By Katrine Kildemo
Since 1979, women in Norway have had the opportunity to choose abortion in the first 12 weeks of pregnancy. The law on abortion finally gave women the right to make decision regarding their own body, and this was an important step towards female rights and gender equality.
Figure 1: Illusatration by Nora Hjelmbrekke
After a recent shift in the Norwegian government from a socialistic party to a more liberal party, it has been suggested to change the liberal law of abortion. According to the Ministry Health and Care Service, the change proposes that the general practitioner (GP), acting as a gatekeeper, can guard himself against a referral and treatment related to abortion due to conflicts of conscience and personal ethics. The GP will be obligated to inform and refer patients to a colleague who will give a referral for the abortion. This has subsequently raised a debate between the left and right wing.
At first thought this may not seem to be a serious issue. One can just book a new appointment at the doctor next door. But Norway is an outstretched country with great distances and a population size of only 5 million inhabitants. Therefore, distances between the inhabitants are vast. The majority of the population is situated in the southern part, which makes municipalities in the north big in size but low in inhabitants. The proposal will therefore mostly affect women living in municipalities with few GPs. “How will the proposal be carried out when the only GP in the municipality refuses to make a referral for the abortion?” asks Marianne Bremnes, the mayor from the many municipalities with limited GPs. The distances between municipalities are extensive, so ‘just’ traveling to a different municipality is not always a convenient choice. There should be an equal opportunity for every woman in Norway to access a GP willing to perform an abortion, but with the distance this is not possible. Hence, there is an obvious disadvantage for women living in remote areas with fewer GPs.
In a time when help and support is absolute, the woman must feel quite neglected and perceive a lack of understanding, when meeting a GP who will not refer her to an abortion. Abortion is for many women a difficult process and can be a traumatic experience. Women who choose abortion because they do not want children or the time is not suited, can have difficultly talking about it. Abortion is one of the most tabooed topics for a woman in the Western world. Yet by introducing this law, women who are already in a vulnerable situation will be even more negatively affected if the GP’s bad guilt and conviction refuses to refer her to an abortion. It should, as it has for the last 30 years, be the woman’s rights and feelings that is the focal point, and not the GP’s guilt and conviction.
One of the important arguments from GPs in favour of the proposed reform is “the respect for life as a doctor and an ethical thinking human being” as the GP Harald Ramm Salbu says. Furthermore, he argues that it is a fight about democratic fundamental principles.
He concludes that if the reform does not become enforced, he will not be continuing as a doctor as it goes against his respect for life and ethical principles. In the Norwegian Medical Association one can find the ethical rules for doctors and in section 1, sub- section 2 it says: “The doctor shall serve the patients interest and integrity.” Does it not go against his ethical principle by acting on self- interest and bad guilt? Shouldn’t a doctor treat and behave objectively?
If this reform gets approved, why should only doctors have this right to guard themselves due to ethical reasons? What if other health personnel start guarding themselves from booking abortion appointment? And what if it does not stop at abortion but continues to prevention? There will be serious problems in the future if considerations will be given to the doctor and other health personnel rather than the patient.
Finally, another perspective of this discussion could be a comparison to a related controversy. Recently a debate started in Norway about whether or not people who reject a job offer due to religious beliefs can expect to get unemployment benefits. So in terms of the doctor’s ethical or religious beliefs, is it more accepted that a GP can make a similar choice without any repercussions?
Eye on Global Health 