Nurses’ right to conscientious objection over abortion is incompatible with non-judgemental practice

Why the needs of the patient trump nurses’ personal beliefs

Why the needs of the patient trump nurses’ personal beliefs

Patients have the right to compassionate and timely care. Picture: iStock

As the director of nursing at BPAS (the British Pregnancy Advisory Service) I believe it is of the utmost importance to ensure the staff we employ are comfortable with the provision of all the services we provide. This includes termination of pregnancy up to 24 weeks. 

Nurses are however entitled to conscientiously object to taking part in certain activities on the grounds of freedom of thought, conscience or religion. In English law there are two statutory provisions that provide a legal right for conscientious objection, the first in relation to abortion and the other in relation to in vitro fertilisation and embryo research; the Abortion Act (1967) and the Human Fertilisation and Embryology Act (1990) have these clauses built into them. 

Abstaining from areas of practice

Generally, nurses are not at liberty to refuse care for any patient. Patients see nurses as kind, non-judgemental and caring, and they expect them to demonstrate these qualities when providing care for them. 

Nurses must also act as advocates for patients by providing support in difficult circumstances and often learn to set aside their own views to respect their patient’s values and beliefs.

Some nurses however choose to abstain from certain areas of nursing practice, citing their conscience. This means there will be times when patients are not able to rely on these nurses to provide the care and support they require.

It is not known how many nurses exercise this legal right, but it is not uncommon, even among staff who work in gynaecology, despite abortion being one of the most common gynaecological procedures undertaken.

‘There is a dichotomy – on the one hand, nurses and midwives are told they need to deliver care without delay, recognising individual choice; on the other, if they don’t agree with that patient’s choice, someone else can take over’

I believe there is a conflict between the fundamentals of nursing practice, in having a non-judgemental approach to care, and the right to conscientiously object. Staff who conscientiously object are being allowed to override the beliefs and values of their patients. 

The Nursing and Midwifery Council stipulates in the Code that registered staff must:

  • Treat people with kindness, respect and compassion.
  • Deliver the fundamentals of care effectively.
  • Avoid making assumptions and recognise diversity and individual choice.
  • Make sure treatment, assistance or care is delivered without undue delay.
  • Respect and uphold people’s human rights.

The Code also stipulates that nurses must tell colleagues, their manager and the person receiving care if they have a conscientious objection to a particular procedure and arrange for a suitably qualified colleague to take over responsibility for that individual's care.

The NMC has acknowledged the provision of conscientious objection in law, as clarified in a supreme court decision in Scotland in 2014. But there is a dichotomy between these two positions: on the one hand, suggesting nurses and midwives need to deliver care effectively without delay, recognising individual choice; on the other, suggesting that if they don’t agree with that patient’s choice then someone else can take over their care.

Nurses are free to choose not to work in certain clinical areas. However, they should not be able to override a patient’s beliefs and values with their own. Instead of having a conscientious objection, clinicians should look at having a conscientious commitment to providing all the services and information their patients require from them.

Think carefully before exercising your right

Unfortunately, I sometimes hear patients' stories about not being treated in a kind, non-judgemental way when trying to access abortion services. So perhaps, conversely, having a law on conscientious objection may actually protect patients from being cared for by staff who do not share their values and beliefs.

Nurses, however, should think carefully before exercising their right to conscientiously object, reflecting on what it really means and how it may be in conflict with some of the basic principles of nursing.   

At BPAS we find that patients are reassured by a referral to us because they know from our advocacy that everyone who works for us firmly believes in a woman’s right to make her own choice.

Further information

The Code: Professional standards of practice and behaviour for nurses and midwives (NMC)

Michael Nevill is director of nursing at the British Pregnancy Advisory Service

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