WEBVTT - When religious doctors refuse healthcare

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<v Speaker 1>I'm Ruby Jones and you're listening to seven AM. As

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<v Speaker 1>hard fought gains in reproductive medicine, voluntary assisted dying, and

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<v Speaker 1>LGBTQI healthcare have been made, another story has emerged, one

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<v Speaker 1>where religious pharmacists, doctors and hospital systems believe it's justifiable

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<v Speaker 1>to withhold medication or support, often with devastating consequences. Now,

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<v Speaker 1>one in five pharmacists in Australia will refuse you care

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<v Speaker 1>if the medication you're asking for doesn't align with their beliefs,

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<v Speaker 1>and in some parts of the country that number is

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<v Speaker 1>closer to half. Today. Writer and reproductive health advocate Hannahbambra

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<v Speaker 1>on the unconscionable reality of conscientious objection. It's Tuesday, January sixth.

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<v Speaker 1>This episode was originally published in September. So Hannah, I

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<v Speaker 1>thought we could start with the story of Ava, although

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<v Speaker 1>I know that isn't her real name, but tell me

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<v Speaker 1>about her.

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<v Speaker 2>Yeah. So, Aver is twenty two and she's studying medicine

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<v Speaker 2>in Ballarat and as a young person, she went to

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<v Speaker 2>her local pharmacy thinking that she would be able to

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<v Speaker 2>pick up emergency contraception, and she was shocked when the

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<v Speaker 2>pharmacist in one of the local pharmacies in Ballarat refused

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<v Speaker 2>her access to what's commonly known as the morning after pill.

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<v Speaker 2>The pharmacist sort of brushed her off and said, I

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<v Speaker 2>don't have time for that today. All of her friends

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<v Speaker 2>describe her as a really kind of non confrontational person,

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<v Speaker 2>but she was really angry and upset and frustrated that

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<v Speaker 2>pharmacist did not recommend another pharmacy where she would be

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<v Speaker 2>able to get emergency contraception. So she was left scrambling

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<v Speaker 2>trying to find an alternative option, and eventually she did,

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<v Speaker 2>but it took up most of her day trying to

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<v Speaker 2>find the contraception that she needed.

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<v Speaker 1>And just tell me more about why that pharmacy would

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<v Speaker 1>not give her them wrding after her.

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<v Speaker 2>So, even though she's a non confrontational person, she went

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<v Speaker 2>back to that pharmacy and had a chat with her.

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<v Speaker 2>She realized that this person was a religious conscientious objector,

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<v Speaker 2>and healthcare professionals are meant to explain that they are

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<v Speaker 2>denying access on religious grounds, and they are supposed to

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<v Speaker 2>refer to someone on to somewhere where they can get

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<v Speaker 2>their medication. But we see it playing out very differently,

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<v Speaker 2>and it's really hard to police. So if someone has

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<v Speaker 2>a bad experience with a healthcare professional, they can report them,

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<v Speaker 2>but at the end of the day, that often isn't recorded.

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<v Speaker 2>It's very difficult to prove and I feel like nobody's

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<v Speaker 2>talking about it, but it's actually really prevalent and prolific.

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<v Speaker 2>A lot of people are denied a huge range of drugs,

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<v Speaker 2>including consciouses.

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<v Speaker 1>Okay, well, let's talk more about that. As you started

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<v Speaker 1>looking into this further, what did you uncover about all

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<v Speaker 1>the different ways in which people can be denied medical

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<v Speaker 1>care if their needs somehow come into conflict with this

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<v Speaker 1>idea of conscientious objection.

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<v Speaker 2>So conscientious objection is broadly accepted in Australia, but the

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<v Speaker 2>rules kind of vary state by state, so it can

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<v Speaker 2>happen at every stage of the healthcare system in Australia, GPS, hospitals, nurses, pharmacists,

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<v Speaker 2>and a survey from a few years ago said that

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<v Speaker 2>twenty percent more than twenty percent, up to one in

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<v Speaker 2>five pharmacists would happily deny someone healthcare if it was

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<v Speaker 2>against their personal beliefs and they felt that that was justifiable,

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<v Speaker 2>even if it meant that that individual person didn't go

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<v Speaker 2>on to get the health care required that they needed.

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<v Speaker 2>Conscientious objection is broadly about religious beliefs, so a lot

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<v Speaker 2>of people think about that as abortion, and particularly medical

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<v Speaker 2>abortion is something that people need to pick up in pharmacies,

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<v Speaker 2>but it's also for things like PREP, which is HIV prevention.

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<v Speaker 2>Same sex couples can also be denied IVF medication that

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<v Speaker 2>they've paid hundreds of dollars to be able to access, contraception,

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<v Speaker 2>medical terminations. There's a huge range of things that pharmacists, doctors, nurses,

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<v Speaker 2>and even entire hospitals are allowed to deny people based

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<v Speaker 2>on their personal beliefs, even if they are legally entitled

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<v Speaker 2>and eligible for that medication.

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<v Speaker 1>Right. And as you've said, this is particularly a problem

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<v Speaker 1>when it happens in a regional town where there may

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<v Speaker 1>not be another option. Ava did eventually find the medication,

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<v Speaker 1>but what happens when that is not possible.

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<v Speaker 2>So through my reporting on conscientious objection, another person that

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<v Speaker 2>I spoke to, it's call her Anika. Anika worked in

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<v Speaker 2>high schools as a nurse and also in clinics as

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<v Speaker 2>a sexual health nurse for a long time, and she

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<v Speaker 2>is really passionate about increasing access in regional areas but

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<v Speaker 2>speaking to her really opened my eyes at how bad

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<v Speaker 2>this can be in some regional and remote towns and cities.

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<v Speaker 2>So Anika told me about a young girl and her

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<v Speaker 2>late teens who approached her after her contraception had failed.

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<v Speaker 2>She asked Anakar if she was able to find her

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<v Speaker 2>emergency contraception, and unfortunately, the pharmacist in that town was

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<v Speaker 2>a conscientious objector. Because that pharmacist refused them access to

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<v Speaker 2>the morning after pill and the young girl couldn't drive.

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<v Speaker 2>That girl then went on to become pregnant unfortunately, and

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<v Speaker 2>the only doctors in the town also wouldn't prescribe abortion,

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<v Speaker 2>medical abortion or refer her on to so abortion. This

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<v Speaker 2>young girl then had to figure out how to access

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<v Speaker 2>a surgical abortion, and at that time she wasn't able

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<v Speaker 2>to drive to Melbourne. She didn't want her parents to know,

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<v Speaker 2>but it's pretty hard for someone to leave their country town,

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<v Speaker 2>find their way to an abortion clinic and get back

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<v Speaker 2>by the end of the school bell that girl was

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<v Speaker 2>eventually able to go to a regional hospital and get

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<v Speaker 2>an abortion, and at that time they were allowing protesters

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<v Speaker 2>at the front, so she had been denied contraception because

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<v Speaker 2>of her pharmacist and her doctor who were the only

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<v Speaker 2>people in the town who could issue those drugs, and

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<v Speaker 2>then she had to walk through a sea of people

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<v Speaker 2>telling her that she was a murderer at eighteen years

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<v Speaker 2>old to be able to get an abortion.

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<v Speaker 1>Coming up, Where does conscientious objection in healthcare come from? Hannah?

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<v Speaker 1>The idea of conscientious objection in healthcare? Where does it

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<v Speaker 1>come from? And has it always been a feature of

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<v Speaker 1>the way that our healthcare system works.

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<v Speaker 2>It hasn't really, So it's over the past, let's say,

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<v Speaker 2>fifty sixty years, as some aspects of healthcare and medicine

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<v Speaker 2>have become more wildly available to people, it's been a

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<v Speaker 2>bit of a compromise with religious groups. So, for example,

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<v Speaker 2>abortion in Australia has taken since the nineteen seventies to

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<v Speaker 2>be completely legalized. Their last state to completely decriminalize abortion

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<v Speaker 2>was Western Australia and that was last year, which I

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<v Speaker 2>think would shock a lot of people that Victoria was

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<v Speaker 2>one of the early adopters and completely decriminalized abortion in

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<v Speaker 2>two thousand and eight. And decriminalized of abortion is relevant

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<v Speaker 2>to this because before decriminalization of abortion, people didn't have

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<v Speaker 2>to think of reasons not to give access to this care,

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<v Speaker 2>so they didn't have to conscientiously object because there was

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<v Speaker 2>nothing to conscientiously object from. And similarly, voluntary assisted dying

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<v Speaker 2>and forms of contraception and things like PREP which is

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<v Speaker 2>a HIV prevention have only come about and become accessible

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<v Speaker 2>to people over the past couple of decades. So since decriminalization.

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<v Speaker 2>One of the kind of bargaining tools that the federal

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<v Speaker 2>government and healthcare system was able to use with religious

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<v Speaker 2>groups was well, we're not going to force anyone to

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<v Speaker 2>issue these medications. Doctors can opt out if they want to,

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<v Speaker 2>and that's where the idea of conscientious objection in health

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<v Speaker 2>care came from. But healthcare is very different to other professions.

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<v Speaker 1>Yeah, tell me about that, because you don't really hear

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<v Speaker 1>of conscientious objection in any other professional context. Yeah.

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<v Speaker 2>Absolutely, if you're a lawyer. The legal profession in Australia

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<v Speaker 2>really upholds this idea that everyone is deserving of legal

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<v Speaker 2>rights and representation. There is some parts of sort of

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<v Speaker 2>private institutions I guess, where someone can say, oh, I

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<v Speaker 2>don't want to sell products to these particular people, but

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<v Speaker 2>those institutions exist in a free market. Healthcare is publicly

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<v Speaker 2>funded Yeah, it.

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<v Speaker 1>Sounds like there is a real issue around transparency here,

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<v Speaker 1>that it is not always made clear to the person

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<v Speaker 1>why they are being denied care. But also they aren't

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<v Speaker 1>necessarily able to access that kind of information about a

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<v Speaker 1>provider ahead of time. Yeah.

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<v Speaker 2>Absolutely, And I think that's partially why it's so problematic.

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<v Speaker 2>There's people who really need timely, safe and trustworthy care

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<v Speaker 2>and they're being turned away without even realizing what they're

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<v Speaker 2>going into. So if a practitioner did list on their

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<v Speaker 2>website or in a publicly available register which doesn't exist

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<v Speaker 2>at the moment, that they don't offer these kinds of care,

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<v Speaker 2>then someone would be able to make informed choices. But

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<v Speaker 2>at the moment, people might be going into a GP's office.

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<v Speaker 2>Sometimes it's even their family doctor that they've seen since

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<v Speaker 2>they were young, But they might be heading in thinking

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<v Speaker 2>that they're able to ask for something which is legal,

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<v Speaker 2>which they're eligible for, which is widely accessible, and that

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<v Speaker 2>GP can make a decision based on their own personal

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<v Speaker 2>values that they think that person should not access that care. Okay,

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<v Speaker 2>and so I mean, perhaps this is a controversial question,

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<v Speaker 2>but do you think that there is a case to

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<v Speaker 2>be made here that the idea of conscientious objection in

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<v Speaker 2>health care should be reconsidered absolutely. I think religious groups

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<v Speaker 2>use the example that you can't force someone to perform abortions,

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<v Speaker 2>but this isn't about asking people to perform surgical abortions

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<v Speaker 2>or administer drugs for voluntary assisted dying. Those are very

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<v Speaker 2>specialized skills that people opt into. What this is about

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<v Speaker 2>is about access to getting that care. So at the moment, nurses, doctors, pharmacists,

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<v Speaker 2>entire hospitals or age care facilities can create barriers for

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<v Speaker 2>very vulnerable people. And personally, I have very little sympathy

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<v Speaker 2>for someone who thinks their right to avoid writing or

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<v Speaker 2>filling a script is more important than a teenager having

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<v Speaker 2>to keep a pregnancy or a terminally ill patient having

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<v Speaker 2>to continue suffering or dying without the dignity that they deserve.

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<v Speaker 2>And I think there is some peak bodies like the

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<v Speaker 2>Australian Nursing and midwiff Re Federation, which says if practitioners

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<v Speaker 2>are thinking that conscientious objection is going to frequently come up,

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<v Speaker 2>then maybe they need to seriously consider other employment. And

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<v Speaker 2>I think that arguably, if you're working in reproductive healthcare,

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<v Speaker 2>if you're a midwife, it's really likely that you are

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<v Speaker 2>going to need to talk to people about things like contraception,

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<v Speaker 2>fetal abnormality testing, pregnancy options. If you're unwilling to put

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<v Speaker 2>your personal beliefs aside and talk about some of these

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<v Speaker 2>very real things that are coming up for people, even

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<v Speaker 2>with wanted pregnancies, then you're in the wrong job.

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<v Speaker 1>Well, Henna, thank you so much for your time, Thank

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<v Speaker 1>you for having me, Thanks for listening. Tomorrow, we're bringing

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<v Speaker 1>you a fascinating two part episode about the bit of

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<v Speaker 1>fallout between James Murdoch and his dad. Rupert. Our guest,

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<v Speaker 1>a reporter with The Atlantic, managed a rare thing to

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<v Speaker 1>pierce the wall of secrecy that surrounds the Murdoch family

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<v Speaker 1>and to get a frank, first hand account of what

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<v Speaker 1>happened when this powerful family ended up in court. It's

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<v Speaker 1>compelling listening and I hope you enjoy it. See you tomorrow.