The World Health Organization (WHO) has updated its Abortion Care Guidance recently, ostensibly ‘in a bid to protect the health of women and girls and help prevent over 25 million unsafe abortions that currently occur each year’. The implication throughout the guidance is that unsafe abortions are universally illegal ones, whilst legal abortions are universally safe. One might be forgiven for thinking the authors had never heard of Kermit Gosnell. Perhaps they haven’t. Considering his multiple crimes, he is not much mentioned. He ran a legal abortion clinic in the US for many years and Wikipedia calls him an ‘American former physician and serial killer’. In 2013, Gosnell was ‘found guilty of first-degree murder in the deaths of three babies born alive [and]…was also found guilty of involuntary manslaughter in the overdose death of an abortion patient’.
While much of what Gosnell did was illegal at the time – killing babies after they had been born alive and aborting babies after his state’s 24-week limit – does the WHO really think that the owner of this ‘filthy’ business, who ‘overdosed his patients with dangerous drugs, [and] spread venereal disease among them with infected instruments’ would suddenly become a safe person to visit for an abortion simply by removing time limits and other restrictions on abortions as their guidance recommends?
Furthermore, the WHO guidance states that ‘conscientious objection in abortion provision may become indefensible’ (Recommendation 22, p. 60). However, multiple concerns were raised about Gosnell years before any action was taken to investigate properly what was taking place in his clinic. Whistleblowing about poor practice is on a continuum with conscientious objection. John Solas notes: ‘Conscientization or conscience raising, makes blowing the whistle, or more precisely, conscientious objection, possible’. If people are silenced and feel intimidated when they raise legitimate concerns about harm – particularly about practices in which lives are terminated, then unsafe practices will continue, including in legal abortion clinics.
The first mention of conscientious objection in the WHO document is in the contents page in a heading in the final section of 3.3 on Pre-Abortion, which reads: ‘Conscientious objection or refusal by health workers to provide abortion care’. The section which follows does not actually explore these as two different alternatives but merely assumes that conscientious objection equates to refusal to provide abortion care. The document gives no consideration to the moral injury that may result to healthcare professionals who are not prepared to participate in abortion (see the three references below). This is unfortunate, not least because many clinicians who carry out terminations are not willing to perform them up to birth. The repeated assertion of the WHO, however, is that every conscientious objector is ‘a barrier to access to safe and timely abortion’, and it emphasises that states which permit conscientious objection must ensure ‘that an effective exercise of the freedom of conscience of health professionals in the professional context does not prevent patients from obtaining access to services to which they are entitled under the applicable legislation’. Yet even abortionists have conscientious objections to some abortions.
There is no recognition by the WHO that many who conscientiously object to abortion altogether hold this view because they see the harm that abortion does to women, especially those who are pressured or coerced into it. The whole tenor of the WHO document is that the abortion process must never be questioned or queried but merely enabled on request in the fastest possible time.
Healthcare providers should not deliberately seek to delay or prevent anyone seeking an abortion without coercion from obtaining one where is it legal. But to intimidate healthcare staff and make them feel compelled to participate in a procedure they consider harmful is unethical and, in the long run, is harmful to mothers as well.
Kim C. Conscientious objection to abortion: why it should be a specified legal right for doctors in South Korea. BMC Med Ethics. 2020;21:70. doi.org/10.1186/s12910-020-00512-3
Blackshaw B, Rodger D. Questionable benefits and unavoidable personal beliefs: defending conscientious objection for abortion. Journal of Medical Ethics. 2020;46:178-182
Gerrard J. Is It Ethical for a General Practitioner to Claim a Conscientious Objection When Asked to Refer for Abortion? Journal of Medical Ethics. 2009; 35:599–602