Sarah Harte: Conscientious objectors are entitled to their beliefs, not their own laws

Medical professionals must adhere to ethical guidelines on abortion services — regardless of their beliefs
Sarah Harte: Conscientious objectors are entitled to their beliefs, not their own laws

Enoch Burke asserts that he has been sacked for his conscientious objection on religious grounds to referring to a trans student as ‘they’ but he was imprisoned for refusing to adhere to a court order. Picture: Colin Keegan, Collins Dublin

LATELY, the right to conscientiously object has been in the news. Unless you’ve been living under a rock you will know that last Friday evangelical Christian Enoch Burke was sacked from his teaching post at Wilson’s Hospital.

On Tuesday, he attended the Westmeath school despite being dismissed and left in the back of an unmarked Garda car. He later returned to the school where a row ensued with the principal.

Mr Burke asserts that he has been sacked for his conscientious objection on religious grounds to referring to a trans student as ‘they’.

However, before his sacking, Mr Burke was imprisoned for failing to adhere to a court order obtained by his employer requiring him to accept the terms of his suspension in advance of a disciplinary case.

So far at least, the court seems to be of the view that while Mr Burke is entitled to his own beliefs, he is not entitled to his own laws.

This distinction is interesting in the medical context. A fortnight ago, it was reported that the review committee into how our abortion laws are working awaits ‘key’ research by Trinity College on the topic of conscientious objection before it releases its findings.

In medical ethics, conscientious objection is where a doctor doesn’t want to provide or participate in a legal, and clinically appropriate treatment because it conflicts with their personal values.

This is an important right and conscientious objectors are often to be admired for their bravery in going against the zeitgeist.

However, when a patient seeks an abortion, and a doctor denies it on conscientious grounds, the patient’s wishes are overridden.

This spotlights where the limits of a doctor’s duty of care to a patient end. The devil may be said to be in the detail.

Hammering out the specifics of abortion legislation involves horse-trading and compromise with political, moral, and legal angles to be considered. Here we have the tectonic plates of a woman’s right to an abortion and a doctor’s right to conscientiously object colliding.

Section 22 of The Health (Regulation of Termination of Pregnancy) Act 2018 currently allows medical practitioners to refuse to provide abortion care on grounds of conscience, except in emergency circumstances such as immediate risk to life or serious harm to health, where they are obligated to provide care.

A doctor may also refuse a woman an abortion where her life isn’t threatened but is required to transfer the care of this woman to another doctor who will provide the abortion “as soon as may be” which seems woolly and open to abuse.

The Irish Medical Council’s Guide to Professional Conduct and Ethics agrees that a doctor may refuse to carry out a procedure that conflicts with “sincerely held ethical or moral values” but states that patients should be informed they have a right to seek treatment elsewhere and obliges doctors to facilitate the transfer of the patient to an alternative provider “in a safe, effective and timely manner” making it “as easy as possible for the patient”.

Last year, an abortion working group convened by the National Women's Council reported that almost one in five survey respondents refused an abortion were also denied a referral to another doctor. Picture: PA
Last year, an abortion working group convened by the National Women's Council reported that almost one in five survey respondents refused an abortion were also denied a referral to another doctor. Picture: PA

Last March, an Abortion Working Group convened by the National Women’s Council made a submission to the Government as part of this review process along with thousands of submissions from a range of stakeholders including lawyers, GPs, hospital consultants, managers, and midwives.

The working group reported that almost one in five survey respondents refused an abortion were also denied a referral to another doctor.

Presumably, the key research to the review committee will give hard data on this claim but it does seem to suggest that some medics may feel that they are subject to their own laws.

This raises the pertinent question of how doctors who breach the Health Act and their professional code of ethics are to be sanctioned and by whom.

Let’s take the hypothetical case of a young woman in a rural area who is refused a termination and a referral to another doctor. Assuming she gets over the stigma of being turned away, would she necessarily have the financial resources, time, and know-how to find another doctor to provide a termination? Should she be forced to?

To avoid a scenario like this a register of refusenik doctors might clarify for those seeking terminations whom to approach. A clear, well-publicised complaints procedure might also rein in ‘extra-legal’ crises of conscience.

A desperate woman could resort to a home abortion, but it is widely agreed that having an abortion without the support or oversight of those with medical expertise leads to a greater risk to health.

Almost 700 abortion pills have been seized by Irish authorities over the past three and a half years, despite the legalisation of the termination of pregnancy during that time although those figures have been lowering yearly.

The consequences of illegal abortions being played out in the US include spine-chilling stories emerging from places such as Texas, which make for upsetting reading.

Another consideration is if a significantly high enough number of potential providers of abortion in hospital and community settings refuse to do so on legitimate moral grounds then de facto access to abortion is being denied to Irish women.

Only half of HSE hospitals offering abortion services

Only roughly half of HSE hospitals are offering terminations of pregnancy despite the fact there is an obligation on publicly funded hospitals to do so. Health Minister Stephen Donnelly has admitted that a wider provision of abortion is needed, which seems like an understatement.

Abortion in Italy is legal and free of charge but around 75% of gynaecologists are registered as conscientious objectors. According to microdata analysis conducted over 14 years, this objection has significantly hampered abortion access, particularly for women suffering economic disadvantage.

There is also the potential for a “chilling effect” on doctors who might otherwise have carried out procedures.

One thinks of young doctors setting out on a career and hoping for promotion unwilling to step forward in front of senior staff who morally disapprove.

It has been reported in the US that young doctors are avoiding obstetrics and gynaecology altogether to avoid having to make tough decisions.

It seems clear that while the exercise of a doctor’s right to conscientiously object must be respected, it should also be carefully monitored, particularly where timely referrals to another doctor are concerned.

The Irish Medical Council must ensure medical professionals adhere to ethical guidelines and are sanctioned when they fail to do so. This will deter doctors who might for “moral reasons” decide to play fast and loose with their prescribed code of ethics and the law.

Medical ethics are complicated, and sometimes fraught with tough decisions. Many fine principled doctors will legitimately object to performing or participating in procedures that they consider involve the taking of innocent unborn lives.

But we have had a democratic referendum, and nobody is above the law.

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