Freedom of conscience is a core element of human rights respected by most European countries. It allows abortion through the inclusion of a conscience clause, which permits opting out of providing such services. However, the grounds for invoking conscientious objection lack clarity. Our aim in this paper is to take a step in this direction by carrying out a systematic review of reasons by midwives and nurses for declining, on conscience grounds, to participate in abortion. We conducted a systematic review (...) of ethical arguments asking, “What reasons have been reported in the argument based literature for or against conscientious objection to abortion provision by nurses or midwives?” We particularly wanted to identify any discussion of the responsibilities of midwives and nurses in this area. Search terms were conscientious objection and abortion or termination and nurse or midwife or midwives or physicians or doctors or medics within the dates 2000–2016 on: HEIN legal, Medline, CINAHL, Psychinfo, Academic Search Complete, Web of Science including publications in English, German and Dutch. Final articles were subjected to a rigorous analysis, coding and classifying each line into reason mentions, narrow and broad reasons for or against conscientious objection. Of an initial 1085 articles, 10 were included. We identified 23 broad reasons, containing 116narrow reasons and 269 reason mentions. Eighty one narrow reasons argued in favour of and 35 against conscientious objection. Using predetermined categories of moral, practical, religious or legal reasons, “moral reasons” contained the largest number of narrow reasons. The reasons and their associated mentions in this category outnumber those in the sum of the other three categories. We identified no absolute argument either for or against conscientious objection by midwives or nurses. An invisibility of midwives and nurses exists in the whole debate concerning conscientious objection reflecting a gap between literature and practice, as it is they whom WHO recommend as providers of this service. While the arguments in the literature emphasize the need for provision of conscientious objection, a balanced debate is necessary in this field, which includes all relevant health professionals. (shrink)

Midwives, like other health professionals, are confronted with ethical issues on a daily basis and acting ethically is a core competence within professional conduct. In midwifery in particular, the complexity of ethical problems is increasing e.g., due to new medical options in diagnostics and reproductive medicine, the increasing diversity of life styles or the high number of preterm births. The main purpose of the current project was to develop effective interventions to increase midwives’ ethical competence in educational and practical settings. (...) To reach this goal, we conducted 43 individual semi-structured and 6 focus group interviews with midwives, lecturers and midwifery students to explore their views on ethics education and the support needed in practice to develop ethical competence. Based on the analysis of these interviews, a set of 15 interventions was designed and piloted in educational and clinical settings. The piloted interventions were then evaluated with an online questionnaire. Results from the interviews, the online questionnaire as well as the lessons learnt from piloting the interventions and the current literature on ethics education were integrated in a spiral curricular model for increasing midwives’ ethical competence. This model, called MidEthics, covers essential competences for midwives to be obtained in training and in clinical practice, and should inform curriculum development and policy makers. (shrink)