Bill to ensure conscience rights for medical practitioners to receive Committee Stage tomorrow

The Free Conscience Campaign has just put out the following press release.

Baroness O’Loan’s Conscientious Objection (Medical Activites) Bill will go to a Committee Stage in the House of Lords tomorrow (Friday 23 March).

The Bill will clarify the law to ensure conscience protections are in place for medical practitioners to protect them from discrimination, enabling them to fully participate in their chosen professions and care for patients to the best of their ability. The Bill will give the right to withdraw from end of life treatment, activities under the Human Fertilisation and Embryology Act and abortion.

Under the existing law, some medical professionals are not protected from unjust discrimination. GPs, as well as many nurses, midwives, pharmacists, and other medical professionals have limited statutory conscience protection. As a result, some areas of the healthcare profession are becoming increasingly difficult places to work for those with certain deeply-held moral, philosophical or religious views. Not only is this discriminatory, it could also mean healthcare professions will become increasingly less diverse, inclusive, and representative of the views of the general population.

An Inquiry in 2016 found that some doctors and nurses face discrimination in the workplace due to their conscientious objection to practices that they believe end a human life.

The conscience rights of midwives were also undermined by a 2014 Supreme Court judgment, which held that the conscience provision in the Abortion Act 1967 did not allow them to refuse to engage in aspects of abortion such as telling someone else that have to carry out an abortion.

A recent ComRes poll found that a majority of the public oppose forcing doctors to participate in abortion procedures against their will if they want to remain in their profession.

The Free Conscience campaign, which has been launched to support the Bill, is calling on the public to visit their website (www.freeconscience.org.uk) where they can write to their MP, asking them to support the Bill.

Baroness O’Loan said:

“No one should be coerced by the risk to their careers into violating their conscience, and it is plainly inconsistent with the principles of equality legislation to exclude whole sections of society from areas of medical employment simply because of their moral beliefs. Reasonable accommodation of conscientious objection is a matter both of liberty and equality: of individual freedom and social inclusion. It is promising to see support from across the country for the Bill”.

Mary Doogan, one of the two midwives in the Greater Glasgow Health Board v Doogan & Anor case, and spokesperson for the www.freeconscience.org.uk campaign said:

“It’s reassuring to see this Bill is gaining momentum and continues to progress through Parliament. This Bill will restore the conscience rights of those who work tirelessly day in and day out to serve and care for others. As medical professionals, we owe patients not only our efforts but also our best moral judgement, and this Bill would allow us once again to practise with the greatest integrity. I fully support this important legislation and commend it to Parliament and the wider public”.

Dr. Mary Neal, leading conscience expert, senior lecturer at Strathclyde University and spokesperson for the www.freeconscience.org.uk campaign said:

“I am heartened to see that this Bill is progressing through Parliament, as it is necessary and much needed. There is a pressing need for statutory conscience rights which actually protect those who need protection. The current law fails to do this, so this Bill is a necessary and timely step.”

Baroness O’Loan’s Conscientious Objection (Medical Activities) Bill deserves our full support

As Christians, we are called to respect the governing authorities as they are instituted by God himself (Romans 13:1,2). But are there limits? What should we do if they try to force us to do something we believe is wrong?

The ‘Free Conscience’ campaign, launched this week with the backing of many Christian groups, supports Baroness O’Loan’s Conscientious Objection (Medical Activities) Bill which passed its second reading (debate stage) in the House of Lords on Friday 26 January. It is now set for a Committee of the Whole House where amendments can be submitted and debated. If it then passes a third reading it will pass to the House of Commons.

The bill aims to strengthen the conscience rights of healthcare professionals who believe it would be wrong to be involved in three specific activities – abortion, activities under the Human Fertilisation and Embryology Act 1990 (like embryo research or egg donation) and withdrawal of life-preserving treatment.

Currently, the law offers general conscience protection. The Equality Act 2010 includes religion and belief as two of nine ‘protected characteristics’ and the Human Rights Act 1998, which brought the European Convention of Human Rights (ECHR) into UK law, states that ‘everyone has the right to freedom of thought, conscience and religion’ (article 9). But these rights are limited.

When it comes to specific protections the situation is much less clear and statute law currently only applies to abortion and activities under HFE Act. For abortion its scope is very limited.

In 2014 the Supreme Court ruled that two Glasgow midwives, who were working as labour ward coordinators, could not opt out of supervising abortions. It said that the conscience clause in the Abortion Act 1967 only applied to those who were directly involved in abortion and not to those involved in delegation, planning, supervision and support. This left many health professionals vulnerable to coercion.

Overall 25 peers spoke in the debate – 13 for and 11 against with the government responding. Labour health spokesperson Baroness Thornton made it clear that the Labour party would oppose the bill and Liberal Democrat Baroness Barker said that most of her party colleagues shared her strong opposition also. The government itself will allow a conscience vote.

The major arguments against the bill were that it expanded the scope of the conscience clause to cover health professionals only indirectly involved in the activity concerned and expanded the number of activities protected. This, they claimed, would hinder access to patient care. Several peers also suggested that there should be a duty for professionals claiming conscience protection to refer the patient to someone who would comply.

Supporters of the bill will need to address these specific concerns convincingly at committee stage if the bill is to proceed.

As Christian citizens we must respect those who rule over us but the Bible is equally clear that if discriminatory laws are passed, and obeying such laws involves disobeying God, then our higher duty is to obey God. If you love me you will obey me, says Jesus (John 14:15).

When the King of Egypt ordered the Hebrew midwives to kill all male Hebrew children they refused to do so and God commended and rewarded them (Exodus 1:15-22).

A fiery furnace did not stop Shadrach, Meshach and Abednego refusing to bow down to the image of the king and a lions’ den did not deter Daniel from persisting with public prayer (Daniel 3:16-18, 6:1-10).

When Peter and John were commanded by the Jewish authorities not to preach the Gospel they replied, 'We must obey God rather than men' and continued to do it (Acts 5:29).

Of course, we should also do our best to oppose the passing of laws which seek to criminalise normal Christian behaviour which is what Baroness O’Loan’s bill is all about. We can thank God that in Britain we still have the democratic right to participate in shaping public policy.

Freedom of conscience is not a minor or peripheral issue and it is not only Christians who are affected. It goes to the heart of healthcare practice as a moral activity. Current UK law and professional guidelines respect the right of doctors to refuse to engage in certain procedures to which they have a conscientious objection.

The right of conscience helps to preserve the moral integrity of the individual clinician, preserves the distinctive characteristics and reputation of medicine as a profession, acts as a safeguard against coercive state power, and provides protection from discrimination for those with minority ethical beliefs.

It is worth fighting for. Christians can get involved through the Free Conscience website which will tell you how to contact your MP and encourage them to support the bill. But it will first need to clear the House of Lords.

Some Big Public Policy Challenges in Bioethics we can expect in 2018

As we look forward to the challenges that 2018 will bring I am struggling to think of a time when we have faced more major public policy challenges in bioethics in so many areas all at once. 

This is perhaps inevitable given the march of secular humanism through parliament, the courts and institutions.

Here is some background on the five major threats currently looming.

1.       Assisted Suicide

Given that 11 attempts in British Parliaments to change the law to allow assisted suicide or euthanasia have failed since 2003 our opponents, not surprisingly, have shifted their attention to the courts in an attempt to change the law through the back door.

Conway, who has motor neurone disease and is seeking assisted suicide, lost his case in which CNK Alliance intervened in the Divisional Court in October, and his appeal to the High Court was denied. He now plans to appeal directly to the Court of Appeal. See my previous comments on the case here.

Omid, who has multiple system atrophy and is also seeking assisted suicide, had a preliminary hearing on 21 November and has appealed to the judges to allow a full enquiry in which all witnesses can be cross-examined along the lines of the Carter case in Canada. We await their decision.

There have been three worrying judgements by the Court of Protection in the last few months (see here and here). Formerly all patients with Permanent Vegetative State (PVS) and Minimally Conscious State (MCS) had to go to court for appeals about the removal of artificial nutrition and hydration (ANH), but now there are moves to withdraw ANH from these and less severely brain-damaged patients who are not imminently dying without going to court provided that both doctors and relatives agree that it is in the patient’s ‘best interests’. The Official Solicitor will appeal these judgements in the Supreme Court on 29 January. My fuller review is here.

A recent case involving a pharmacist (Desai) who helped his father end his life with a morphine and insulin overdose resulted only in a nine-month suspended sentence. The general trend is toward fewer prosecutions and convictions for assisted suicide and the DPP’s prosecution criteria on assisted suicide are being interpreted very liberally.

2.       Abortion

The ‘We Trust Women’ campaign (masterminded by Ann Furedi of BPAS) is gaining momentum and now has the support of the RCOG, BMA and RCM. Whilst there is no bill currently before Parliament (and none likely to appear before 2019) proabortion activists may seek to amend a government health bill to achieve their aim of completely decriminalising abortion (see my previous posts here, here, here and here).

This will most likely involve repealing Sections 58 and 59 of the Offences Against the Person Act 1861 (OAPA) which make procuring an abortion for oneself or others a crime punishable by life imprisonment. The effect would be to make abortion legal for any reason up to 28 weeks and, if the Infant Life (Preservation Act) 1929 is repealed too, up to birth.

Were this to succeed the Abortion Act 1967 with all its provisions (two doctors, licensed premises, reporting, conscience clause etc) would fall as it is contingent upon the OAPA.

There are also calls to relax the abortion laws in Northern Ireland, Ireland and the Isle of Man.

3.       Organ transplantation

Geoffrey Robinson MP wants to bring in an opt-out system for organ donation in England. His Organ Donation (Deemed Consent) Bill is due its second reading (debate stage) on 23 February 2018.

In 'deemed' (presumed) consent, a person, unless he or she specifically 'opts out', is assumed to have given consent to the harvest of their organs after death, even if their wishes are not known. Although relatives may be consulted (a so called 'soft' opt out), to ascertain any wishes of the deceased expressed before death, their views can still be overruled by the state should they decide against transplantation. Wales already operates an opt-out system for organ donation and it is likely that Scotland will follow.

Robinson's private member's bill may be overtaken by a new government bill seeking to achieve the same thing. The government has just launched a consultation, closing on 6 March 2018, which proposes 'changing the current law on organ donation consent whilst also allowing people to opt out if they want to'. Both Theresa May, the prime minister and Jeremy Corbyn, the leader of the opposition have signalled support and a Daily Mirror Campaign has built support.

However, evidence for the claim that an opt-out system will increase transplants is still lacking. In Wales, where an opt-out system was introduced in December 2015, there has been a small dip in the number of deceased donors. The Nuffield Council advised in October that robust evidence is needed before any change to the law is considered. But it is also unethical.

Donation must be without coercion and the final decision must lie with the family based on what the person would have wanted, if this is known. Organs are not the property of the state and must not be 'taken' without permission, however needy any prospective recipient may be (see previous CMF articles and blog posts here, here and here)

4.       Transgender

Under the Gender Recognition Act 2014, to change gender legally, one must have lived in one’s chosen gender for two years, be 18 or over, have a medical diagnosis of gender dysphoria and appear before a gender recognition panel.

Justine Greening, the Secretary of State for Education, Women and Equalities, wants to allow people to change their gender purely based on self-declaration without having to see a doctor nor appear before a gender recognition panel.

A consultation toward this end has been announced and is to be launched shortly. A Scottish consultation is already underway and closes on 1 March.

She has the support of both Theresa May and Jeremy Corbyn although there is now some resistance growing and recent reports suggest that Greening may be having second thoughts (see further comment here and here).

5.       Freedom of Conscience in healthcare

Currently there is statutory conscience protection for health professionals only for involvement in abortion and activities authorised under the Human fertilisation and Embryology Act. The scope of the former is restricted because of a Supreme Court judgement on the case of two Glasgow midwives.

Freedom of conscience for other activities (eg. Hormones for transgender, abortifacient contraceptives, PrEP, withdrawal of ANH etc) is covered only partially by equality legislation.

There were two significant victories on freedom of conscience last year. The General Pharmaceutical Council, which regulates Pharmacists and Pharmacies, modified new guidance which would have replaced a ‘right to refer’ with a ‘duty to dispense’, in response to protests from interest groups (see my previous comment here).

The Faculty of Sexual and Reproductive Health (FSRH), part of the RCOG, reversed regulations which denied those with conscience objections to some contraceptives, from obtaining its diplomas. This appeared to be in response to criticism by CMF.

These two wins underline the fact that conscience freedom depends on constant vigilance.

Baroness O’Loan’s Conscientious Objection (Medical Activities) Bill is to have its second reading in the House of Lords on 26 January 2018. Although this bill is much narrower in scope than we would have preferred (covering only abortion, IVF and related technologies and withdrawal of treatment) it has our support.

So, a busy year awaits. Watch this space for further developments. 

College climbs down over ban on Christian doctors and nurses training in sexual and reproductive health

Doctors and nurses wishing to practise in sexual and reproductive health have been granted more liberty to exercise freedom of conscience under new guidelines published earlier this year.

The Faculty of Sexual and Reproductive Healthcare (FSRH), a faculty of the Royal College of Obstetricians and Gynaecologists (RCOG), has relaxed its stance on conscience in new guidelines issued in April so that those with an ethical objection to certain procedures can now obtain qualifications which they were previously excluded from.

Christian doctors and nurses in the UK are practising in an environment that is increasingly hostile to their beliefs and values. We have accordingly come to expect new constraints on our freedom of conscience almost as a matter of course. So this is a refreshing backtrack by the College.

In April 2014 I highlighted the fact that the FRSH was barring doctors and nurses with pro-life views from receiving its degrees and diplomas and may also be breaking the law (see also here). The story was later picked up by the Telegraph.

Under the previous guidelines, now removed from the FSRH website but still accessible in the Telegraph, doctors and nurses who had a moral objection to prescribing ‘contraceptives’ which can act by killing human embryos (levonelle, ellaOne, IUCDs etc) were barred from receiving diplomas in sexual and reproductive health even if they undertook the necessary training.

The wording was as follows (emphasis mine):

‘Completing the syllabus means willingness during training to prescribe all forms of hormonal contraception, including emergency, and willingness to counsel and refer, if appropriate, for all intrauterine methods…Failure to complete the syllabus renders candidates ineligible for the award of a FSRH Diploma.’

It added:

‘Doctors who hold moral or religious reservations about any contraceptive methods will be unable to fulfil the syllabus for the membership … or speciality training…This will render them ineligible for the award of the examination or completion of training certificates.’

However, the new guidance grants much more freedom.

It begins by underlining the faculty’s commitment to diversity:

‘The FSRH welcomes and values having a diverse membership, representing a wide range of personal, religious and non-religious views and beliefs.’

It then underlines the fact that there is already statutory protection for healthcare professionals (HCPs) to opt out of abortions and procedures authorised under the Human Fertilisation and Embryology Act (HFEA):

‘There are currently two specific statutory protections for HCPs who have a conscientious objection 1) to participating in abortion (Abortion Act 1967, s.4) 2) to technological procedures to achieve conception and pregnancy (Human Fertilisation and Embryology Act 1990, s.38) .’  

But it also recognises that both the Human Rights Act 1998 and Equality Act 2010 offer some conscience protection in areas other than abortion and IVF:

‘The Human Rights Act 1998 incorporates the European Convention on Human Rights (ECHR) into UK law. Article 9 of the ECHR protects “the freedom of thought, conscience and religion; this right includes … to manifest his religion or belief, in worship, teaching, practice and observance.”’

‘Part 5 of the Equality Act 2010 sets out provisions for non-discrimination in employment. Specifically, s.39 prohibits employers from discriminating against individuals on the basis of “protected characteristics” (of which religious belief is one) and places an obligation on employers to make ‘reasonable adjustments’ to accommodate religious beliefs.’

The guidance recognises that the rights to ‘freedom of thought, conscience and religion’ and to ‘religious beliefs’ are not absolute, but qualified, and also that NHS employers may interpret these in different ways than the faculty, but this is nonetheless a significant step forward.

The guidance says that it applies to all FSRH qualifications and training, but a closer reading suggests that those seeking to sit the membership examination of the Faculty of Sexual & Reproductive Healthcare (MFSRH) will need to undergo ‘practical assessment of the provision of contraception (all methods including emergency contraception)’ and those seeking a Letter of Competence in Intrauterine Techniques (LoC IUT) will need to demonstrate ‘practical competence in the relevant live procedures’.

However, with respect to the Diploma of the Faculty of Sexual & Reproductive Healthcare (DFSRH and NDFSRH), holder must simply be ‘competent and willing to advise on all forms of contraception and manage SRH consultations, including providing evidence-based information on the options for unplanned pregnancy’. But there is no duty actually to provide all treatments.

‘The FSRH requires all Diplomates to provide patients with the full range of contraception choices, including emergency contraception and support of a woman with an unplanned pregnancy and appropriate onward referral. HCPs who plan to opt out of providing aspects of care because of their personal beliefs may still be awarded the Diploma, or recertified, if they can demonstrate commitment in their practice to the principles of care in section 5 of this document. For example, if a HCP chooses not to prescribe emergency contraception because of their personal beliefs, she/he has a personal responsibility to ensure that arrangements are made for a prescription to be issued by a colleague without delay, ensuring that the care and outcomes of the patient are never compromised or delayed.’

Although some would see referral to another doctor or nurse as a form of complicity, this is nonetheless a big improvement on the previous guidance.

Previously doctors or nurses who refused to fit coils or prescribe the morning after pill (MAP) were also barred from receiving the diploma signifying expertise in the management of infertility, cervical cancer or sexually transmitted infections. This effectively meant that many thousands of doctors and nurses were not able to obtain qualifications to pursue a career in gynaecology and sexual health.

This is no longer the case.

Quite why the faculty has relaxed its guidance is not clear, but I wonder if they have been conferring with the General Pharmaceutical Council (GPhC) who also similarly relaxed their guidance on dispensing drugs after receiving submissions from Christian Medical Fellowship and the Christian Institute earlier this year.

The GPhC’s attention was drawn to the fact that their proposed new guidance might well be illegal under Equality legislation (I made the same point about the FSRH in 2014).

The GPhC backtracked after the Christian Institute made it clear, in pre-action legal correspondence exchanged with the Council’s lawyers, that they ‘were fully prepared to litigate’.

Perhaps the FSRH also, on reflection, thought it wise to protect themselves by erring on the side of caution and taking themselves out of the legal firing line.

However, whatever the reason, the climb down is most welcome and will enable many more doctors and nurses to obtain diplomas in sexual and reproductive health. That can only be good for patient care. 

New parliamentary report on conscientious objection to abortion calls for widespread changes

A new parliamentary report has found that there is ‘widespread and increasing pressure’ on healthcare professionals to participate in abortions which is ‘in large part due to inadequate observance of the current legislation’.

‘Freedom of Conscience in Abortion Provision’, which was published on 21 July, is the culmination of a four-week consultation and makes nine key recommendations. In total 150 witnesses contributed to the inquiry, of whom nearly a third were current or former healthcare professionals or healthcare bodies.

Notable amongst these was the British Medical Association (BMA), the doctors’ trade union, which spoke of doctors ‘being harassed and discriminated against because of their conscientious objection to abortion’.

The inquiry, carried out by the All Party Parliamentary Prolife Group (APPG), sought to assess the extent to which the Conscience Clause provides adequate protection for doctors and other health professionals who do not wish to participate in abortion, directly or indirectly, and to examine how freedom of conscience in the law and professional guidance can be developed. It is the first parliamentary inquiry into this subject and is long overdue.

The 37 page report, calls on both Government and NHS governing bodies to ensure that the legal right of healthcare professionals to conscientious objection is properly protected and makes specific practical suggestions about how this can be achieved.

AGGP chair Fiona Bruce MP (pictured with five other MPs from the APPG)  concluded, ‘Freedom of conscience is a key part of living in a diverse and democratic society. It is vital that conscientious health professionals who do not wish to participate in abortion can be confident in their right to opt-out of doing so without fear of censure, discrimination or abuse. It is essential that our hardworking doctors, nurses and midwives are given the protection the law requires if they do not want to participate in abortions.’

She said that while the Inquiry received some examples of good practice, it also received accounts from nurses, midwives and doctors who had been pressured and discriminated against despite their right to conscientious objection, often seeing their career or training options limited.

The report makes clear that, whilst there is legal protection for healthcare professionals who have a conscientious objection to participating in abortion, this is not being properly observed in practise.

Section 4 of the Abortion Act (1967) requires that ‘no person shall be under any duty, whether by contract or by any statutory or other legal requirement, to participate in any treatment authorised by this Act to which he has a conscientious objection’.

Commonly known as the ‘Conscience Clause’, the purpose of this section of the 1967 legislation was to enable men and women with conscientious objections to abortion to remain fully engaged in providing healthcare without being compelled to participate in the provision of abortion.

The report, which is well worth reading in its entirety, expresses deep concern about the way the conscience clause has been both interpreted and applied and reserves specific criticism for the Royal College of Obstetricians and Gynaecologists, which refused to give evidence to the inquiry, and the Vice President of the Supreme Court, Lady Hale, who in a recent judgement, narrowed the scope of the conscience clause so that it applied only to staff directly involved in abortion provision.

It also recommends that the Government conduct a review into the training of medical students, and calls for the principle of ‘reasonable accommodation’ to be introduced into legislation in this country. The report calls specifically on the Royal College of Obstetrics and Gynaecologists to publish a statement clarifying its position on this issue.

‘Freedom of Conscience in Abortion Provision’ makes nine practical recommendations to strengthen provision of the protection which Parliament intended for healthcare professionals with a conscientious objection to abortion:

1.      A cross-party Parliamentary Commission should be established to examine the role of conscience in the context of ‘British Values’ and any new ‘British Bill of Rights’.

2.      The Government should commission a full review into the training given to healthcare students to ensure that they are given full information about their right to conscientiously object.

3.      The General Medical Council should maintain their current guidelines ensuring that no doctor who has a conscientious objection to abortion should be required to refer a patient to another practitioner.

4.      All professional healthcare bodies should adopt the wording of the current GMC guidelines ensuring that no healthcare professional who has a conscientious objection to abortion is required to refer a patient to another practitioner (Recent Royal College of Midwives (RCM) guidance makes referral mandatory).

5.      The Royal College of Obstetricians and Gynaecologists (RCOG) is requested to publish a statement in response to this Inquiry to clarify their view on career progression for healthcare professionals who conscientiously object to abortion.

6.      Government and NHS governing bodies should ensure that an appropriate appeal system for those who believe they have been discriminated against because of their conscientious objection is set up.

7.      New guidelines for managers must state how those with a conscientious objection to a procedure should be fairly and respectfully treated and also propose solutions for how employers can accommodate practitioners with a conscientious objection.

8.      The Government should consider the feasibility of extending conscientious objection to indirect participation in abortion by authorising trials in several hospital departments and clinics across the country.

9.      Consideration be given to the introduction of the principle of ‘Reasonable Accommodation’ into legislation in this country, in the form of an amendment to the Equality Act 2010.

This inquiry has done a great service to the healthcare professions and NHS, not simply in its detailed and helpful analysis of current practice, but also in making specific achievable suggestions about how the problems with the conscience clause can be addressed. Doctors and other health professionals must now press the relevant authorities, not least parliament itself, to implement its recommendations.

It is particularly striking that all the witnesses who submitted evidence to the inquiry stressed the importance of conscience, regardless of their beliefs on the substantive issue of abortion. 

As the report concludes, ‘Conscience plays a crucial part in the dignity and morality of each individual. Any downplaying of conscience in public life is to the great detriment of society and individuals.’

Further Reading

The Report - ‘Freedom of Conscience in Abortion Provision’

The Inquiry – http://www.conscienceinquiry.uk/

CMF’s Official Submission to Inquiry

CMF File – The Doctor’s Conscience
Premier Radio Story and Interview 

New parliamentary inquiry launched to review freedom of conscience in abortion

A new parliamentary inquiry into freedom of conscience over abortion has just been launched.

Commissioned by Fiona Bruce MP, it seeks to examine whether the Conscience Clause in the 1967 Abortion Act provides adequate protection for doctors and other healthcare professionals who do not wish to be involved, directly or indirectly, in termination of pregnancy.

The closing date for written submissions (online, by email or by letter) is 5pm on Monday 11 July. 

There are seven questions and a maximum limit of 500 words per question.

They include: Why is freedom of conscience important? Do doctors and other health professionals have enough protection? Can you give examples of good or bad practice? Do you know of good precedents from elsewhere in the UK or abroad? What legal or regulatory changes would you suggest?

Section 4 of the Abortion Act (1967), the ‘conscience clause’, requires that ‘no person shall be under any duty, whether by contract or by any statutory or other legal requirement, to participate in any treatment authorised by this Act to which he has a conscientious objection’.

Its purpose is to ensure that people with a conscientious objection to abortion are not put under coercive pressure to take part.

The application of the clause has been the subject of much legal and ethical debate and has also been tested in the courts. Most of the debate centres around the meaning and scope of the two words ‘participate’ and ‘treatment’.

There is general agreement that the clause protects doctors or nurses from being forced against their consciences to be directly involved in carrying out abortions – for example by performing or assisting an operative procedure or administering abortifacient drugs.

But what about preparing a patient for surgery, attending them afterwards, supervising others doing abortions, typing a referral letter or being part of the referral process? Here the application is less clear.

The problem is that legal precedent and professional guidelines vary in how they interpret and apply the conscience clause.

The recent Glasgow Midwives case (Doogan and Wood) narrowed its scope. The Scottish Court of Appeal (Lady Dorrian) had ruled that the two nurses involved could refuse to delegate, supervise or support staff involved in abortions:

‘In our view the right of conscientious objection extends not only to the actual medical or surgical termination but to the whole process of treatment given for that purpose.’

But this was later overturned by the Supreme Court. Lady Hale ruled that:

‘The conscience clause does not cover making bookings or aftercare for patients who have undergone a termination. Nor does it cover fetching the drug before it is administered. “Participating” is limited to direct participation in the treatment involved. It does not cover administrative and managerial tasks.’

Furthermore Hale added that any medical professional who refuses to provide an abortion ‘must arrange for a referral to someone else who will do so’.

This legal ruling conflicted with 2013 General Medical Council (GMC) guidance that doctors are not obliged to refer patients seeking abortion to other doctors who will do it but must ‘make sure that the patient has enough information to arrange to see another doctor who does not hold the same objection’.

What about nurses?

Clause 4.4 of the Nursing and Midwifery Council (NMC) Code allows for conscientious objection in only limited circumstances. But a new position statement on abortion from the Royal College of Midwives (RCM) narrows this protection even further and states that midwives should be involved in all care of a woman undergoing a termination.

They have the right to opt out on the basis of conscience only from those clinical procedures directly involved in the abortion. Furthermore, both the NMC and RCM make referral to another competent practitioner mandatory. 

Many would consider that a referral for abortion is actually participating in abortion. If I do not physically take part in an immoral act but knowingly provide others with the means to do so, am I not equally culpable?

In fact doctors in New Zealand felt so strongly about this that they took their regulatory body, the NZMC, to court for suggesting referral was an obligation, and won! The NZMC subsequently dropped its appeal of the ruling.

The European Convention of Human Rights (ECHR) and the Equality Act 2010 are also relevant here. The Equality Act 2010 prohibits discrimination on the grounds of religion and belief and Article 9 of the ECHR guarantees freedom of thought, conscience and religion. There is a duty under the Equality Act to make 'reasonable accommodation' for those who have a disability and the argument is that there should be similar provision for religious beliefs.

As Professor John Wyatt has argued in a useful CMF File, the right of conscientious objection is not a minor or peripheral issue. It goes to the heart of medical practice as a moral activity.

The right of conscience helps to preserve the moral integrity of the individual clinician, preserves the distinctive characteristics and reputation of medicine as a profession, acts as a safeguard against coercive state power, and provides protection from discrimination for those with minority ethical beliefs.

Current UK law and professional guidelines respect the right of doctors to refuse to engage in certain procedures to which they have a conscientious objection. This applies not just to abortion but to other activities as diverse as artificial reproduction and gender reassignment.

Christians are called to show respect for governing authorities (Romans 13:1-7), but this is not a call for unquestioning obedience. Ultimately we obey God and not men (Acts 5:29).When the King of Egypt ordered the Hebrew midwives to kill all male Hebrew children they refused to do so and God commended and rewarded them (Exodus 1:15-22).

This new consultation is timely. It provides a great opportunity for anyone with strong feelings on this issue, and especially those with experience of how the conscience clause works in practice, to provide input which may help to shape future law and regulations.

It’s an opportunity well worth taking – especially for doctors and nurses.

Please visit the Inquiry website www.conscienceinquiry.uk where you will find more information. 

Three new worrying conscience cases – Christians must be prepared to pay the price for obeying God in the face of legal threats

There were three interesting stories this week involving people getting into trouble for exercising freedom of conscience.

The striking thing was that each of these occurred in supposedly democratic countries which pride themselves in upholding human rights – Canada, France and the United States.

In the first the Canadian Medical Association (CMA) voted to reject a motion to protect the conscience rights of physicians who refuse to refer patients to die by euthanasia. This requirement is not yet law but the lack of support for conscience rights from the doctors’ own representative body does not bode well.

The second case involved a French Muslim registrar who was sent to court for refusing to perform a same-sex marriage. The Marseille penal tribunal will render its judgment on 29 September. The maximum penalty for a registrar who illegally refuses to give access to a legal right is a 75,000-euro fine and 5 years' imprisonment.

In the third case a Kentucky county clerk has already been jailed for refusing to give marriage licenses to same-sex couples.

I tweeted about all three of these cases yesterday. The two tweets involving same sex marriage generated the most response and three people came back to me suggesting that custodial sentences were justified for conscientious objectors.

I’ve pasted their tweets below. Interestingly all three were doctors. I found their open hostility quite revealing – a sign of things to come perhaps. I also wondered how they themselves might react if forced to do something they considered morally wrong.

The Bibles teaches that God institutes human authorities and expects us to obey them:

‘Let everyone be subject to the governing authorities, for there is no authority except that which God has established. The authorities that exist have been established by God.  Consequently, whoever rebels against the authority is rebelling against what God has instituted, and those who do so will bring judgment on themselves.’ (Romans 13:1,2)

But Scripture is equally clear that if laws which discriminate against Christians are passed, and obeying such laws involves disobeying God, then there is a place for civil disobedience. In fact when we are forced to do something wrong it is a Christian duty.

When the King of Egypt ordered the Hebrew midwives to kill all male Hebrew children they refused to do so and God commended and rewarded them. (Exodus 1:15-22)

Rahab the harlot similarly refused to co-operate with the king of Jericho in handing over the innocent Israelite spies and was later praised for her faith.( Joshua 2:1-14)

Even death threats did not stop Shadrach, Meshach and Abednego refusing to bow down to the image of the king or Daniel persisting with public prayer.( Daniel 4:6-8, 6:1-10)

When Peter and John were commanded by the Jewish authorities not to preach the Gospel they replied, 'We must obey God rather than men' and continued to do it.(Acts 5:29)

So whilst recognising that we have an obligation to obey the governing authorities God has instituted, nonetheless our obedience to God himself takes precedence if the law of the land requires us to disobey him.

Of course we should do our best to oppose the passing of laws which seek to criminalise normal Christian behaviour. And if their passing looks inevitable we should seek for reasonable accommodation to be made. The Abortion Act and Human Fertilisation and Embryology Act, for example, both contain conscience clauses protecting those with a moral objection to the activities they legalise from being forced to be involved.

But we may not be successful, so in such circumstances we also need to be willing to count the cost and to pay the price for being faithful to God in the face of threats.

The long list of heroes of faith in Hebrews 11 contains those who were delivered from the legal consequences of civil disobedience but also those who paid the price.

And paying the price through facing discipline, dismissal, a fine, imprisonment or even execution may be what God requires us to do in similar circumstances.

In all this we have the confidence that we follow in the footsteps of a Saviour, who in facing everything the greatest Empire on earth could throw at him, willingly carried the cross and emerged ultimately victorious.

'Blessed are those who are persecuted because of righteousness, for theirs is the kingdom of heaven. Blessed are you when people insult you, persecute you and falsely say all kinds of evil against you because of me. Rejoice and be glad, because great is your reward in heaven, for in the same way they persecuted the prophets who were before you.'(Matthew 5:10-12)

Freedom of conscience in medicine is under sustained attack but is worth fighting for

I have previously highlighted the case of two Glasgow midwives who were disciplined by their NHS Trust for refusing to participate in abortion.

Their Trust was found to be in the wrong by the Scottish Court of Appeal and the case has been referred to the UK Supreme Court where a further hearing is still awaited.

A single act of physician refusal to abort a patient can evoke headlines around the world, especially in nations targeted by the pro-abortion industry.   

Conscientious objection on the part of Hippocratic physicians is a major obstacle now under concerted attack worldwide.

The Center for Reproductive Rights (CRR) has recently submitted its wish list to the UN to be incorporated in the Sustainable Development Goals  (SDG’s)  now under negotiation.

Especially interesting is the direct targeting of rights of conscience.  The CRR document encourages nations to track  ‘Rates of implementation of judicial or administrative decisions concerning violations of reproductive rights, including through the unregulated use of conscientious objection…’

Because many  physicians have stubbornly refused to kill their unborn patients,  the UNFPA (United Nations Fund for Population Affairs) has decided to recruit midwives to fill the void of abortion providers. 

The report states:  ‘The definition of “midwifery” used in this report is: the health services and health workforce needed to support and care for women and newborns, including sexual and reproductive health and especially pregnancy, labour and postnatal care. This includes a full package of sexual and reproductive health services, including preventing mother-to- child transmission of HIV, preventing and treating sexually transmitted infections and HIV, preventing pregnancy, dealing with the consequences of unsafe abortion and providing safe abortion in circumstances where it is not against the law.’ (emphasis mine)

In biblical thinking, the conscience is one of the most fundamental aspects of what it means to be a human being. The conscience is part of our created humanity and it is present in all, not just those who are believers. The conscience is seen as, in some sense, an internal reflection of God's law for all mankind. The Apostle Paul, writing of the Gentiles who did not receive the Mosaic law, states that 'what the law requires is written on their hearts' 

Freedom of conscience is not a minor or peripheral issue. It goes to the heart of medical practice as a moral activity. Current UK law and professional guidelines respect the right of doctors to refuse to engage in certain procedures to which they have a conscientious objection.

The right of conscience helps to preserve the moral integrity of the individual clinician, preserves the distinctive characteristics and reputation of medicine as a profession, acts as a safeguard against coercive state power, and provides protection from discrimination for those with minority ethical beliefs.

It is worth fighting for.

Sources – AAPLOG and CMF Files 

Is the RCOG breaking the law by preventing pro-life doctors from receiving its degrees?

Last week I highlighted the fact that a faculty of the Royal College of Obstetricians and Gynaecologists (RCOG) is barring doctors with pro-life views from receiving its degrees and diplomas. The story has been picked up by the Telegraph today. 

Doctors and nurses who have a moral objection to prescribing those ‘contraceptives’ which can act by killing human embryos are to be barred from receiving diplomas in sexual and reproductive health even if they undertake the necessary training according to updated FSRH guidelines .

The Faculty of Sexual and Reproductive Health (FSRH) is also barring such doctors from membership of the faculty and from specialty training.

Or to put it bluntly – if you refuse to fit coils or prescribe the morning after pill (MAP) then you can’t train to treat infertility, cervical cancer or HIV either. This effectively means that many thousands of doctors will not be able to pursue a career in gynaecology and sexual health. 

And yet the use of emergency contraception and IUCDs like the coil makes up only a tiny part of the specialty of sexual and reproductive health (SRH) which also encompasses the following long list of conditions, treatments and procedures: screening for cancer of the cervix, ovary, breast, bowel, prostate and testes; all methods of contraception which act before fertilisation; reproductive endocrinology; SRH epidemiology; miscarriage and ectopic pregnancy; forensic gynaecology (management of sexual assault); genitourinary medicine (sexually transmitted infections, HIV, AIDs);  infertility/subfertility (male and female);  medical gynaecology (menorrhagia, dysmenorrhoea, dyspareunia, endometriosis, PCOS, amenorrhoea, pelvic pain, PMS ,continence, menopause); management of menopause; postnatal depression; prenatal diagnosis and psychosexual issues.

So the effect of this RCOG ban will be to drive those with a moral objection to interventions which kill early human embryos (including Christians, Muslims and others) not just out of family planning but out of all these other areas of medical care as well.

This is an extraordinary case of taking a sledge-hammer to a walnut more worthy of gulag or gestapo than what David Cameron has called a ‘Christian country’. Surely reasonable accommodation could be made for pro-life doctors? Can the RCOG really argue that there is no creative alternative to these draconian measures?

After all, allowance is already made by the RCOG for doctors who have a moral objection to abortion to train in sexual and reproductive health because the Abortion Act 1967 has a conscience clause. 

But the RCOG, it appears, is exploiting the fact that no similar legal provision exists for fitting coils or prescribing the MAP, by punishing doctors who want to abide by the Declaration of Geneva (which enjoins the utmost respect for human life from the time of conception).

This action by the RCOG is not just profoundly discriminatory but may also be illegal. Under equality legislation, it is unlawful to discriminate against people who have ‘protected characteristics’ - treating someone less favourably because of certain attributes of who they are. This is known as ‘direct discrimination’.

Examples of direct discrimination include dismissing someone because of a protected characteristic, deciding not to employ them, refusing them training, denying them a promotion, or giving them adverse terms and conditions all because of a protected characteristic.

These protected characteristics include religion or belief. It’s also possible to be discriminated against for not holding a particular (or any) religion or belief. Imagine the outcry if the College were to bar from training doctors who wished to prescribe the morning after pill.  But the belief that killing embryos is OK, is a belief, just like the belief that it is not OK.

So it appears, at least on the surface, that the RCOG might well be guilty of direct discrimination. The RCOG is claiming in the Telegraph today that these guidelines are not new as if that somehow justifies their position. But the key issue is that the guidelines are not just and fair and now that the news is out I'm sure that many will be concerned. 

I expect that some serious questions will be asked in parliament and elsewhere about this matter in the coming days and I would not be surprised if some government ministers got very angry as a result, or if a doctor, or a group of doctors and nurses, contemplated bringing a legal case against the College. 

RCOG faculty bars prolife doctors from receiving its degrees and diplomas

Doctors and nurses who have a moral objection to prescribing ‘contraceptives’ which act by killing human embryos are to be barred from receiving diplomas in sexual and reproductive health even if they undertake the necessary training according to new guidelines.

Under new rules issued by the Faculty of Sexual and Reproductive Health (FSRH) earlier this year these doctors and nurses are also to be barred from membership of the faculty and from specialty training.

The FSRH is a faculty of the Royal College of Obstetricians and Gynaecologists established on the 26th March 1993 as the Faculty of Family Planning and Reproductive Health Care. In 2007 it changed its name to the Faculty of Sexual and Reproductive Healthcare.

Whilst many contraceptives act by preventing the union of sperm and egg, some, including most IUCDs (intrauterine contraceptive devices) and the morning-after pill EllaOne (ulipristal acetate), also act by preventing the implantation of an early embryo. In other words they are embryocidal or abortifacient, rather than truly contra-ceptive.

Many doctors, of all faiths and none, have a moral objection to destroying human life and wish therefore to avoid using drugs or methods which act after fertilisation.

In fact this position was once held by the British Medical Association (BMA) when it adopted the Declaration of Geneva in 1948. This states, ‘I will maintain the utmost respect for human life from the time of conception even against threat’.

But in 1983 the words ‘from the time of conception’ were amended to ‘from its beginning’ due to sensitivities about increasing medical involvement in abortion. The word 'beginning' was left undefined, giving doctors the opportunity to argue, contrary to the biological reality, that early human life was not actually human life at all. 

Now it seems that doctors who wish to abide by the original wording of the Declaration of Geneva are to be barred from practising in certain medical specialties. This is an extraordinary about face. 

The Faculty may argue that they are not barring doctors and nurses from practising, but simply from obtaining certain qualifications. But as many job appointments will be conditional on applicants having these qualifications this is effectively also a bar on practice.

Interestingly doctors who have a moral objection to abortion are still able to complete the Faculty’s qualifications because the Abortion Act 1967 contains a conscience clause which protects them. But there is no law protecting those who object to destroying human embryos. 

Many Christians believe that every human life, regardless of age, sex, race, degree of disability or any other biological characteristic, is worthy of the utmost respect, wonder, empathy and protection.

This is based on the idea, taught in the Bible, that human beings are made in the image of God. In a society which is becoming more hostile to Christian faith and values it is perhaps not surprising that we are seeing institutional discrimination of this kind.

Perhaps it is time for Christian doctors and nurses, and others who share their prolife views, to set up an alternative training programme.

Resolution promoting abortion, undermining conscience and perverting sex education gets short shrift at European Parliament

The European Union voted last week to deny acceptance of a draft report which would have established abortion as a human right, and simultaneously squelched conscientious objection as well as established a perversion of sexual education for children.  

In a resounding victory for common sense, following a short but lively debate in the European Parliament, a majority of MEPs voted to refer the highly controversial resolution on the Estrela report back to the Committee on Women's Rights and Gender Equality.

The resolution on Sexual and Reproductive Health and Rights was presented by Portuguese MEP Edite Estrela (pictured) but her report is said to be the work of the International Planned Parenthood Federation in Brussels.

The fact that it has been referred back to committee implies, that a revised report cannot not be presented until early next year, thus, limiting the time available to the Parliament to deal with it, prior to the next European elections. In other words, this rejection may well be a fatal blow stopping the report’s progress.

The Estrela report  bemoaned the fact that many physicians even in Europe, refuse to participate in abortions:

‘There are cases reported from Slovakia, Hungary, Romania, Poland, Ireland and Italy where nearly 70 per cent of all gynaecologists and 40 per cent of all anaesthesiologists conscientiously object to providing abortion services… These barriers clearly contradict human rights standards and international medical standards.’

It also recommended that member states:

‘regulate and monitor the use of conscientious objection so as to ensure that reproductive health care is guaranteed as an individual’s right, while access to lawful services is ensured and appropriate and affordable referrals systems are in place’.

In addition to the war on rights of conscience, the defeated measure sought to establish abortion as a human right:  ‘[as a human rights concern, abortion should be made legal, safe and accessible to all’.

And finally, the report recommended that member-states ensure compulsory sex education consistent with the recommendations of the report by the WHO in 2010.  More information about the content of the sexuality standards is available here. I quote:   

‘(The European Parliament) calls on Member States to ensure compulsory, age-appropriate and gender-sensitive sexuality and relationship education, provided in a mixed-sex setting, for all children and adolescents (both in and out of school).’

The standards for sex education referred to include these:

‘ Children aged 0-4 should be informed about: “enjoyment and pleasure when touching one’s own body”, “early childhood masturbation”, “different family relationships”, “the right to explore gender identities”, “the right to explore nakedness and the body, to be curious”, etc. and they should develop “curiosity regarding own and others‘ bodies” and “a positive attitude towards different lifestyles”.’

‘Children aged 4-6 should be informed about “enjoyment and pleasure when touching one’s own body”, “early childhood masturbation”, “same-sex relationships”, “sexual feelings (closeness, enjoyment, excitement) as a part of all human feelings ”,“different kinds of (family) relationship”, “different concepts of a family”, and should develop “respect” for those different lifestyles and concepts.’

‘Children aged 6-9 should go on learning about “enjoyment and pleasure when touching one’s own body (masturbation/self-stimulation)”, but they also should be informed about “different methods of conception” and “the basic idea of contraception (it is possible to plan and decide about your family)”.’

‘Children aged 9-12 should be informed about “first sexual experience”, “orgasm”, “masturbation”, and should learn to “make a conscious decision to have sexual experiences or not” and “use condoms and contraceptives effectively”.’

The standards differentiate between ‘minimum’ and ‘optional’ achievements, but masturbation at age 0-4 is mandatory. In short, this is a programme for sexual initiation beginning at toddler age, and one seriously has to ask oneself whether this kind of sexual education is not in fact a form of systematic and structured child abuse, albeit under a pretext of ‘education’ or ‘skill development’.

There is a conspicuous absence of any genuinely moral attitudes towards sexuality that should be transmitted to the child: no reference to chastity, no reference to conjugal fidelity, only a vague sense that ‘everything is ok if it feels good, is consensual, and doesn’t entail an unwanted pregnancy’.

That attitude, however, appears to be compulsory in the sense that it would appear to be in violation of these ‘Standards’ if parents attempted to transmit to their children any genuine (and in particular Christian) moral values related to sexuality.

We can be hugely thankful to those who were alert to this measure and lobbied so effectively to defeat it. It was a rare victory but a reminder that the price of freedom is eternal vigilance. For now, at least, children both born and unborn, have been protected from a great deal of harm.

I’m grateful to both AAPLOG and Patrick Buckley for this report