Conscientious objection obstructs women’s health … it’s not brain surgery

Blogpost by Lisa Hallgarten

It doesn't take a brain surgeon to work out that you can’t be a brain surgeon if you don’t believe in brain surgery. Nor does it take a rocket scientist or even a person of average intelligence to work out that a doctor who is not willing to prescribe the full range of contraceptive methods should not have a qualification that implies that they are able and willing to do so. The Faculty of Sexual and Reproductive Healthcare (FSRH) which provides a diploma in sexual and reproductive health, has recently updated its guidelines to confirm that doctors and nurses who have a ‘conscientious objection’ to prescribing hormonal contraception - including emergency contraception – and fitting women with IUDs and IUSs will not be able to complete the whole syllabus that is required in order to receive its diploma.

This seems uncontroversial. No woman should go to a certified doctor with a specialist qualification to discuss contraception, only to discover that her doctor will not prescribe or fit some of the available methods for reasons of personal conscience. It would be worse still for a woman seeking emergency contraception, because those who seek the right to conscientiously object do not support any method of emergency contraception. In this situation time is of the essence: if a woman wants to take Levonelle it is most effective in the first 24 hours following unprotected sex, EllaOne must be taken within five days and an IUD fitted within the same time-frame. No woman should have to scrabble about trying to find an alternative doctor who will provide her with this last ditch chance to prevent an unwanted pregnancy. Nor should any woman be preached at about why the only moral thing to do in this situation is to cross her fingers and hope for the best. You would think that even those who support a doctor’s right to conscientiously object must agree with this, but apparently not. The Christian Medical Fellowship (CMF) objects to the updated guidance because, ‘it bars pro-life doctors from specialising in sexual and reproductive health and also makes it much more difficult for non specialists to get jobs in family planning or reproductive health’.

The CMF seems to be asking for something over and above the right to conscientiously object. It seems to be asking for the right for anti-choice doctors to be certified so that they can advertise their specialism in family planning and attract women seeking contraception, with the full intention of refusing access to the full range of family planning methods.  This is not about passively opting out, this is obstruction. Likewise, the case of the two Scottish midwives who insist that they can use conscientious objection to opt out of even supervisory and management duties in relation to staff carrying out abortions.  Their appeal against an original judgement which refused them this right, on the basis that it would jeopardise abortion provision in their hospital, was funded by anti-choice organisation SPUC. This kind of extension by stealth of the right to conscientiously object is addressed in a new paper, ‘Dishonourable disobedience – Why refusal to treat in reproductive healthcare is not conscientious objection’. The authors, Canadian abortion rights advocate, Joyce Arthur, and Austrian obstetrician Christian Fiala question the moral basis for conscientious objection and challenge its interpretation and implementation by anti-choice doctors and anti-choice institutions. It is the latest salvo in a pro-choice fightback against the once uncontested concept of conscientious objection, and crucial reading for anyone who still believes that it is a benign practice which is simply about the quiet expression of personal belief.

Other useful articles on conscientious objection personal, and institutional:

• Conscientious commitment, Bernard Dickens in The Lancet
• Termination of pregnancy as emergency obstetric care: the interpretation of Catholic health policy and the consequences for pregnant women. An analysis of the death of Savita Halappanavar in Ireland and similar cases, Marge Berer for RHM Journal