I am a medical student. I am also a Christian. One day, I hope to graduate, register, and practice medicine. When I do so, I hope I will have the freedom to practice, with the aim of increasing health outcomes, and not acting against my conscience. I hope I will be able to act in accordance with the ethical principles that have guided medical practice for centuries, which can be summarised as: beneficence, non-malfeasance (“first do no harm”), autonomy and justice. And I hope that in allowing a patient to exercise his or her own autonomy, I won’t be impinging on my own.
It is on the last point that I am particularly concerned. Many have argued that a woman’s choice of abortion is an exercise of her autonomy. While the justification of my position is beyond the scope of this discussion, it will suffice to summarise my position as “pro-life”. I am of the conviction that personhood starts when biological humanity starts, which is at conception. I believe a living homo sapiens who happens to be developing inside a uterus should have just as much of a right to continue existing as a living homo sapiens who happens to be developing outside a uterus. This is partly because I am a Christian, but partly because I think any other definition is purely arbitrary.
The history of the abortion debate, and the variety of positions both legal and popular taken by peoples and their governments around the world, makes it clear that abortion is not an ethically incontrovertible issue. It is then also unsurprising that issues of conscientious objection should arise among the community of medical practitioners, who represent a diverse group of people from a vast range of cultural and religious backgrounds but who, despite this diversity, are increasingly expected to be homogeneous in the range of services they provide.
There are those who believe an unborn human is a person who deserves special protection if and only if this person’s parents desire for him or her to exist. If not, he or she may be discarded at his or her parents’ will. Most proponents of this attitude hold it on the basis that we cannot impose on the mother's freedom. I find this ironic, because many of these same proponents have pushed to have my freedom as a doctor removed and to not be involved in this process.
Some people would have a problem with me choosing to use my future position of influence as a doctor to tell women that it is morally wrong to end the life of their unborn offspring. In the same way, I have a problem with the State choosing to use its position of power over me, forcing me to be involved in the process that will result in an unborn human unnecessarily losing his or her life.
This is exactly what has happened in Victoria’s recent Abortion Law Reform Act 2008 (the Act). One of the biggest concerns for medical professionals - even those who have no moral problem with abortion - was the imposition on the freedom of conscience of Victorian Health Care Workers.
Section 8 of the Act forces doctors with a conscientious objection to abortion to disclose their beliefs before referring women to a doctor who is not opposed to termination. In effect, this means the doctors are involved in a woman procuring an abortion. They are required by law to act in a manner which is well known to be contrary to the consciences of many doctors.
If a woman came to my practice with a non life-threatening pregnancy seeking an abortion, I’m not sure I could, in good conscience, facilitate that process. Under the legislation a woman can seek an abortion for any reason up until 24 weeks (and quite easily thereafter). Babies born at less than 24 weeks have been known to survive, which could present a very understandable question of conscience for practitioners, religious or otherwise.
The Victorian Parliament was aware of the difficulties this part of the legislation caused. But this did not deter them. The Bill was passed without amendment. In fact, some bioethicists have championed this sort of imposition on freedom of conscience. Professor Julian Savulescu, of the Oxford Uehiro Centre for Practical Ethics, has said “If people are not prepared to offer legally permitted, efficient, and beneficial care to a patient because it conflicts with their values, they should not be doctors.”
Putting aside for a moment the question of whether abortion is beneficial for a woman (a point which is hardly clear, even before considering the welfare of the fetus), what are the values that Professor Savulescu is so indifferent towards? The values that extend all the way back to the Hippocratic Oath, which states: “I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion.” A woman may have the right to request an abortion, but a doctor should maintain the right to not be involved in her receiving that abortion.
Many people would champion the cause of unfettered patient autonomy with no room for any ethical considerations of the doctor. They would say we are basically service providers, and if that’s what the patient wants, that’s what the patient must get. However, I think the implications of a doctor not being able to exercise his or her own freedom of conscience in medicine are enormous.
Let me provide an analogy. Think for a moment of a practice that all reasonable Australians would consider grotesque: female genital mutilation (FGM). It is defined by the World Health Organization as a procedure that “intentionally alters or injures female genital organs for non medical reasons” (often social or cultural). It is associated with significant morbidities and even mortalities, not just because of the procedure itself, but because of the unsafe and unhygienic practices often associated with it.