Head to head: Should be able to object to providing abortions?
By Jason Conroy | Nov 1 2018Yes, by Jason ConroyIf a person comes to an Irish doctor pregnant, distressed, and looking for an abortion, no doctor will ever say, “you’re on your own”. A doctor’s job doesn’t consist of just dispensing certain desired functions. A doctor is one human being caring for another, using the skills and expertise that they’ve spent their life acquiring for this very purpose. If a doctor truly believes that they have two patients to treat rather than one, the woman and the infant in the womb, then they’ll give the same top-class professional care to both patients, not abandon them both. Doctors become personally invested in their patients - they’re on the patient’s side, fighting for them to get their health, their full life, back. In such a relationship, it’s always personal. There are few nobler and more privileged vocations. The example of New Zealand, shows in practice that conscientious objection never means pregnant patients are on their own. There, doctors are not required to provide treatment which they think will be harmful, and all doctors still support and care for their pregnant patients for the duration of the pregnancy, conscientious objection or no. No one’s health or life is put at risk. Medical professionals may opt-in to the performance and facilitation of abortions. Doctors who wish to treat their patient in the womb as well as the pregnant patient remain outside the country’s abortion regime, and they aren’t obliged to refer for abortions either. This is the freedom of conscience that we need in Ireland.The right to conscientious objection isn’t just a rhetorical point, used by religious bigots to justify discrimination, it’s the foundation of our pluralistic, liberal society. For most of history, people have reacted to differences of belief with violence and coercion, accounting for most of the wars not only in Ireland, but in the whole world. In recent times, however, we’ve found a way of living in peace with those we fundamentally disagree with. The United Nations Universal Declaration of Human Rights reads “Everyone has the right to freedom of thought, conscience and religion; this right includes freedom to change his religion or belief, and freedom, either alone or in community with others and in public or private, to manifest his religion or belief in teaching, practice, worship and observance.”In the words of UCD’s founder John Henry Newman: “In the depths of his conscience, man detects a law which he does not impose upon himself but which holds him to obedience. Always summoning him to love well and avoid evil, the voice of conscience, when necessary, speaks to his heart: do this, shun that … Conscience is the most secret core and sanctuary of a man.”Conscience is a person’s sense of right and wrong, and everyone has one. To force someone to perform an act that they sincerely believe to be wrong and harmful is an immense violation of their dignity and humanity. To be protected from this form of tyranny is a right that everyone has. Doctors cannot be obliged to facilitate an act which they believe harms their patient and takes the life of a child.Let’s have a society that allows everyone to serve, regardless of our different beliefs and worldviews. Let’s not push world-class healthcare professionals out of Irish healthcare, their patients are the ones who will lose out.Rebuttal, By Sophie CarberryThe fundamental issue with these arguments is that they are subject to the personal beliefs of the doctor, whilst disregarding the consequences for the pregnant person entirely. The argument that there are two patients presenting to a doctor hinges on a subjective belief that has no standing in the medical field, particularly when there is a real and imminent threat to the life of the pregnant person.Someone who is devoted to the Islamic faith may not believe in the practice of selling alcohol, and should therefore avoid working in a bar. These situations are incomparable with regards the seriousness of the nature of the matter, but the principle remains. In a country where abortion is a procedure that pregnant people are entitled to, they are being denied care that could ultimately save their life as a result of the personal convictions of the doctor being employed in a professional capacity.The argument about the practice of conscientious objection in New Zealand is far from compelling. What exactly is to be derived from the fact that a doctor will deny a patient care while also refusing to refer? It is the job of the doctor to provide care regardless of the decision of the patient. It is also bold to argue that ‘no one’s health […] is put at risk.’ There is no evidence to suggest that on a case by case basis. To completely deny referral for treatment is to undermine the autonomy and dignity of the patient, as well as being a violation of informed consent. It perpetuates an ongoing hurt by putting patients in a position whereby they feel their judgement is being disregarded in lieu of a subjective belief that is being projected onto them. The argument pertaining to the UN should be read in accordance with the OHCHR Information Series on Sexual and Reproductive Health and Rights, wherein it affirms that a state where the practise of conscientious objection is permitted should immediately be proceeded by referral. Although this is not quite the case in New Zealand, the doctor is obliged to explain to the patient that they cannot provide this care but that the patient has a right to seek another doctor.Tolerance and acceptance of disagreement is absolutely conducive to a harmonious society, but when it begins to influence medical practice in a way that has been proven to do more harm than good, it should be re-examined. It is not sufficient to simply agree to disagree in a situation where someone is presenting to a medical professional in seek of the care to which they are entitled. No, By Sophie CarberryAbortion being regarded as a moral, rather than medical, issue has facilitated a debate that will ultimately do more harm than good. The notion that conscientious objection is a physician’s ‘right’ is to the detriment of the patient to whom they have a duty of care. While there is something to be said about individual moral standing on a personal basis, a medical environment should not accommodate for each and every one of these beliefs as it would entrench upon the operations of the health service by putting patients in a vulnerable and undignified position. The laws surrounding conscientious objection in countries where it is an option are often unclear, unenforced, and result in a great deal of unnecessary harm. The choice to enter into this profession is one that must inhabit the medical ethical principle of ‘do no harm.’ To disregard the very foundations of medical practice in favour of a subjective belief endangers patients, restricting their access to safe abortion services. When a patient presents to a GP’s office looking to procure abortion services for a myriad of reasons, it is expected that they will be treated as any other patient, with dignity and effective care. For a practitioner to deny them this on personal moral grounds is directly in conflict with their duty of care. This also makes the process longer and arduous. Conscientious objection will endanger the health of any patient seeking the service on the grounds of a pre-existing condition, as these cases are time sensitive. Additionally, even if the damage is not physically visible, it is also psychologically detrimental, undermining the patient’s autonomy and dignity. The World Health Organisation condemns the practice of conscientious objection as being a “barrier to safe abortion” in all circumstances. Returning to the argument that the medical professional may conscientiously object to providing abortion services on the grounds of morality – why should it be the case that this field allows for this kind of exemption? Additionally, how can we be sure that, given the choice to conscientiously object, there would be absolute accordance with the law? In countries where doctors may choose not to perform abortion services, such as Italy, there is a startling amount of abuse of this power due to ambiguous and unenforced laws. That is to say, doctors not referring patients for abortion services elsewhere, and instead using their position to coerce patients into progressing with a pregnancy. This is due, in part, to the non-verifiable nature of conscientiousness, and the staggering numbers of refusals that make it difficult to control. Why, then, should we assume Ireland would be any different?Many of the commonly cited reasons for conscientious objection fall outside of the presumed religious beliefs. Of course, there are doctors who do not morally agree with the practice. However, research suggests that ostracism from peers and general stigma around the topic is something that motivates much conscientious objection in the field. How, in these circumstances, can we argue in favour of it? Prioritising one’s pride and reputation over the wellbeing and needs of the patient is in direct conflict with the ethics of the profession, wilfully allowing harm to be done. As long as it is supported, the stigma remains tenacious.To allow practitioners to practice medicine on the grounds of their own personal beliefs would be doing more harm than good. It imposes further restriction to abortion services, and the process becomes more difficult than is necessary for the patient. The potential physical and psychological consequences of delaying or obstructing care undermines the profession as a whole.Rebuttal, by Jason ConroyIt’s ironic that the “Do No Harm” principle would be cited as a reason to deny conscientious objection when this very principle is precisely the reason why medical professionals object to participating in abortions. The argument made against conscientious objection succeeds only by ignoring the reality that there are two patients involved, the mother and her child, when in fact this is the heart of the issue. This is not “personal moral grounds”, this is a real ethical issue, a matter life and death.Doctors object to abortion because it violates the principle of “Do No Harm.” A poll by GPBuddy.ie shows roughly 70% of Irish GPs will not provide abortion pills. The sentiments of most GPs were voiced by Dr Brendan Crowley last week when he said “I became a doctor to save lives, not to take them.”There is an important distinction to be made between medical treatments for a woman which indirectly endanger the life of her child, and procedures whose sole purpose is to directly end the life of the child in the womb. The former has been accepted medical practice in Ireland for several years. The latter is abortion.When a pregnant woman is given necessary medical treatment which indirectly endangers her child, the goal of the treatment is to help the woman, not to harm the child. There is no ethical problem with this - it’s just a sad and tragic reality that these medical situations happen. In these situations, doctors do their best to save the child as well. This can involve delivering the child prematurely. As medical technology continues to advance, more and more premature babies are living to see their first birthday. In 2014, a baby girl was delivered at just 21 weeks - she is now four years old, alive and kicking.Even if the child does not survive, doctors still apply palliative care to make the infant’s short life as comfortable and painless as possible, using Calpol and warm towels. The child’s life and humanity are acknowledged and respected. This is not done in abortion.To oblige doctors to refer women to an abortion provider is to oblige doctors to become party to abortion. If medical treatment is needed for the mother, medical treatment will be given - and if this indirectly endangers the child, doctors will do their best for her too. Conscientiously objecting doctors ask for nothing more than to be allowed to practice medicine, to “Do No Harm,” and to treat both patients, both human beings.