Conscientious objection to abortion care should only go so far

Should midwives be allowed to be exempt from all aspects of abortion care on conscientious grounds? Is it acceptable for them to refuse to delegate, support or supervise staff caring for women having abortions, because they are Roman Catholic, for example?

BPAS absolutely supports the right to conscientious objection. We believe healthcare professionals who believe abortion is wrong should not have to participate in such procedures, not least because we believe women deserve better than being treated with contempt by those who believe they are sinners.

But what does it mean to participate in abortion care, and what legal protections should be provided by the conscientious objection clause in the Abortion Act?

In 2014 the Supreme Court considered a case involving two Roman Catholic midwives who were labour ward co-ordinators. They were not asked to carry out abortions. They were not asked to administer medications to induce the abortion. They were not asked to provide any care or emotional support to women undergoing a procedure. Their patients were primarily women in traumatic circumstances, ending their pregnancies after a diagnosis of fetal anomaly. What they were asked to do, as co-ordinators of the labour ward, was delegate, supervise and support staff providing this care to women. They objected and took legal action.

While a first court rejected their claim that this amounted to participation in treatment, a second court upheld it – concluding that their right to conscientious objection as covered by the Abortion Act should extend to duties that are not directly linked to the abortion. The health board that employed these midwives has appealed this decision to the Supreme Court.

BPAS and the Royal College of Midwives intervened in the case. Why? Because we think the implications of an extension of conscientious objection to cover duties removed from the abortion itself could be profound.

If midwives running a ward could in effect make it impossible for staff to look after women having abortions by refusing to co-ordinate any care, or even answer a phone to book in a woman, then this would make it all but impossible to deliver care appropriately. It would mean a tiny number of healthcare professionals opposed to abortion could ensure their own beliefs trumped women's right to access a legal service, and overrode their colleagues' commitment to delivering that service.

Conscience works both ways. Many people involved in abortion care do so because they have a deep moral commitment to supporting women and enabling them to end a pregnancy that they cannot continue at that point in their lives.

A significant number of abortions, and particularly later procedures, are now carried out under contract to the NHS by not-for-profit organisations dedicated to this area of women's care where issues of conscientious objection are unlikely to arise. But a third of abortions remain within the NHS.

Women with serious medical problems who need to end a pregnancy will almost always need to be treated within the NHS, and those who have received a diagnosis of fetal anomaly are often only offered medical abortion (induction) on the labour ward. It is essential for women's health that these services can be provided without being undermined by a ludicrously wide interpretation of conscientious objection.

Regularly at BPAS, we see women who have been delayed by a GP with a conscientious objection to abortion. The current interpretation of the law already affords healthcare professionals extensive protections from being involved in abortion. It would be a grave injustice if these rights were further extended to the detriment of women making their own decisions about their pregnancy, in accordance with their own conscience.

About the author

Clare Murphy is BPAS director of external affairs