients as important as his own Catholic conscientious objection to abortion.

I thought that Catholicism alone couldn’t explain the differences in the ethics of their behavior towards their patients and me because the two appeared equally religious.

My other Catholic colleague was venomous in his objection to abortion. He condemned it to the medical students in his charge and, when a “right to life” organization sent out flyers that depicted abortion providers as sleazy outcasts of medicine who weren’t “real doctors,” he posted them on his office door. He refused to discuss any aspect of abortion and never, that I knew of, referred a patient to our abortion service.

I admired the first colleague’s determination to do what he saw as best for our hospital, its residents and our patients despite his discomfort with abortion.

The disdain the second colleague had for those who did abortions offended me, and, in my view, he’d abandoned his patients who needed abortions. I thought that Catholicism alone couldn’t explain the differences in the ethics of their behavior towards their patients and me because the two appeared equally religious. I should have, could have, but never did, explore with them the effect of their religious beliefs on their conscientious objections to abortion. Their contrast reminds me now of the difference I see between two other devoted Catholics, Pope Francis, who offered forgiveness to women who had abortions, and his predecessor Benedict, for whom doctrine seemed more important than compassion.

Phillip D. Darney is distinguished professor, emeritus of obstetrics, gynecology, reproductive sciences and health policy, and director, Bixby Center for Global Reproductive Health, University of California, San Francisco, as well as codirector of the Fellowship in Family Planning at UCSF.

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