Are medical professions “free”?

[William Kent] On 26th January a new Bill was discussed in the House of Lords – the Conscientious Objection (Medical Activities) Bill. This Bill, which proposes to clarify the role of conscience in the medical profession, will continue its progression through parliament over the next few months. The time is right therefore for all of us to reflect on the place of conscientious objection within the field of healthcare and to contribute to the public debate that this new Bill will hopefully stimulate.

The sort of questions that form the context to this newly proposed legislation are: “does a healthcare professional have the right to refuse a procedure if they are morally opposed to it?” or “should a nurse or GP be allowed to avoid any involvement with providing abortions or facilitating the end-of-life if they deem it immoral”? Such lines of inquiry have an ever-growing relevance. In 2014 two Scottish midwives were removed from their profession for refusing to have any oversight over the provision of abortion. They claimed that the conscientious objection clause contained in Section 4 of the 1967 Abortion Act excused them from any involvement. Initially a Scottish Court agreed with this interpretation but following various interventions the case came to the Supreme Court where it was decided that medical professionals could only refuse to be involved if they were required to have a “hands-on role”. Thus, Mary Doogan and Connie Wood, who had served as midwives for years, were removed from their profession for refusing to go against their convictions.

Many have argued that the legal ruling in the midwives’ case has softened the position of conscientious objection within the medical profession and that as a result many potential medics and midwives are now weary of entering such jobs because they are afraid they will be forced to go against their consciences. Many believe that the law needs to be changed to clarify the right of medical workers to conscientious objection – that is why the Conscientious Objection Bill has been introduced into the House of Lords.

The first thing to note is that no one, or rather very few, want healthcare workers to go against their beliefs simply for the sake of it. In this country there is widespread recognition of the importance of freedom of religion, conscience, and belief. Why, therefore, do many deem that it was right for the two Scottish midwives to be struck off from their lifelong profession for following their strongly held convictions? The answer – because they wish to maintain the patient at the heart of healthcare. They believe that if all medical professionals are free to object to involvement with certain procedures then patients will suffer from a diminished quality or access to care. They believe that if a woman wants an abortion then she should not have to face being judged and rejected treatment.

It is important to observe that most proponents of this view do not believe that doctors should be entirely stopped from acting on their conscience, but rather that this should never be allowed to interfere with the rights of patients. Thus, they argue that a doctor is obliged to refer a patient on for a procedure if they themselves are not comfortable doing it. They believe that the current law in this country provides a good balance between meeting the needs of patients and allowing doctors to object in conscience. With cases like Mary Doogan’s, however, it is important to ask if such a balance has properly been reached. If a doctor believes that abortion is the ending of a human life, then even to refer a patient to someone else is a considerable violation of conscience – should they be allowed then to refuse to make even a referral?

Mary Doogan and Connie Woods

What is essential to consider when discussing the role of conscience in the medical profession, and indeed other areas of work and life, is that if a person is forced to go against their conscience their moral integrity is undermined. Freedom is a principle upheld widely throughout Western society, this includes the freedom to hold moral convictions. To undermine someone’s moral integrity, is to undermine their freedom and their ability to determine whether certain actions are permissible or not. Defending an individual’s moral integrity is not the same as arguing that a person can impose their moral code on others. However, it does mean preserving a person from being coerced into acting in way they find objectionable.

Having moral integrity is an essential part of our lives, to undermine it would reduce people to passive rather than active agents. In the case of medicine, undermining healthcare professionals’ freedom to oppose to some procedures reduces them to mechanised dispensary units. How can trust, respect, and authentic relationship be developed between a patient and their doctor if the latter is required to suspend their sense of morality? This side-effect of opposing conscientious objection is, therefore, to reduce the quality and consistency of overall patient care because the healthcare worker is reduced to a passive agent that must meet every request of their patient, even if it violates their deeply held convictions.

Many assume that religious beliefs are the main source behind the demand for conscientious objection and conclude that the law should not be adapted specifically to cater for the needs of religious people, arguing that this is a form of legislative favouritism. However, it is essential to note that freedom of conscience is not only concerned with religious convictions. There are many non-religious examples of why a healthcare professional might oppose to abortion. For example, currently the law allows abortion up to birth for a foetus with a disability. Many doctors see this as discriminatory legislation and may refuse to carry out an abortion after the 24-week limit that applies to an unborn child without a disability. The right to freedom of conscience extends to these circumstances as much as any healthcare professional with religious reasons for opposing certain procedures.

As the debate around conscientious objection reopens in this country, it is essential that the role of moral integrity, the place of freedom of belief, and the true nature of doctor-patient relationships all be duly examined. It is important to defend the right of conscientious objection both to maintain the freedom of individuals and to maintain the quality of the medical profession. Evidence does not suggest that widening the law around conscientious objection will have a dramatic on access to care for patients. If it does, the question should be asked – if so many professionals are opposed to a procedure and would cease to carry it out if a change in the law allowed them to do so, is such a procedure one that should be so readily offered by the health service at all?

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