6 March 2012

Abortion: A conscience about conscience?

Last week, some of you may have read reports in the press about two senior midwives working in Glasgow's Southern General Hospital, who lost their case in the Court of Session. Committed Catholics, Mary Teresa Doogan and Concepta Wood shared the job of labour ward co-coordinator at the hospital.  Medical terminations took place in the ward under the Abortion Act 1967, but after the closure of the Queen Mother's hospital, and some rejigging between institutions, the number of abortions taking place in Doogan and Wood's ward increased. This caused them concern - so much concern in fact that having exhausted internal grievance procedures at Greater Glasgow and Clyde Health Board, they took their case before Lady Smith in Edinburgh.  As you might expect given the controversy of the topic, the Abortion Act 1967 includes a "conscientious objection" clause, which reads:

4 Conscientious objection to participation in treatment.
(1) Subject to subsection (2) of this section, 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 ...
(2) Nothing in subsection (1) of this section shall affect any duty to participate in treatment which is necessary to save the life or to prevent grave permanent injury to the physical or mental health of a pregnant woman.

Doogan and Wood did not participate in abortion procedures themselves, but objected that their supervisory role as ward coordinators meant that there were basically facilitating abortions, if not administering drugs which brought them about. As such, they argued that they should be entitled conscientiously to object to all aspects of their job which in some sense related to or facilitated medical terminations. For those interested in a more detailed legal reading, I've a guest post up on the UK Human Rights blog, summarising the case.  In brief, however, Lady Smith dismissed their petition for judicial review, rejecting what she called a "horse shoe nail" approach to causation, holding that the right of conscientious objection only extended to more or less direct "participation in treatment" - to abortion procedures themselves - and not to the sort of work Doogan and Wood object to, that of its background facilitation, in organisational and management roles. 

But what to make of it on a wider, ethical level? The philosopher Hugh McLachlan composed a short thought or two for the Scotsman after the case was decided last week, essentially arguing that:

"... when we adopt particular roles and accept particular jobs, we waive particular moral and legal rights and acquire duties. If we voluntarily accept the benefits of a situation, we ought to accept the attendant burdens. It might well be unreasonable to compel a midwife to be directly involved in an abortion." 

By contrast, Scottish Catholic blogger Cum Lazaro detects a significant absence from much of our public discourse on this sort of topic:

"What is lacking, both in MacLachlan's analysis and in the sort of combox debates I've regularly found myself involved in on similar cases is any sense of why conscientious objection is a good thing. In the absence of such reflection, the argument appears very simple. On the one hand, you have the general duties of a job and the inconvenience caused to others by conscientious objection. On the other hand, you have the hurt feelings of a couple of deluded believers in Sky Fairies. Not much of a contest.

Now putting aside, from the Catholic perspective, that you are asking two women to partake in murder, why should society, even when it disagrees with a particular moral position, and despite all the arguments against it,  facilitate conscientious objection? The general answer is given in John Stuart Mill's On Liberty: that society has an interest in the encouragement of individuality and conscientious reflection among its members."
For myself, I can't quite decide what to make of it all. Clearly, the idea of a ward coordinator and supervisor refusing to coordinate or supervise an aspect of their ward's activity is bound to generate frustration and inconvenience. Yet convenience isn't king, a fact recognised by the pervasive notion of making "reasonable adjustments" to accommodate the convictions or disabilities of your employees (embraced more and less enthusiastically by employers). As Cum Lazaro emphasises, universalising the question - what if every labour ward coordinator refused to supervise abortion processes in any way? - doesn't strike me as an immediately helpful way of posing the problem either, obfuscating rather than illuminating the real predicament before us, of religious minorities working in a medical field of both life and death, with strongly-held convictions about the immorality of abortion. 

What do you think?


  1. It's got nothing to do with "conscience". The women in question did the job previously, so it's not the principle they're objecting to, but the volume.

    If you don't agree with aspects of a job, don't apply for that job. It's not like the job was advertised as flower-arranging and then they sprung abortions on them after a week.

    It's more like a chef getting a job in a steakhouse and then announcing he's only prepared to cook vegan food. To which the only reasonable response is "Get the hell out of the way and let someone who's prepared to accept ALL their responsibilities do it."

    Approximately 99.999% of all jobs don't involve facilitating abortions in any way whatsoever. Get one of those, ladies.

  2. I can't see they had a case. They did not have any clinical contact with the patients themselves. I think it is perfectly reasonable to say that people should be able to opt out of any clinical contact with patients having an abortion if they have a conscientious objection. But not to say that they should also be able to opt out of any contact with those who are dealing with those patients.

  3. The manager who was interviewed about the case on the television said that Lady Smith's ruling was a relief, as the persons who actually were carrying out the abortions needed to know that in the case of difficulties they had support. It seems to me that is something of an admission that the supervisory midwives' involvement WAS essential to the procedure. Lady Smith may be right in law; but I can see, as a Catholic myself, that the proximity of the supervisory midwives to abortions might be much closer than a reasonable conscience could accommodate. And surely, RevStu, you don't think that midwifery should be a profession closed to Catholics?

  4. I think that any profession should be closed to people who aren't prepared to actually do it. "No Jewish applicants for this ham-tasting job please" isn't prejudice in my book, just common sense.

  5. People should not be allowed to shirk certain responsibilities just because they choose to follow a certain religion.

    This case was ridiculous. It reminds me of a recent episode of Law & Order: Special Victims Unit, where a doctor was found guilty of neglecting to offer HIV medicine to patients because he didn't believe HIV caused AIDS.

    These women have the right not to have abortions themselves, but they have no right to impose that choice on others, which in a round-about way is effectively what they are doing here.

    This is just another example of why I dislike religion and would like to see its grip on the human race disappear.

  6. I think they have a perfect right not to have any involvement in abortions if they see that as murder and legally they have that right. But I think the Health Board has fulfilled its obligations in that regard. I actually read the whole judgement to verify that they were not required to have any clinical contact with patients who were in for that procedure and they were not.

    As far as I can tell they were arguing that because they have a supervisory role - and that involved supervising staff who do have clinical contact with women who are in for abortions - that meant the Health Board was making them have an involvement with abortion.

    But they applied for those jobs knowing full well that the ward they would be working on would have patients who were in for a termination.

    Maybe they disagree with having those patients admitted to the labour ward but if they wanted to make the Health Board reconsider that they went about it the wrong way because all a court would consider is whether the Health Board was obeying the law, not whether women who are in for an abortion should be admitted to the same ward as women who are there to give birth.

  7. RevStu - but your ham-tasting analogy isn't quite fair. Most people would accede to the proposition that the profession of midwifery is rather more about delivering healthy babies than assisting at abortions. In fact, the perversion of the sworn aims of the medical profession involved in abortion is one of its depressing aspects. "First, do no harm..."

  8. "Most people would accede to the proposition that the profession of midwifery is rather more about delivering healthy babies than assisting at abortions."

    More, sure. But not all. Either do all of the job or make way for someone who will.

  9. I am against abortion for convenience sake - but in favour when there are medical or pyschological (eg rape) reasons for it. However, I don't see how my opinion should count, since I am not the person who would undergo the procedure.

    However, I cannot possibly support these women here. They knew exactly what their job may involved, and to be blunt, if they don't want to do the job then resign and get someone else in.

  10. In terms of how you feel about a job your feelings about what the company does can matter, and can be affected by the degree to which the organisation is involved in something. I worked for many years for a semiconductor company and knew that one of their departments made devices for military use. I felt a bit uncomfortable about it, but it was a very small operation and I was never required to spend any time there - I could put it out of my mind. More recently I applied for a job with what I thought was an IT services company. To my horror a little internet research revealed that they were hugely involved in the US defence industry, most particularly the downright sinister 'Homeland Security'. I declined the interview. If I had taken that job before discovering the company's main line of business, would I have resigned? Back then, as a single parent, it would have been a pretty tough call. I know it's dishonest, but I can somewhat sympathise with these women (without supporting their 'moral' position) who found something which they found distasteful becoming impossible to ignore.

  11. Groundskeeper Willie9 March 2012 at 09:55

    Barbarian of the North said...
    'I am against abortion for convenience sake - but in favour when there are medical or pyschological (eg rape) reasons for it.'

    The logic of that escapes me.

    It's either human life or it's not, there's no half way house. If it's not human life then abort, abort,abort. If it is, don't.

    If you don't know whether it's human life or not then either err on the side of caution and don't abort, or if that's not expedient at least be honest, say you don't know whether it's human life but you're prepared to take a chance and are going to abort anyway.

  12. Wullie,

    There are times when abortion in a medical necessity. What I object to are people who decide to get one simply because of an unwanted pregnancy.

    Go and speak to a rape victim - I know one - , and see how they would feel about being denied an abortion because some person decides to use religion as an excuse.

    What if it is a 13 year old girl, who has been abused by her father?

    When I talk about abortion in these cases, I mean at a very early stage. But there are also medical reasons for a late abortion.

    You cannot place a blanket ban on something by generalising, and especially when someone brings religion into the argument.

  13. The thing that people also need to bear in mind is that the law around abortion defines what medical assistance can be provided to women to end a pregnancy.

    If opponents of current abortion laws had their way it would not end abortion. It would just end qualified medical assistance.

    But you cannot actually stop women aborting unwanted pregnancies, unless you are going to lock them up and keep them under a 24 hour watch. And I think everybody would recognise that is not possible.

  14. I support the right of doctors and nurses to refuse to participate in the clinical procedures of abortion - though I'd hope that a medical professional with an issue about abortion would be conscientious enough to recuse themselves from pregnant women's healthcare, since abortion is a clinical necessity. Countries which make abortion illegal or inaccessible are invariably* also countries with a far higher maternal mortality/morbidity rate.

    But I don't support the right of administrators and other support staff who want to make things more difficult for staff who do perform abortions. Which seems to have been the basis for these midwives "conscientious objection" - they wanted to make work more difficult for the staff who were performing abortions, an obligation which they had already excused themselves from.

    *The frequently-cited exception of course being Ireland, which exports virtually all abortions to mainland UK.