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

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

doi:10.1016/j.socscimed.2019.03.034

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

Soc Sci Med. 2019 Jul:232:181-189. doi: 10.1016/j.socscimed.2019.03.034. Epub 2019 Mar 23.

Authors

Danielle Czarnecki¹, Renee R Anspach², Raymond G De Vries³, Mercedez D Dunn⁴, Katrina Hauschildt⁴, Lisa H Harris⁵

Affiliations

¹ McGill University, Social Studies of Medicine Department, Biomedical Ethics Unit, Canada. Electronic address: danielle.czarnecki@mcgill.ca.
² University of Michigan, Ann Arbor, Department of Sociology, USA; University of Michigan, Ann Arbor, Department of Women's Studies, USA.
³ University of Michigan, Ann Arbor, Department of Sociology, USA; University of Michigan, Ann Arbor, Center for Bioethics and Social Sciences in Medicine, USA; Maastricht University/CAPHRI School for Public Health and Primary Care, Netherlands; University of Michigan, Ann Arbor, Department of Obstetrics & Gynecology, USA.
⁴ University of Michigan, Ann Arbor, Department of Sociology, USA.
⁵ University of Michigan, Ann Arbor, Center for Bioethics and Social Sciences in Medicine, USA; University of Michigan, Ann Arbor, Department of Obstetrics & Gynecology, USA; University of Michigan, Ann Arbor, Department of Women's Studies, USA.

PMID: 31100698
DOI: 10.1016/j.socscimed.2019.03.034

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.

Keywords: Abortion; Bioethics; Care moments; Conscience; Decision-making; Moral work; Qualitative research; Sociology; USA.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Abortion, Induced / ethics*
Abortion, Induced / psychology
Adult
Conscience*
Female
Humans
Interviews as Topic / methods
Obstetrics and Gynecology Department, Hospital / ethics
Obstetrics and Gynecology Department, Hospital / organization & administration
Pregnancy
Qualitative Research
Social Participation / psychology*