An Abuse of Conscience?

An Abuse of Conscience?

The move by a group of anti-abortion doctors to undertake a legal challenge to proposed Medical Council guidelines on dealing with a physician’s conscientious objections to abortion has sparked a fierce debate, some of the most interesting of which has appeared on feminist and pro-choice blogs. (Some links coming below.)

According to a Herald article of 19 Feb. the proposed guideline, (part of the council's "Statement on beliefs and medical practice”) reads:

"While the council recognises that you are entitled to hold your own beliefs, it remains your responsibility to ensure that a pregnant woman who comes to you for medical care and expresses doubt about continuing with the pregnancy is provided with or is offered access to objective information or assistance to enable her to make informed decisions on all available options for her pregnancy, including termination."

(The Herald notes this was the March draft, and the guideline under distpue might be different. The Medical Council has promised the court it won’t release the proposed guideline until the challenge has been settled.)

As numerous bloggers have pointed out, this is not about taking part in an abortion procedure. Medical personnel are already protected on that score, including by “Conscientious objection” clause of the 1977 Contraception, Sterilisation and Abortion Act

No medical practitioner, nurse, or other person shall be under any obligation—

(a) To perform or assist in the performance of an abortion or any operation undertaken or to be undertaken for the purpose of rendering the patient sterile:

(b) To fit or assist in the fitting, or supply or administer or assist in the supply or administering, of any contraceptive, or to offer or give any advice relating to contraception,—

if he objects to doing so on grounds of conscience.

No, this is about giving women access to information. Yes, information. Deborah, blogging at In a Strange Land, comments “I’m already pretty unhappy with the balance in favour of doctors: why on earth should doctors be allowed to refuse to provide medical treatment in the first place. But this is hardly an imposition, that doctors should be required to tell patients about the possibility of a particular procedure.”

Other pro-choice bloggers to weigh in were Julie at The Hand Mirror with a quick breaking-news post followed a couple of days later by a delightful “what if” post titled: "An article we'll never see on the front page of the Herald."

That piece starts off like this: “Anti-vasectomy doctors have gone to court to challenge new Medical Council on how physicians with personal objections to vasectomy must deal with patients.”

Queen of Thorns had something to say, too, in a post titled: “If we tell them about it'll just encourage them."

The pro-choice bloggers, and their many commenters, have covered most of the talking points on this issue pretty well. But I’d like to make a few comments on the use, or abuse, of “conscience” that appears to be going on here, and with reference to an excellent piece called “The Ethical Responsibilities of Conscience,” by Bernard Dickens, a professor emeritus of Health Law and Policy at the University of Toronto. (It’s from the IPPF Medical Bulletin of December 2009, which you can download here.)

Dickens helpfully outlines a fairly well-accepted account of the “conscience objection” and its use regarding medical care:

“Once a provider- patient relationship comes into existence, the provider cannot ethically withdraw from delivery of lawful care which the patient seeks, without referring the patient, in good faith and good time, to another provider who is able and willing to render the indicated care. The duty to make appropriate referral satisfies both the provider’s right of conscientious objection, and the patient’s right of timely access to requested lawful care.”

Now most of us would assume that this “delivery of lawful care” would include information, that is, ensuring women are informed of all the (legal) medical options open to them, and that if the physician will not do that, s/he at the very least has a duty to refer the patient to someone who is willing to provide this information. (Setting aside for the moment the equally crucial question of whether it is an abuse of “conscience” – or even ethical – to refuse to provide such information in the first place.)

But how can patients be warned that X or Y doctor will not discuss or provide information about Q or R – without mentioning Q or R? If a physician won’t give information about abortion based on conscience, why would s/he refer a patient to someone who will, since that is an almost imperceptibly short step away from providing it him/herself?

“Conscience”, as we’ve all noticed by now, is another front in the war on reproductive rights. The aim is to broaden the scope of "conscience" with respect to reproductive health care well beyond participation in actual medical procedures (abortion, sterilization, writing a prescription for contraception, IVF, etc.) to incorporate the provision of information about those things. 

Dickens describes the right of conscientious objection as “an important human right”, and few would disagree.  But he also sees evidence of its abuse. In a section of the article with that title (“abuse of conscience”), Dickens notes that

“On the final day of its authority, on 20 January 2009, the Bush administration in the U.S. brought into legal effect similar immunities of healthcare providers which all recipients of funds from the Department of Health and Human Services are obliged to grant. These federal provisions govern performing, participating in, referring for, learning, teaching or administering procedures for abortion, sterilization and contraception, and some forms of terminal care.” (My emphasis)

He (and we) conclude:

“Under the cover of protecting healthcare providers against discrimination, these provisions were apparently motivated and supported in order to make such lawful procedures unavailable to dependent patients. One effect is that patients whose care is not religiously or morally contentious, such as safe removal of dead fetuses or of cancerous reproductive organs, may have access only to healthcare professionals who are untrained to perform or participate in necessary procedures, because they or their instructors object to some of the uses to which the training may be put. Such provisions expose the paradox of the unconscionable abuse of conscience.”

ADDENDUM:

A reader writes:

There is also another section on conscience in the Health Practitioners Competence Assurance Act 2003
Clause 174 Duty of health practitioners in respect of reproductive health services.
(1) This section applies whenever -
(a) a person requests a health practitioner to provide a service (including, without limitation, advice) with respect to contraception, sterilisation, or other reproductive health services; and
(b) the health practitioner objects on the ground of conscience to providing the service.
(2) When this section applies, the health practitioner must inform the person who requests the service that he or she can obtain the service from another health practitioner or from a family planning clinic.

In  the past anti-abortion doctors have claimed that "other reproductive health services" does not include abortion because, if parliament had wanted that to be included, parliament would have specified abortion. This differs from the interpretation given by the Medical Council in their draft statement on beliefs.

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Another reader points us to a great post we missed by Luddite Journo titled "Doubts About Your Pregnancy -- Just Try Harder."

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