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Conscience reconsidered: The moral work of navigating participation in abortion care on labor and delivery

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  • Czarnecki, Danielle
  • Anspach, Renee R.
  • De Vries, Raymond G.
  • Dunn, Mercedez D.
  • Hauschildt, Katrina
  • Harris, Lisa H.

Abstract

How do caregivers make decisions about participating in morally contested care, such as abortion? Debates about conscience in the delivery of health care generally assume that participation decisions stem from religious beliefs and moral values. Few studies have examined this question in the context of everyday practice. Drawing on 50 interviews with the staff of a labor and delivery unit offering abortion care—including nurses, maternal-fetal medicine specialists, obstetrics and gynecology residents, and anesthesiologists—we show that respondents have varied definitions of “participation” in abortion care and that participation decisions are driven by an array of factors beyond personal beliefs. We present a conceptual model of “moral work” that shows conscience to be an emerging, iterative process influenced not only by beliefs—religious and non-religious—but also by personal and work experiences and social and institutional contexts. Our study brings new insights into understanding conscience and participation in contested care.

Suggested Citation

  • Czarnecki, Danielle & Anspach, Renee R. & De Vries, Raymond G. & Dunn, Mercedez D. & Hauschildt, Katrina & Harris, Lisa H., 2019. "Conscience reconsidered: The moral work of navigating participation in abortion care on labor and delivery," Social Science & Medicine, Elsevier, vol. 232(C), pages 181-189.
    • Handle: RePEc:eee:socmed:v:232:y:2019:i:c:p:181-189
    DOI: 10.1016/j.socscimed.2019.03.034
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    References listed on IDEAS

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    1. Martin, Lisa A. & Hassinger, Jane A. & Debbink, Michelle & Harris, Lisa H., 2017. "Dangertalk: Voices of abortion providers," Social Science & Medicine, Elsevier, vol. 184(C), pages 75-83.
    2. Davidson, Laura A. & Pettis, Clare T. & Joiner, Amber J. & Cook, Daniel M. & Klugman, Craig M., 2010. "Religion and conscientious objection: A survey of pharmacists' willingness to dispense medications," Social Science & Medicine, Elsevier, vol. 71(1), pages 161-165, July.
    3. Chiarello, Elizabeth, 2013. "How organizational context affects bioethical decision-making: Pharmacists' management of gatekeeping processes in retail and hospital settings," Social Science & Medicine, Elsevier, vol. 98(C), pages 319-329.
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    Cited by:

    1. Ramm, Alejandra & Casas, Lidia & Correa, Sara & Baba, C. Finley & Biggs, M. Antonia, 2020. "“Obviously there is a conflict between confidentiality and what you are required to do by law”: Chilean university faculty and student perspectives on reporting unlawful abortions," Social Science & Medicine, Elsevier, vol. 261(C).
    2. Mills, Lisa & Watermeyer, Jennifer, 2023. "A meta-ethnography on the experience and psychosocial implications of providing abortion care," Social Science & Medicine, Elsevier, vol. 328(C).
    3. de Londras, Fiona & Cleeve, Amanda & Rodriguez, Maria I. & Farrell, Alana & Furgalska, Magdalena & Lavelanet, Antonella F., 2023. "The Impact of ‘conscientious objection’ on abortion-related outcomes: A synthesis of legal and health evidence," Health Policy, Elsevier, vol. 129(C).

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