Refusal to engage in abortion: Should the caregiver's conscience clause be changed?

Illus appointment of family planning Interruption Voluntary pregnancy. – Alexandre GELEBART / 20 MINUTES

  • The words of Bertrand de Rochambeau, the president of the union of gynecologists, which compares the abortion with a "murder", have reacted a lot since Tuesday.
  • He relies on the conscience clause to refuse to commit abortions.
  • In France, 1 in 3 women use an abortion in her life.
  • Who can call this conscience clause? Under what circumstances? Should we change this right? "20 minutes" makes up the balance of this controversial issue.

"We are not here to take life, the words of Bertrand de Rochambeau, president of the Syndicate of Gynecologists (SYNGOF), who compared the abortion with a murder in the show daily Tuesday
do not stop with questions. And especially on the
conscience clause, the right that allows doctors to refuse to perform an abortion.

What is the conscience clause?

The ethics code of doctors states that "except in cases of distress and where he falls short in his duties of humanity, a physician has the right to refuse his care for professional or personal reasons." If he is relieved of his mission, he must inform the patient and provide useful information for the continuation of care to the doctor appointed by him. "

But we often talk about the "double conscience clause" because in France a second clause is specific to abortion. Article L2212-8 of the Public Health Code states that "a doctor is never obliged to perform an abortion", as well as "no midwife, no nurse, no medical assistant, whatever it is, is not obliged to compete" with this medical act. Provided he sends his patient to a colleague as quickly as possible. "We will not let a patient down from her cabinet," she says
Jean-Marie Faroudja, from the Council of the Order of Doctors. For him, "this clause must be of specific conscience because pregnancy is not pathology and it is a very specific situation."

Should it be removed?

In a report of January 2017, the High Authority for Equality launched several ways to further improve access to abortion. Among them the deletion of the conscience clause that is specific to abortion.

For some doctors, this oppression would not change anything, because a gynecologist could play the more general clause. Others, on the other hand, would see it as a strong symbol. "This clause of reinforced conscience about the abortion gives a negative signal, underlines that it is still not a legitimate right and reinforces the medical strength of a personal choice," says Véronique Séhier, co-chair of family planning.

Should we go further in this case and gynecos only appeal to the determination of conscience? "This is not the best solution, nuance Laurence Danjou, gynecologist and co-chair of the Association of Centers for Interrupted Pregnancy and Contraception (ANCIC), because a hostile caregiver will not treat the patient properly, but on the other hand it can be a promise are from the caregiver at the time of hiring or the distribution of positions to the boarding school: one in three women needs an abortion! It is as if an infectiologist refuses to care for AIDS … "

"This article deserves to be kept in its current form because it in no way prevents the right of women to abort," replies Jean-Marie Faroudja of the Council of the Order. "It is very important that doctors can keep this right," adds Odile Bagot, a gynecologist and blogger. Personally, I am a gynecologist, a Catholic and for abortion. But I understand that a confrere for whom life begins with the union of the two cells, does not want to go against this prohibition. Especially if there are other options for the patient to stop. "

Is this a real barrier to access to abortion?

But evaluating and guaranteeing these alternatives appears to be complicated. No study, no figure can tell which part of the doctors refuses to perform this action. The gynecologists, doctors and midwives we have contacted share the same observation: being unable to perform an abortion or exceeding the deadline due to a doctor who would have played his clause remains extremely rare. But the brake can be more subtle.

Indeed, in medical deserts, when a woman is confronted with a refusal, she sometimes has to walk for miles to be supported. "It is up to the state to ensure sufficient mesh", justifies Jean-Marie Faroudja.

"Some women nowadays have difficulty access to abortion in France: in the hospital of Sarthe the three gynecologists are conscientious, adds Véronique Séhier, and other patients arriving at the planning explain that they are not reoriented if required by law."

"At the moment it is said that practitioners who are in favor of abortion have retired and there is not the same follow-up," acknowledges Anne-Marie Curat, chairman of the National Council of the Order of Midwives, whether it is the number of gynecologists or personal convictions. The result is that fewer people are willing to perform an abortion. "

According to her, the will of the previous government to open the possibility for midwives to commit drug-induced abortion since the Health Law of 2016. An effective measure to improve access to abortion. "But some liberal midwives have problems on the spot," continues Anne-Marie Curat. In order to be able to do IVG at home, the midwife or generalist must be in partnership with a nearby technical center. But sometimes the hospital is too far away or the hospital management refuses to sign this document. Another limit: if a woman can break off with medication until
In the fifth week of pregnancy she has to go through an instrumental IVG afterwards. Only gynecologists can offer.

"It is not the conscience clause that restricts access to abortion, says Odile Bagot.Catholics, we find more masses, also in caretakers! Nevertheless, we must pay attention to possible deviations: some call for reasons of faith, but others may be because it is not very interesting or profitable, perhaps one should think about asking for a justification for the health professional. "

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