The 1967 Abortion Act puts it plainly: “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”.
Forty-nine years on, a new report from the All-Party Parliamentary Pro-Life Group (APPG) claims that in today’s NHS, it is not that simple. There is “widespread and increasing pressure”, says the report, for doctors and nurses to take part in abortions.
In part, this reflects the strain on NHS resources. If you don’t refer a woman for an abortion, you must offer her a second opinion, creating more work for your colleagues. But it also indicates that there is a more militant pro-choice movement within the NHS, and less toleration for conscientious objectors.
That suggests a twofold challenge: to change NHS culture, and to establish a workable law around religious freedom. Nothing too strenuous, then.
On the first point, it should be said that there are countless pro-life doctors and nurses in the NHS. But it would be naïve to dismiss the large body of anecdotal evidence about problems faced by those who want to protect human life.
It can start early: pro-life medical students are ridiculed, according to the inquiry. One former GP told the inquiry he had left medicine because “the pressure on you for abortion can be huge.”
Others corroborated this: one, Dr Michael Jarmulowicz, was told by a member of an appointments panel that he was turned down for a job because of his pro-life views.
Some areas will be safer than others – working with elderly patients can be a way to avoid the issue entirely; on the other hand, obstetrics and gynaecology is a notoriously difficult (some say now impossible) field for pro-life doctors, and the report calls on the Royal College of Obstetricians and Gynaecologists to clarify its position on career progression. They also want the NHS to strengthen its procedures – not out of the question, since Jeremy Hunt is more sympathetic to pro-lifers than most recent health ministers.
No full study has been carried out to back up these anecdotes, but it seems there is a pattern, in some places more than others, of pro-life doctors and nurses feeling they are on thin ice. As the inquiry’s chair Fiona Bruce MP says, “the right to opt out” depends far too much on “the views and attitudes of individual managers”.
The British Medical Association, in a statement to the inquiry which is both admirable and alarming, say they are aware of harassment and abuse directed at doctors who refuse to carry out abortions. The BMA affirms its support for conscientious objectors, and encourages anyone in a difficult situation to get in touch with a BMA employment advisor.
But in doing so, you would want to be confident you had the law on your side – which brings us to the second point. Since the Glasgow midwives Mary Doogan and Connie Wood lost their case at the Supreme Court, pro-lifers have had reason to doubt that the law will see conscience cases as they do. The midwives felt that supervising a ward in which abortions were taking place infringed their consciences; the Scottish courts agreed, but Lady Hale and the rest of the Supreme Court did not. They ruled that the Abortion Act only meant to protect doctors from having to physically carry out an abortion – not from more indirect forms of participation.
Ironically, the inquiry looks to Lady Hale for a possible legal solution. It was she who floated the idea of a “reasonable accommodation” clause in British law. Canada has a version of this law: it means employers must make provision for conscientious objection, unless it would impose “undue hardship upon the employer”. It is a law on the objector’s side.
The APPG backs this solution. But as the junior doctor Calum Miller remarks, the pressure to perform abortions looks increasingly inexplicable.
“The recent medical consensus,” Dr Miller observes, “is that abortion provides no mental health benefits on average. In light of this, it is quite indefensible that clinicians should be punished for not performing a procedure which gives none of the health benefits we once thought it might have done.”
Which raises another question. Is the pressure which pro-life doctors face a sign of the pro-choice lobby’s strength? Or is it a panicky show of force from a movement which knows it has lost the argument?