The new conchies?

Monday’s Guardian reports that an increasing number of doctors are refusing to perform abortions on pregnant women, which goes some way to explaining why the NHS feel the need to outsource the provision to private providers.

A study in the Journal of Medical Ethics reports that “almost a third of students would not perform an abortion for a congenitally malformed foetus after 24 weeks, a quarter would not perform an abortion for failed contraception before 24 weeks and a fifth would not perform an abortion on a minor who was the victim of rape,”

The Guardian goes on to report “The Royal College of Obstetricians and Gynaecologists has voiced concern about the “slow but growing problem of trainees opting out of training in the termination of pregnancy and is therefore concerned about the abortion service of the future”.

Ann Furedi takes the infuriatingly liberal and patronising line that these young doctors are clearly young, ill-educated ideologues in need of training in order to make them more right-thinking. She guesses that “students may not be required to engage much with the reasons why a woman may find herself with an unwanted pregnancy” and goes on to assert the “need to ensure that young doctors understand why women need abortions”.

She assumes that the reason why doctors may not wish to perform abortions is because they are somehow casting judgement on the woman’s character and doesn’t wish to entertain the idea that perhaps doctors are uncomfortable with performing unnecessary abortion procedures, because they recognise that it is the destruction of life, something which they are bound to protect.

Having already introduced the idea that refusing abortion might be all about the irrational prejudices of doctors, the article goes on to consolidate this, by conflating the issue of abortion, with that of whether or not patients with drink or drug related problems should be treated, quoting selectively from the Chair of the GMC . “It is not acceptable to opt out of treating a particular patient or group of patients because of personal beliefs or views about them, for example if they misuse drugs or alcohol,” said Dr Peter Rubin, the GMC’s chair.”

The issue of abortion is entirely unrelated to what a doctor might think about their patient, it is disingenuous to link the idea of being opposed to the destruction of human life and thus refuse to carry out a procedure to kill another, to that of moral judgement upon an individual and the circumstances in which they may find themselves. A refusal to participate in abortion does not amount to any sort of moral judgement as to how that woman became pregnant or the reasons behind her decision. It is more an absolutist principle as to the ethics of abortion.

The Department of Health said: “Patients’ clinical needs always come first, and practising doctors understand this. It is unlawful to discriminate on the grounds of religion or belief and the law does not entitle people to apply such beliefs in a way which impinges upon other people, even if they claim that their religion or belief requires them to act in this way.”

The concept of clinical need is clearly a highly subjective one, does a woman wishing to have an abortion for social reasons constitute a “clinical need”? What would happen to her medically if she could not have the procedure? In most cases, the answer physically is nothing, any adverse effect would arise out of her own intervention, although mental health is undeniably a factor when it comes to assessing issues of clinical need. Could the mental distress and anguish at not being able to procure abortion be enough to compel the patient to harm herself and would the harm outweigh the harm done to the unborn child?

The problem with the abortion law is that it casts the doctor into the role of moral arbiter, as with any other treatment. A person can’t simply demand a specific course of action because that is what they have already deemed appropriate. What constitutes clinical need will always be a highly subjective affair and thus talk of “why women need abortions” is nothing more than pro-abort propaganda. I fail to see why doctors would be any less aware than the rest of the population as to why an abortion might seem to be a solution. Aren’t they taught these things in school these days? Or is it that Ms Furedi feels that the message has clearly not permeated through the thick skulls of those who are studying for one of the most competitive, intellectually rigorous and academically selective professions? Doctors will be the ones taking these decisions so they need to be shown which are the right ones? Bit rich coming from someone who can hardly claim to be the most impartial on the matter.

What interests me is that whenever abortion is discussed, the inevitable polemic consisting of “you can’t force me to carry a baby to term against my will, ” comes into play. If this is the case, why is it then deemed acceptable to force a clinician to physically perform a procedure that is against their will?

Fortunately the GMC also reminds practitioners that the 1967 Abortion Act permits that ‘no person shall be under any duty, whether by contract or by any statutory or other legal requirement, to participate in the treatment authorised in this Act to which he has a conscientious objection’.

Furthermore the case of Janaway v Salford Health Authority All England Law Rep 1988 Dec 1;[1988] 3:1079-84 set a precedent and defined participation as ‘actually taking part in treatment designed to terminate a pregnancy’.

My suspicion is that students are opting out of the training in order that they don’t need to get involved in ever performing an abortion or being put in the position whereby they may need to exercise their conscience. Much easier to say “I can’t do that, I’m not qualified”.

It would be interesting to note, should a test case ever come up,which way the ECHR might fall on this, particularly in the light of last week’s announcement; the battle has already been won, although it seems as though there are some who would like to pursue this.

The UK has a brave and noble tradition of conscientious objectors. Long may it continue.

UPDATE:

<a href="This website also discusses the “problem” and suggests that students need to be “triaged” for unhelpful beliefs. How very sinister. It seems that the conchie, the person who refuses to be coerced by the state into killing another, is as relevant and as pressing a “problem” now, as it was over 70 years ago.