Ethics and professionalism in health care education: A solid wall to defend sex and reproductive rights in Sweden 

I am fortune. I grew up in an era when women’s rights had prevailed. Gone were the days in the 1960s when Swedish women had to seek help in Poland for abortion. Abortion was not allowed in Sweden until 1974. There were also other countries in Europe with a very rigid legislation regarding birth control and, indeed, abortion. The prime example is perhaps Ireland, where even contraceptives were illegal well into the 1970th. In the US, the well-known and now actualized case Row vs Wade from 1973 protected women’s rights to have an abortion. 

For most of my life, the right to an abortion has not been a major concern; sex and reproductive rights have been taken for granted, although there has always been some dangerous under currents, but not really a major threat. But suddenly. Poland’s conservative Law and Justice Party changed the abortion laws in 2019 and made it a crime, with one of the hardest laws in Europe. In Hungary, the government party pushed through, as late as 2022, a law that forces women, to have an abortion, first to listen to the fetus's heartbeat themselves. Ireland and Malta are countries where abortion is only allowed if the woman's health is in danger. In the United States, the right to abortion has been severely restricted in many states after the decision in the US Supreme Court in 2022, in the case Dobbs vs. Jackson Women's Health Organization. 

What does all of this actually mean for training the next generation of midwifes, physicians and specialists in obstetrics and gynecology? What does it mean for women’s health, safety and safe medical care? What socio-economic consequences does this have? 

We live in a Europe with free mobility of labor. The Professional Qualification Directive, 2013/55/EC, implies that professionals in the EU can move across borders and practice their occupation or provide services abroad. But what happens then if you are trained in a European country, like Poland or Hungary (quite common for medical students) and later start to practice in Sweden? How well-prepared are you for abortion counseling and abortion services? 

Another topic of concern is the right to conscientious objection. In Sweden there is no right to conscientious objection in health care as recognized in domestic law. This has also been established by the Swedish Labor Court in 2017, in a case about a midwifes refusal to conduct abortions.

How can Swedish health care uphold sex and reproduce rights for women? How do we prevent conscientious objection to people who refuse to perform or participate in abortion, euthanasia (not allowed in Sweden though) or any act that may cause the death of a human fetus or embryo? How do we guarantee that health care professionals trained in other European countries or outside Europe are fit for practice in general in healthcare, and indeed in sex and reproductive health? Part of the answer is that ethics and professionalism in training of health care professionals are more important topics than ever. It’s pivotal.  We need to defend the values and norms in Swedish health care. Health professions education, on all levels of training, and in all health professions are paramount.

/Jonas

Summary

This conversation explores the evolving landscape of abortion rights globally, particularly in light of recent legal changes in the US and Europe. It discusses the implications for healthcare education, the challenges faced by medical professionals, especially midwives, and the importance of maintaining awareness and legal protections for reproductive rights. The dialogue emphasizes the interconnectedness of abortion rights with broader issues of democracy and healthcare education.

Takeaways

• Abortion has been legal in Sweden since 1974, but global anti-abortion movements are rising.
• 44% of US obstetrics and gynecology training occurs in states with restricted abortion access.
• Legal changes in the US have significant implications for healthcare education worldwide.
• Medical education in countries with restrictive abortion laws may lack essential training.
• Midwives play a crucial role in abortion care and need proper education.
• Awareness of the historical context of abortion rights is vital for future advocacy.
• Legal protections for abortion rights are essential to prevent regression.
• The intersection of abortion rights and democracy is increasingly relevant.
• Healthcare education must adapt to include comprehensive reproductive health training.
• Sweden's approach to abortion rights and education can serve as a model for other countries.