Imagine you are a Catholic who has just finished general medical training and is now seeking experience in the field of obstetrics and gynaecology.
At the interview for a training post you are not asked “Are you a Catholic?” That would be discrimination on grounds of religion. Instead, you are asked: “Are there any procedures that you would not be able to do?” You answer: “Yes. Abortion.”
Shortly afterwards, you hear you haven’t been chosen for the position. The letter doesn’t mention your conscientious objection to abortion. That is the reason for your rejection, but the letter covers that up by saying the job was given to a “better” candidate. This actually means “more suitable”, as the candidate will be willing to perform the abortions that the post demands. You will now have to change specialties.
Evidence is naturally anecdotal, but my research suggests that virtually all Catholic obstetricians and gynaecologists in Britain have trained abroad and it is virtually impossible not only for Catholics but also for others with strong religious convictions to train here in these areas.
The problem is not limited to obstetrics and gynaecology. In midwifery, pharmacy and geriatrics there are pressures from our increasingly secular society making it virtually impossible for Catholics and other religious believers to work in them. The Catholic community is largely unaware of this. It needs to wake up to the problem.
A Catholic doctor friend was asked to give a talk entitled “Is it possible to be a Catholic doctor in the NHS?” The answer was “with difficulty”. And that applies not only to doctors, but also to other health care professionals such as nurses, midwives and pharmacists.
Why should this be so? In principle the health care professions, with their emphasis on caring for the sick, should be ideally suited not only to Catholics but also other religious believers. The faithful bring to this work personal qualities founded on care for the individual based on a holistic view of life with a strong religious ethos and, above all, a focus on the value of life itself. That explains why there are so many Catholics working in the health service, whether in the NHS or for private providers. One thinks, for instance, of the many nurses from the Philippines and Africa who sustain our healthcare.
Catholics working in geriatrics will face serious difficulties if the Assisted Dying Bill, assiduously promoted by Lord Falconer, becomes law. The procedure so euphemistically known as “assisted dying” – which is really assisted suicide – may become part of medical practice in the same way abortion has. So those working in geriatrics and, indeed, palliative care will be asked the same insidious question that is now asked of prospective gynaecologists and obstetricians.
Those working in palliative care already face acute problems. One nurse told me she worked on a ward where some patients were terminally ill but others, while old and frail, had come in merely for respite care and symptom review with the intention that they would be discharged home. She was shocked to be told by the clinician in charge not to give food to a particular patient who was intended to be discharged home as “her time has come”. The Department of Health has phased out the Liverpool Care Pathway, after complaints that it was being used as a form of “backdoor euthanasia”, but horrifying attitudes towards the elderly persist.
One profession you might have thought would be safe from all of this would be midwifery, as the whole idea of helping to bring new life into the world is so in tune with the Christian message. But that’s not so, as the recent case of Mary Doogan and Concepta Wood shows. They were midwives who worked for many years at the Southern General Hospital in Glasgow as labour ward co-ordinators. They argued that they should not have to delegate, supervise or support other midwives and nurses involved in abortions. At issue was the extent of section four of the Abortion Act 1967, which says that “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”.
The midwives sought confirmation that, having already expressed a conscientious objection to the termination of pregnancy, they would not be required to supervise other staff in the participation and provision of care to patients undergoing abortions. But this was refused. Their employers, the Greater Glasgow and Clyde Health Board, argued that supervising staff who were providing care to patients throughout the abortion process was not covered by section four.
In December the Supreme Court sided with the Health Board and gave a very narrow interpretation of the crucial word “participate” in that section. Lady Hale, in the leading judgment, held that the word did not cover what she termed “the host of ancillary, administrative and managerial tasks” that might be associated with an abortion service.
This decision was in line with previous case law, but the lower court had held that “the right of conscientious objection extends not only to the actual medical or surgical termination but to the whole process of treatment given for that purpose”, and this included the role of the midwives. Lady Hale’s reasoning will, chillingly, also apply to the identical conscience clause proposed in the Assisted Dying Bill.
Where does this leave us? In some ways, but not others, worse off than before.
First, the bad news. Suppose you are a GP who, as a Catholic, has a conscientious objection to abortion. A patient requests that you authorise one for her. You can do two things. The better course is to actually apply the Abortion Act 1967 and point out that as a doctor you must have formed an opinion in good faith that an abortion is justified on one or more of the grounds set out in the Act. The overwhelming majority of abortions (around 97 per cent) are on the ground of injury to the mental health of the pregnant woman. Thus in order to form your opinion you send the patient for an assessment of her mental health by a psychiatrist. This is never done in practice, but it is perfectly justified and, one might almost say, required by the Act. It will also give your patient time to think and may mean that she decides against an abortion. Moreover, a doctor who acts in this way is using conscience positively, to promote good, and not just as a defence to what is believed to be wrong.
But suppose you instead tell her that, as a Catholic, you cannot in conscience become involved in an abortion. Do you then have to tell her that there is another doctor in the practice that she can see who will be prepared to be involved? This is what Lady Hale said in the Supreme Court that a doctor must do. But is this right? Does it not amount to saying: “I won’t, but I know a man who will?” Not all Catholic doctors will agree, but surely the moral complicity is just the same and the doctor is simply indulging in a Pontius Pilate cop-out.
Unfortunately, you can’t necessarily rely on your professional body for help. Take pharmacists. The General Pharmaceutical Council has issued guidance to pharmacists stating that, if their beliefs prevent them from providing a pharmacy service such as the morning-after pill, then if they refer the patient to another pharmacy they must check there is another pharmacist who can provide the pill and has the relevant stock. The pharmacist might as well provide the pill anyway.
Surely the answer is for the healthcare professional to simply tell the patient that they have the right to a second opinion but not oblige them to effectively seek out someone who will do what they want.
But the professional bodies have a lamentable record of failing to offer support to healthcare workers faced with such issues of conscience. Far from supporting Mary Doogan and Concepta Wood, the Royal College of Midwives joined forces with the abortion provider BPAS in arguing before the Supreme Court that “to give a broad scope to the right of conscientious objection will put at risk the provision of a safe and accessible abortion service available to all pregnant women who need and want it”.
But there is some good news. It is buried deep in the judgment of Lady Hale in the case of the Glasgow midwives, where she advised them to, in effect, reinstate their claim at an employment tribunal. There an employee can claim that they have suffered unlawful discrimination, in this case on religious grounds, and Lady Hale said that the midwives “may still claim that, either under the Human Rights Act or under the Equality Act, their employers should have made reasonable adjustments to the requirements of the job in order to cater for their religious beliefs”.
In a lecture at Yale Law School in March 2014 Lady Hale asked: “Would it not be a great deal simpler if we required the providers of employment, goods and services to make reasonable accommodation for the religious beliefs of others?” Just as there is a duty on employers and others to make reasonable accommodation for disabled people so, she suggested, there should be this duty where people’s religious beliefs come into conflict with their employer’s requirements. Lady Hale argued that Britain should adopt a similar system to Canada, where the faithful are entitled to “reasonable accommodation” of their religious beliefs.
Lady Hale is opening a door for Christians here. Let’s push at it with all our might and see what happens. This may
get us much further than relying on the conscience clause in the Abortion Act.
As medical science advances other procedures that are in conflict with Catholic teaching are emerging. One thinks of gender reassignment surgery and, most recently, the creation of “three-parent babies”.
It would be a tragedy if the gradual creeping exclusion from healthcare of Catholics and others with strong religious and conscientious principles continued. We must act to stop it.
We should support a new initiative by the MP Tom Clarke, who has said that he intends to “fight as hard as he can” in Parliament for better legal protections for freedom of conscience in the wake of the Supreme Court’s ruling against the Glasgow midwives.
We also ought to campaign for a law to allow reasonable accommodation of religious beliefs. This will take a great deal of groundwork and evidence-gathering in particular cases. But if we act sensibly and quickly we can achieve much. All is not lost.
This article first appeared in the latest edition of the Catholic Herald magazine (06/3/15).
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