Last month, the all-party parliamentary Pro Life group, led by Fiona Bruce MP, closed its consultation into the workings of the Abortion Act 1967 (as amended 1990) clause on conscientious objection. It is not clear what the consultation is intended to achieve. The questions seemed concerned with whether the clause works to allow doctors who object to abortion to opt out of involvement. It also seeks evidence of discrimination against doctors who declare an objection to performing abortion.
The Group’s concern is diametrically at odds with many supporters of legal abortion who claim that conscientious objection undermines access to provision. Indeed, in recent years, conscientious objection has become one of the most contested issues at international reproductive health gatherings – with claims that in many Catholic countries the principle of respecting the conscience-based decisions of individual doctors renders abortion unattainable, regardless of the law or public opinion.
Fiona Bruce may be surprised to find that bpas as institution committed to supporting women’s choice to end pregnancy is also committed to supporting the choice of some doctors to not be engaged in actions that they believe (however misguidedly) are the equivalent of murder.
bpas provides NHS funded treatment for about 65 thousand women each year and we are keenly aware of the problems that doctors who consciously object to abortion can cause for women. Even in Britain, where abortion is widely available, many women are reluctant to involve their family doctor because they fear their request will be refused or they will be judged. Abortion is already stigmatized and women often carry a burden of guilt about unplanned pregnancy, even when they are certain that abortion is right for them. An unplanned, unwanted pregnancy, in our society, suggests ‘failure’ of some kind, and no woman feels good about that.
Here we are fortunate in that the relevant professional bodies and regulators are clear that if one a practitioner cannot meet a woman’s legal request, she must be referred without delay to someone who can help. But that doesn’t eliminate the awfulness of being refused care because a provider believes they’re being asked to commit a sin.
But maintaining this difficult balance between the conscience of the woman and the conscience of the doctor is preferable, both on moral and practical grounds to a system that forces doctors to act against their consciences. It is better for doctors with a moral objection to opt out of services, providing they direct their patients to others who can help. Women who need abortion deserve better than treatment from coerced doctors.
The problems caused by objecting doctors must be resolved by changing the ways in which services are organized, rather than forcing doctors to be involved in procedures to which they fundamentally object. For example, allowing women to refer themselves directly into services without their GP’s involvement by-passes the need for family-doctor involvement altogether. It circumvents the problem of GP conscientious objection, is more convenient for women, and saves precious resources in general practice by allowing doctors to concentrate on patients that are actually ill.
Allowing health care practitioners who positively want to prove abortion because they are conscientiously committed to providing reproductive choice is a way to fill the gap left by doctors who object. The law in the Britain, and many other countries, legally restrict abortion practice to doctors, when midwives, nurses, healthcare assistants and all manner of practitioners could offer safe services. Indeed with medication, it is the law and not clinical safety that stops women from simply obtaining the means to end a pregnancy from a pharmacy.
When all is said and done, the right due to a woman to control her own body does not extend to the right to force another to act against their morals to provide that care. We surely don’t want to see doctors simply ‘following orders’ and carrying out procedures that they believe are wrong . Clinicians should hold values and make value judgments, including that they will, in “good faith”, act in the interests of their patients; demonstrating beneficence and an absences of maleficence. If doctors believe that abortion is wrong and that it would cause harm, surely we must – in the same spirit of tolerance that should be shown to women – respect their judgment over their actions.
The provision of abortion is the responsibility of institutions not individuals. It’s the responsibility of the state, it’s health service and public hospitals to ensure that abortion is available where it is legal. Building clinical care in a framework where abortion is accepted and understood, where it is not seen as a moral wrong, but an enabling act showing consideration and faith in a woman’s judgment would be a giant step forward.