This is the transcript from my short talk at the recent panel discussion in QUB Chaplaincy.
I just want to say a few words from my point of view as a healthcare worker in Northern Ireland, someone who respects and loves life, and someone who has spent his career fighting for that life, upholding that life, rejoicing in that life and mourning that life when it departs. I have been concerned about the changes in our culture and in our society over the last few years leading up to the recent legislative changes, and I am concerned about the changes in my profession. My appeal tonight is for a return to professionalism, for healthcare workers to be ethically and clinically consistent, and a call for the practice of virtuous medicine. I’m going to mention 4 points first of all briefly which concern me:
- the loss of professionalism in our medical culture. Healthcare runs the risk of being reduced to either a mercenary service industry, a race to the bottom where money is the final arbiter, or a rigid protocol-driven agent of the state staffed by automatons. The NHS in the UK walks a fine line between the two extremes, being pulled this way or that by different forces. This is a call for a return to the standards of the Hippocratic Oath – an appeal to a professional code which transcends the shifting sands of popular opinion and short term vote-winning policies [distressingly, if you look up the Hippocratic Oath on wikipedia, someone has chopped out the bit about abortion…]. The profession needs to return to a traditional understanding of medicine as one which intends life, not death.
- the ethical inconsistency of abortion – I’m sure many of us are familiar with the ethical arguments for and against abortion, and I’ll not restate them tonight, but I’m firmly of the opinion that the pro-life argument is the only ethically consistent position which does not, by extension, legitimise things like the killing of newborn children and, by further extension, the devaluing of human life in old age, terminal illness and disability.
- the clinical inconsistency of abortion – The clinical case for abortion is equally weak – as doctors we are advised to practice on the basis of evidence found in clinical trials. The evidence for abortion is very poor. It is offered as a preventative for physical and mental ill health problems, but there is little evidence that it is any more effective than following through with a pregnancy. For the 1 in 7 abortions in WANTED Pregnancies, the rates of mental ill health afterwards are very much greater than if the pregnancy had been allowed to go to term. Abortion as treatment is ineffective. In the rest of the UK, lip service is given to concerns for the mother’s health. We know that 98% of abortions are for essentially social reasons. It is clinically inconsistent to offer a medical procedure for someone who is not unwell, and for no clear improved clinical outcome.
- This is a lament – a lament for the loss of the love of life. What has happened to our culture? Why do we pursue death so vigorously and call it freedom? Why do physicians advocate for something so contrary to our art?
There is something which is so fundamentally wrong that it leads normally quiet, mild-mannered people to speak out – and that is wrongful killing. There is something about the unjust taking of a human life that can’t be ignored. It’s a like a punch in the gut, it’s like the ripping of a beautiful painting, or like the burning of good books. It causes a visceral reaction in those who are sensitive to these things. But I think that not everyone gets this, or that some people learn to tune it out – perhaps it’s the result of a particularly tender conscience, a pathological softness in the head. Some people can’t understand why anyone would object to abortions being carried out – they just don’t understand, they don’t have the same view of how the world works. In their understanding of the world around them, it makes perfect sense for a tiny bunch of cells to be cast off so that another person should be happier. In a rationalistic, pragmatic, (secular) humanistic world, that makes absolute sense. The problem is, that many of us don’t inhabit that same world. And it’s so hard for the latter group to understand why we should care about something as irrelevant and weak as a fertilised egg. So when healthcare workers get incensed about abortion, and about the rights of the unborn child, to the latter group, we sound like we’re absolutely nuts! But they don’t understand – what we see is the gravest injustice possible to a human being committed upon someone weak, against their will, brutally and arbitrarily – and the most sickening part of all is that we are expected to call this HEALTHCARE and to participate fully and to celebrate it? And they call US mad? My advice for those of us tonight who support abortion – don’t underestimate the depth of feeling in those who are radically opposed to abortion. In fact, for a pro-life healthcare worker to be compelled to participate in abortion, or to be complicit in the processes surrounding abortion, could be considered to be a form of moral torture, to directly damage us as individuals.
At this point I want to ask a question – Why are people so scared of conscientious objection?
Isn’t allowing conscientious objection just a sop to the pearl clutchers, the selfish and the weak minded? Why should we allow any healthcare professional to refuse to do something within the sphere of their job role, just because they feel bad about it? Why can’t we just force people to do the job that they’re employed to do? That’s how these objections might be pitched, and the responses are usually framed in a negative light. I’ll admit that for a long while I thought conscientious objection clauses were there largely to protect the occasional individual who had funny ideas – but circumstances have led me to reconsider my own practice over the last number of years, and to consider my motives for doing, or not doing, certain things. The time that I’ve spent thinking about this has actually been productive and valuable for me, and I want to offer this suggestion – conscientious objection has made me a better doctor. Why do I think that? I’m going to pinch a number of points from an article by Trevor Stammers [which I’ve already blogged about here] which outlined very clearly for me why the right to conscientious objection is not a luxury, but a necessity for our health service.
- Conscientious objection protects patients. A very simple example for me – I don’t prescribe the contraceptive pill. That means that when I get handed my large bunch of prescriptions to sign every day, I am looking at every single one of those scripts carefully and rigorously to ensure that I know what I am signing off on. At the other end of the spectrum, consider a system where doctors have to participate in euthanasia – where is the protection from the next Harold Shipman, where are the concerned workers monitoring and reflecting and critiquing?
- Conscientious objection protects healthcare institutions. It “fosters the moral agency of healthcare professionals necessary for such institutions to run properly” (Stammers). Basically, if you can’t criticise the system, then you can’t help to fix the system. And if you’ve got experience of the monolith that is the NHS, you’ll know that there is lots that needs to be fixed!
- Conscientious objection improves patient wellbeing. If I am sensitive to the ethical implications of my practice, then I will also be sensitive to the needs of my patient, not just when they share my beliefs.
- Conscientious objection promotes moral integrity – to be forced to act in a way which runs counter to your beliefs is not morally consistent, and is not compatible with human flourishing.
- I’ll end with Trevor Stammers’ final point too – “If conscientious objection is outlawed, the whole purpose of medicine becomes distorted… put simply, if the doctor merely does as the state or patient dictates, what place is there for professional judgement, clinical experience and the objects of medicine – to cure sometimes, relieve often, but comfort and care always?“