Comment

Should midwives be forced to participate in abortions, even if they oppose the practice?

Christian Medical Fellowship head of nursing Steve Fouch argues that midwives must have the right to conscientiously object to involvement in terminations

Christian Medical Fellowship head of nursing Steve Fouch argues that midwives must have the right to conscientiously object to involvement in terminations

Fallout from the Glasgow midwives' case continues. The case of Doogan and Wood highlighted an issue with the conscientious objection clause in the 1967 Abortion Act, specifically around what actually constitutes being involved in an abortion procedure.

On the basis of a conscientious objection to abortion, the two senior midwives at a maternity unit in Glasgow made it clear they did not wish to be responsible for supervising junior staff involved in termination of pregnancy procedures.

Although the Scottish Court of Appeal upheld their claim, the Supreme Court ruled in 2014 that they had no right to opt out of supervision, delegation or support of junior staff, as the right to conscientious objection

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Christian Medical Fellowship head of nursing Steve Fouch argues that midwives must have the right to conscientiously object to involvement in terminations

Fallout from the Glasgow midwives' case continues. The case of Doogan and Wood highlighted an issue with the conscientious objection clause in the 1967 Abortion Act, specifically around what actually constitutes being involved in an abortion procedure.

On the basis of a conscientious objection to abortion, the two senior midwives at a maternity unit in Glasgow made it clear they did not wish to be responsible for supervising junior staff involved in termination of pregnancy procedures. 

Although the Scottish Court of Appeal upheld their claim, the Supreme Court ruled in 2014 that they had no right to opt out of supervision, delegation or support of junior staff, as the right to conscientious objection only applied to those involved in direct clinical procedures. Supervisory roles could not be subject to the right to conscientious objection in the Abortion Act.

New position

Earlier this month, the Royal College of Midwives published - rather quietly and unobtrusively - their new Position Statement on Abortion.

This maintains that midwives should be involved in all care of a woman undergoing a termination, but that they have the right to opt out on the basis of conscience only from those clinical procedures directly involved in an abortion. This further toughens up clause 4.4 of the Nursing and Midwifery Council code that, likewise, allows for conscientious objection in only very limited circumstances. 

Furthermore, both the NMC and RCM make referral to another competent practitioner an obligation. This is justified with reference to General Medical Council guidelines, stating that these guidelines say a doctor who objects must refer.

Actually, the GMC says no such thing. Its guidance specifically says: ‘Make sure that the patient has enough information to arrange to see another doctor who does not hold the same objection as you.’ No referral is required if the patient is able to make their own arrangements.

Freedom of conscience is no minor side issue. Imagine, for example, working in another country and being asked to ‘supervise’ activities that were legal there but that most people in the UK would regard as highly unethical, such as euthanasia for people with dementia or depression, amputation for stealing, female circumcision, or the torture of political prisoners. I think most of us would feel we had a right to conscientiously object in those circumstances.

Referral is a real issue of conscience for anyone with a moral objection to abortion, many of whom would view delegation, supervision and/or support as effective participation in termination of a pregnancy.

To ‘participate’ does not just involve direct involvement. If I do not physically take part in a robbery, but knowingly provide the thieves with information or equipment to perform the robbery, or provide a getaway car or help conceal or dispose of the loot, I should be guilty under the law as if I had been on the premises myself.

Mother and child

The RCM stance comes on the back of their public support for the campaign to fully legalise abortion throughout the UK. This campaign is largely led by the British Pregnancy Advisory Service, the UK’s leading abortion provider, of which RCM chief executive Cathy Warwick is also chair. 

It is worrying that an organisation representing professionals most concerned with the safety and wellbeing of both mother and child, should be so actively campaigning for the liberalisation of the few remaining safeguards in current legislation.

But leaving that to one side, my biggest concern is that, once again, freedom of conscience is being constricted. Once one area of freedom of conscience is constrained, it will be easier to constrain it in all other areas.

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