Conscience and competence

They giveth and yet they taketh away. The Supreme Court ruled that the Responsible Parenthood and Reproductive Health Law is constitutional but at the same time ruled that eight provisions of the law should be struck down.

The eight provisions had mostly to do with the “conscientious objectors”—health service providers, institutions and even local officials who for one reason or another would refuse to provide reproductive health services, commodities or other forms of support for such services. The questioned provisions threatened sanctions on the objectors, which the Supreme Court overruled, thus rendering them “toothless.” Indeed, the exceptions covered even the most innocuous requirements: providing information on family planning to their clients, referring individuals they refused to treat to other service providers, and providing free or “pro bono” services to the poorest patients.

The justices also put more value on parental and spousal rights over those of individual rights—even as they seemed to prioritize the “conscience” of objectors (over those of patients or clients). Based on the ruling, health service providers could require an individual seeking a procedure (ligation or vasectomy) to seek the permission of his or her spouse before providing the service (in a “nonemergency” situation). Adolescents seeking RH services (again not in an emergency) could also be required to show proof of parental consent before receiving these services.

Another provision that was struck down was one defining an “abortifacient” as one that “primarily” results in the termination of a pregnancy. To my mind this still could lead to the banning of any contraceptive or medication on grounds that it could result in an abortion, even as a side-effect. Given the contention of anti-RH groups that links a condom to abortion, the high court has opened the door to endless challenges to all forms of contraception.

* * *

Despite these eight exceptions, though, I do believe the Supreme Court ruling is, as Sen. Miriam Defensor Santiago put it, “a triumph of reason over superstition.”

It could also be a triumph of our individual consciences over those who would impose their own consciences, values or beliefs on ours. Now, more than ever, it’s important for women—and men—to check the willingness or ability of health service providers to share RH information and services in a truthful, comprehensive and helpful manner.

I would question, for one, the dedication and ability of a nurse, midwife or doctor who cannot or will not provide family planning or RH information and services to patients. (Or refer patients to colleagues who would do what they refuse to do.)

How can they claim to provide the full spectrum of services to clients when they refuse to touch on such a crucial health concern? I would question, for one, any doctor’s motive (and competence) to specialize in obstetrics and gynecology without any intention to provide information or services on reproductive health, which is what the specialization is all about.

So if you’re a woman or couple seeking a specialist to consult regarding pregnancy, fertility, or any RH problem, make sure to inquire about the doctor’s views on reproductive health and rights, and if he or she is willing to provide right and timely information, advice and services to you. Check, too, with other patients to see if the doctor or midwife is being completely honest with you.

I still remember a friend’s story that when she suffered from an ectopic pregnancy (where the fetus starts developing in a fallopian tube and not in the womb), her doctor chose to wait “until the last possible moment” before excising the fetus, on grounds that it could possibly be an abortion. This, despite scientific evidence, long proven, that an ectopic pregnancy is not viable, and that it poses a very real risk to the life of the mother. In this instance, her doctor chose to prioritize his or her conscience (erroneously) over the patient’s own health and life. Still gives me the heebie-jeebies!

* * *

Of course, for the great majority of mothers (and fathers) in the country, choosing who to consult in case of a pregnancy—or the desire to prevent or postpone one—is a luxury. The only choice for poor couples is to visit a public health clinic or center, provided they have the money for transportation or the luxury to skip a day of work for a consultation.

What choice would a poor woman have if the doctor, nurse or midwife she encounters at the health center refuses to give her information on family planning? Especially if the service provider refuses to even refer her to another clinic or provider?

Of course the “exception” mentioned in the Supreme Court decision covers only private and non-maternity clinics or facilities. But can the Department of Health, for instance, terminate a health service provider on the grounds of the provider’s exercise of conscience? I smell a possible test case already.

And as anecdotal evidence shows, even now, even before the DOH and other authorities could implement the law, there is already in place an informal system of sanctions on those seeking RH services. Young people, for instance, say that they are deterred from consulting authorities in health centers regarding their RH questions because these midwives, nurses or doctors know their parents and neighbors and could gossip about them.

Women also tell me of being reluctant to seek RH services—even about something as innocuous and necessary as a pap smear—because health center personnel might start gossiping about their sex lives.

In this instance, culture may be an even bigger deterrent than the law.