In a “Perspective” piece published Thursday in the New England Journal of Medicine, Lisa Harris of the University of Michigan argues that just as conscience compels some physicians to refuse to perform abortions, physicians who choose to offer abortion services may also be guided by conscience.

Pro-choice activists hold placards during a rally outside of the Supreme Court January 23, 2012 in Washington, DC. (MANDEL NGAN/AFP/GETTY IMAGES)

Harris, who in 2008 wrote about her own experience performing an 18-week abortion when she herself was 18 weeks pregnant, notes in "Recognizing Conscience in Abortion Provision" that ever since Roe v. Wade made abortion legal in the U.S., “the idea that conscience-based care means not providing or referring for abortion or other contested services has become naturalized.”

Yet, she argues, over the course of history many doctors have chosen to offer abortions as a safer, healthier alternative to self-induced abortions and “back-room” abortions, procedures performed under potentially dangerous or deadly conditions. Those physicians, she writes, acted out of conscience just as surely as those who refuse to provide abortions do.

Even today, with abortion legal, she observes, physicians may offer “abortion care” because “deeply held, core ethical beliefs compel them to do so. They see women's reproductive autonomy as the linchpin of full personhood and self-determination, or they believe that women themselves best understand the life contexts in which childbearing decisions are made, or they value the health of a woman more than the potential life of a fetus, among other reasons.”

Harris emphasizes the importance of separating “conscience” from other factors such as politics that may influence physicians’ attitudes toward abortion. “Certainly, if abortion providers' conscience-based claims require scrutiny, so do conscience-based refusals, to ensure that refusals are indeed motivated by conscience and not by political beliefs, stigma, habit, erroneous understanding of medical evidence, or other factors,” she writes.

“Health care workers with conflicting views about contested medical procedures might all be ‘conscientious,’ even though their core beliefs vary. Failure to recognize that conscience compels abortion provision, just as it compels refusals to offer abortion care, renders ‘conscience’ an empty concept and leaves us all with no moral ground (high or low) on which to stand,” Harris concludes.

Women’s reproductive rights, including those related to abortion, are of course a major political issue as we head toward Election Day. Do you think we’ll hear more about this notion of “conscience” as it applies to performing or not performing abortions?