Speaker 1: I'm Ruby Jones and you're listening to seven AM. As
Speaker 1: hard fought gains in reproductive medicine, voluntary assisted dying, and
Speaker 1: LGBTQI healthcare have been made, another story has emerged, one
Speaker 1: where religious pharmacists, doctors and hospital systems believe it's justifiable
Speaker 1: to withhold medication or support, often with devastating consequences. Now,
Speaker 1: one in five pharmacists in Australia will refuse you care
Speaker 1: if the medication you're asking for doesn't align with their beliefs,
Speaker 1: and in some parts of the country that number is
Speaker 1: closer to half. Today. Writer and reproductive health advocate Hannahbambra
Speaker 1: on the unconscionable reality of conscientious objection. It's Tuesday, January sixth.
Speaker 1: This episode was originally published in September. So Hannah, I
Speaker 1: thought we could start with the story of Ava, although
Speaker 1: I know that isn't her real name, but tell me
Speaker 1: about her.
Speaker 2: Yeah. So, Aver is twenty two and she's studying medicine
Speaker 2: in Ballarat and as a young person, she went to
Speaker 2: her local pharmacy thinking that she would be able to
Speaker 2: pick up emergency contraception, and she was shocked when the
Speaker 2: pharmacist in one of the local pharmacies in Ballarat refused
Speaker 2: her access to what's commonly known as the morning after pill.
Speaker 2: The pharmacist sort of brushed her off and said, I
Speaker 2: don't have time for that today. All of her friends
Speaker 2: describe her as a really kind of non confrontational person,
Speaker 2: but she was really angry and upset and frustrated that
Speaker 2: pharmacist did not recommend another pharmacy where she would be
Speaker 2: able to get emergency contraception. So she was left scrambling
Speaker 2: trying to find an alternative option, and eventually she did,
Speaker 2: but it took up most of her day trying to
Speaker 2: find the contraception that she needed.
Speaker 1: And just tell me more about why that pharmacy would
Speaker 1: not give her them wrding after her.
Speaker 2: So, even though she's a non confrontational person, she went
Speaker 2: back to that pharmacy and had a chat with her.
Speaker 2: She realized that this person was a religious conscientious objector,
Speaker 2: and healthcare professionals are meant to explain that they are
Speaker 2: denying access on religious grounds, and they are supposed to
Speaker 2: refer to someone on to somewhere where they can get
Speaker 2: their medication. But we see it playing out very differently,
Speaker 2: and it's really hard to police. So if someone has
Speaker 2: a bad experience with a healthcare professional, they can report them,
Speaker 2: but at the end of the day, that often isn't recorded.
Speaker 2: It's very difficult to prove and I feel like nobody's
Speaker 2: talking about it, but it's actually really prevalent and prolific.
Speaker 2: A lot of people are denied a huge range of drugs,
Speaker 2: including consciouses.
Speaker 1: Okay, well, let's talk more about that. As you started
Speaker 1: looking into this further, what did you uncover about all
Speaker 1: the different ways in which people can be denied medical
Speaker 1: care if their needs somehow come into conflict with this
Speaker 1: idea of conscientious objection.
Speaker 2: So conscientious objection is broadly accepted in Australia, but the
Speaker 2: rules kind of vary state by state, so it can
Speaker 2: happen at every stage of the healthcare system in Australia, GPS, hospitals, nurses, pharmacists,
Speaker 2: and a survey from a few years ago said that
Speaker 2: twenty percent more than twenty percent, up to one in
Speaker 2: five pharmacists would happily deny someone healthcare if it was
Speaker 2: against their personal beliefs and they felt that that was justifiable,
Speaker 2: even if it meant that that individual person didn't go
Speaker 2: on to get the health care required that they needed.
Speaker 2: Conscientious objection is broadly about religious beliefs, so a lot
Speaker 2: of people think about that as abortion, and particularly medical
Speaker 2: abortion is something that people need to pick up in pharmacies,
Speaker 2: but it's also for things like PREP, which is HIV prevention.
Speaker 2: Same sex couples can also be denied IVF medication that
Speaker 2: they've paid hundreds of dollars to be able to access, contraception,
Speaker 2: medical terminations. There's a huge range of things that pharmacists, doctors, nurses,
Speaker 2: and even entire hospitals are allowed to deny people based
Speaker 2: on their personal beliefs, even if they are legally entitled
Speaker 2: and eligible for that medication.
Speaker 1: Right. And as you've said, this is particularly a problem
Speaker 1: when it happens in a regional town where there may
Speaker 1: not be another option. Ava did eventually find the medication,
Speaker 1: but what happens when that is not possible.
Speaker 2: So through my reporting on conscientious objection, another person that
Speaker 2: I spoke to, it's call her Anika. Anika worked in
Speaker 2: high schools as a nurse and also in clinics as
Speaker 2: a sexual health nurse for a long time, and she
Speaker 2: is really passionate about increasing access in regional areas but
Speaker 2: speaking to her really opened my eyes at how bad
Speaker 2: this can be in some regional and remote towns and cities.
Speaker 2: So Anika told me about a young girl and her
Speaker 2: late teens who approached her after her contraception had failed.
Speaker 2: She asked Anakar if she was able to find her
Speaker 2: emergency contraception, and unfortunately, the pharmacist in that town was
Speaker 2: a conscientious objector. Because that pharmacist refused them access to
Speaker 2: the morning after pill and the young girl couldn't drive.
Speaker 2: That girl then went on to become pregnant unfortunately, and
Speaker 2: the only doctors in the town also wouldn't prescribe abortion,
Speaker 2: medical abortion or refer her on to so abortion. This
Speaker 2: young girl then had to figure out how to access
Speaker 2: a surgical abortion, and at that time she wasn't able
Speaker 2: to drive to Melbourne. She didn't want her parents to know,
Speaker 2: but it's pretty hard for someone to leave their country town,
Speaker 2: find their way to an abortion clinic and get back
Speaker 2: by the end of the school bell that girl was
Speaker 2: eventually able to go to a regional hospital and get
Speaker 2: an abortion, and at that time they were allowing protesters
Speaker 2: at the front, so she had been denied contraception because
Speaker 2: of her pharmacist and her doctor who were the only
Speaker 2: people in the town who could issue those drugs, and
Speaker 2: then she had to walk through a sea of people
Speaker 2: telling her that she was a murderer at eighteen years
Speaker 2: old to be able to get an abortion.
Speaker 1: Coming up, Where does conscientious objection in healthcare come from? Hannah?
Speaker 1: The idea of conscientious objection in healthcare? Where does it
Speaker 1: come from? And has it always been a feature of
Speaker 1: the way that our healthcare system works.
Speaker 2: It hasn't really, So it's over the past, let's say,
Speaker 2: fifty sixty years, as some aspects of healthcare and medicine
Speaker 2: have become more wildly available to people, it's been a
Speaker 2: bit of a compromise with religious groups. So, for example,
Speaker 2: abortion in Australia has taken since the nineteen seventies to
Speaker 2: be completely legalized. Their last state to completely decriminalize abortion
Speaker 2: was Western Australia and that was last year, which I
Speaker 2: think would shock a lot of people that Victoria was
Speaker 2: one of the early adopters and completely decriminalized abortion in
Speaker 2: two thousand and eight. And decriminalized of abortion is relevant
Speaker 2: to this because before decriminalization of abortion, people didn't have
Speaker 2: to think of reasons not to give access to this care,
Speaker 2: so they didn't have to conscientiously object because there was
Speaker 2: nothing to conscientiously object from. And similarly, voluntary assisted dying
Speaker 2: and forms of contraception and things like PREP which is
Speaker 2: a HIV prevention have only come about and become accessible
Speaker 2: to people over the past couple of decades. So since decriminalization.
Speaker 2: One of the kind of bargaining tools that the federal
Speaker 2: government and healthcare system was able to use with religious
Speaker 2: groups was well, we're not going to force anyone to
Speaker 2: issue these medications. Doctors can opt out if they want to,
Speaker 2: and that's where the idea of conscientious objection in health
Speaker 2: care came from. But healthcare is very different to other professions.
Speaker 1: Yeah, tell me about that, because you don't really hear
Speaker 1: of conscientious objection in any other professional context. Yeah.
Speaker 2: Absolutely, if you're a lawyer. The legal profession in Australia
Speaker 2: really upholds this idea that everyone is deserving of legal
Speaker 2: rights and representation. There is some parts of sort of
Speaker 2: private institutions I guess, where someone can say, oh, I
Speaker 2: don't want to sell products to these particular people, but
Speaker 2: those institutions exist in a free market. Healthcare is publicly
Speaker 2: funded Yeah, it.
Speaker 1: Sounds like there is a real issue around transparency here,
Speaker 1: that it is not always made clear to the person
Speaker 1: why they are being denied care. But also they aren't
Speaker 1: necessarily able to access that kind of information about a
Speaker 1: provider ahead of time. Yeah.
Speaker 2: Absolutely, And I think that's partially why it's so problematic.
Speaker 2: There's people who really need timely, safe and trustworthy care
Speaker 2: and they're being turned away without even realizing what they're
Speaker 2: going into. So if a practitioner did list on their
Speaker 2: website or in a publicly available register which doesn't exist
Speaker 2: at the moment, that they don't offer these kinds of care,
Speaker 2: then someone would be able to make informed choices. But
Speaker 2: at the moment, people might be going into a GP's office.
Speaker 2: Sometimes it's even their family doctor that they've seen since
Speaker 2: they were young, But they might be heading in thinking
Speaker 2: that they're able to ask for something which is legal,
Speaker 2: which they're eligible for, which is widely accessible, and that
Speaker 2: GP can make a decision based on their own personal
Speaker 2: values that they think that person should not access that care. Okay,
Speaker 2: and so I mean, perhaps this is a controversial question,
Speaker 2: but do you think that there is a case to
Speaker 2: be made here that the idea of conscientious objection in
Speaker 2: health care should be reconsidered absolutely. I think religious groups
Speaker 2: use the example that you can't force someone to perform abortions,
Speaker 2: but this isn't about asking people to perform surgical abortions
Speaker 2: or administer drugs for voluntary assisted dying. Those are very
Speaker 2: specialized skills that people opt into. What this is about
Speaker 2: is about access to getting that care. So at the moment, nurses, doctors, pharmacists,
Speaker 2: entire hospitals or age care facilities can create barriers for
Speaker 2: very vulnerable people. And personally, I have very little sympathy
Speaker 2: for someone who thinks their right to avoid writing or
Speaker 2: filling a script is more important than a teenager having
Speaker 2: to keep a pregnancy or a terminally ill patient having
Speaker 2: to continue suffering or dying without the dignity that they deserve.
Speaker 2: And I think there is some peak bodies like the
Speaker 2: Australian Nursing and midwiff Re Federation, which says if practitioners
Speaker 2: are thinking that conscientious objection is going to frequently come up,
Speaker 2: then maybe they need to seriously consider other employment. And
Speaker 2: I think that arguably, if you're working in reproductive healthcare,
Speaker 2: if you're a midwife, it's really likely that you are
Speaker 2: going to need to talk to people about things like contraception,
Speaker 2: fetal abnormality testing, pregnancy options. If you're unwilling to put
Speaker 2: your personal beliefs aside and talk about some of these
Speaker 2: very real things that are coming up for people, even
Speaker 2: with wanted pregnancies, then you're in the wrong job.
Speaker 1: Well, Henna, thank you so much for your time, Thank
Speaker 1: you for having me, Thanks for listening. Tomorrow, we're bringing
Speaker 1: you a fascinating two part episode about the bit of
Speaker 1: fallout between James Murdoch and his dad. Rupert. Our guest,
Speaker 1: a reporter with The Atlantic, managed a rare thing to
Speaker 1: pierce the wall of secrecy that surrounds the Murdoch family
Speaker 1: and to get a frank, first hand account of what
Speaker 1: happened when this powerful family ended up in court. It's
Speaker 1: compelling listening and I hope you enjoy it. See you tomorrow.