Responses to Abortion Law Reform Bill 2008

State of Victoria, Australia

• Doctors in Conscience Against Abortion Bill
• Dr. John Neil
• Mary Lewis, MBBS, FRACGP, DRANZCOG, MICD, B Min
• Jacinta Le Page (Medical Student)
• Joanne Grainger (Registered Nurse, Bioethicist)
• Justine Armstrong (Victorian Division One Theatre Nurse)
• The Australian Egyptian Doctors and the Coptic Doctors

Doctors in Conscience Against Abortion Bill

Position Statement
Reproduced with permission

Conscientious objection is a right for all health professionals

We are a newly formed group of Victorian doctors from a range of medical specialties, with diverse backgrounds, representing various faiths and none. We call upon the Victorian government to reject the Abortion Law Reform Bill 2008.

We consider the proposed legislation to be poorly framed and unnecessarily coercive. It is based on false premises, incorrect definitions and is not reflective of current clinical realities nor is it supportive of vulnerable pregnant women.

1. The AntiConscience Clause.

Clause 8 of the Bill is unconscionable and unprecedented in this country.

We believe it to be an attack on the basic human rights of health professionals which undermines their moral integrity and professional autonomy. The state should not coerce its health professionals to participate in the taking of human life. Many doctors, nurses and pharmacists, with strong ethical, religious and cultural beliefs against abortion will have to consider whether to continue to practice in breach of the law or to discontinue working as healthcare professionals in this state.

We concur with the position put forward by Dr Doug Travis, President of the AMA (Victorian Branch): “The Bill infringes the rights of doctors with a conscientious objection by inserting an active compulsion for a doctor to refer to another doctor who they know does not have a conscientious objection. Respect for a conscientious objection is a fundamental principle in our democratic country, and doctors expect that their rights in this regard will be respected, as for any other citizen.”

We believe the right to conscientiously object to participation in the process of abortion, either directly or through referral, should also be respected for Nurses, Pharmacists and other healthcare workers. . . [Full text]

Dr. John Neil

Doctors in Conscience Against Abortion Bill

Speech delivered 6 October, 2008
Queen's Hall, Parliament House, Melbourne, Australia

Background. I am an Obstetrician who began training as a specialist in 1969 in the year of the Menhennit ruling. Issues were black and white in those days, but the ethics of abortion rapidly became more grey. This has always been a very difficult issue and these women need a lot of compassion and support in their choices. I am old enough to have seen maternal deaths from severe infection after illegal abortion. We are not proposing a return to that situation. The existing common law is unsatisfactory and needs proper legislation, which this bill is not.  My purpose is to make clearer the clinical aspects which I find very confused in this bill.

1. The anticonscience clause. It is ludicrous that a “registered medical practitioner” should have to perform an emergency abortion. Firstly it is coercive, and others will speak about this. Secondly, it is based on a false premise that an emergency abortion actually is ever necessary.  Coercion to make an “effective referral” is also unnecessary and prejudicial . . . [Full text]

Mary Lewis, MBBS, FRACGP, DRANZCOG, MICD, B Min

Chairperson of the Victorian Branch of the Christian Medical and Dental Fellowship of Australia

Speech delivered 6 October, 2008
Queen's Hall, Parliament House, Melbourne, Australia

Ladies and Gentlemen,
Thank you for this opportunity to speak to you on our objection to the Abortion Law Reform Bill 2008.  I wish to raise three objections to this Bill

1. This Bill devalues human life and cuts across doctors' duty of care to do no harm to their  patients. . .

2. This Bill misunderstands and devalues the recognised social position of pregnant mothers . . .

3. This Bill misrepresents and undervalues the process and responsibilities of professional referral. This Bill implies that referral removes obligation and participation. However, referrals between medical professionals imply a partnership of care. If I make a referral to a specialist colleague that the patient and I have chosen for their particular expertise, availability and suitability because they can provide medical care that I cannot, I write a letter detailing my patient's history, treatment and a request for treatment. I am facilitating further care with my colleague but not handing over my patient. This patient will return to my care with a suitable letter and report from the specialist colleague. We have a working partnership between the three of us. There is no way that a practitioner can make or receive such a referral in good conscience if they do not agree with the procedure and care to be undertaken. This Bill completely misunderstands and trivialises the implications and responsibilities of referrals between medical colleagues. [Full text]

Jacinta Le Page (Medical Student)

Speech delivered 6 October, 2008
Queen's Hall, Parliament House, Melbourne, Australia

(singing) “Australian’s all let us rejoice for we are young and …”

I hesitate to sing the next word due to the restraints I understand that are being legislated over my conscience.

Hi, I’m Jacinta, and with me here are some of my fellow colleagues who would like to stress our concerns. We acknowledge some here are not doctors yet, but eagerly await the day when we can serve our community.

I have received much input from the media, the community, and even lecturers in relation to this Bill. I have read it over and over, and from my young perspective, believe that many of these people seem to misunderstand the significance and ramifications. We are gravely concerned about what this means for our careers!

Firstly, referring personally to another medical practitioner, as this Bill states, seems to be clearly participating in abortion. In our classes in medical school, it has been taught to refer is to simply hint or name under our breath the Royal Women’s Hospital, and the woman we are counselling will understand immediately where she is to go to get her abortion. This has been suggested as a way of getting around the conscience clause. However, this seems disingenuous to me. It does not acknowledge what it means to refer. Nor does it give weight to the gravity of what this procedure means to myself. But we must refer to another health colleague which is far more personal and involving. Furthermore, we fear we will be required to research for a colleague who will readily ‘help’ her have an abortion. Such a personal referral equals participation in the killing.

Secondly, we fear the deep compromise we will be required to undergo. We are not training to be machine operators or robots. We are trained to deal with life and death, difficult decisions, communicate and respect patients and their loved ones from all cultures and walks of life. We are trained to consider and grapple with the implications treatment decisions, complications and side effects. We are taught to
be honest with our patients, yet compassionate. To become such a doctor requires integrity and conscience. However, we understand this bill will force us to detach ourselves. But our core, our conscience, is more than just a separate and external compartment to our practice of medicine – it is the foundation of our being. It is what drives and determines our everyday decisions, as we deal with patients in all different circumstances. Please, Members of Parliament, do not force us to merely operate in a system, rather than engage as a person! Please, do not strip us of our freedom to exercise our deepest commitment to practising medicine – saving and improving the quality of life.

Thirdly, we fear the potential of this Bill to divide, and estranges us from our colleagues. Unity and teamwork are of vital importance in the world of learning and practising medicine – to care for the patient wholistically. If the law doesn’t reflect respect for one’s desire to not be involved at all, then we are concerned this may filter into our future workplaces, and divide us from our colleagues respect, which currently unifies us in comradeship and teamwork. It has already affected some of us as students, without even passing through government! I have already experienced estrangement, conflict and abuse, and I am only a fifth year student. We are concerned that it may identify us and singles us out. It may cultivate group pressure within the medical team in which we work, where failure to participate is resented. In addition, our disagreeance with abortion, when it is so universally permissible in our State’s legislation, may easily be read as disagreeing with our colleagues work and efforts. Given the above concerns, we may strongly consider training in different specialties – which would only heighten the shortage of GPs and the like. Or, as I am interested in Obstetrics & Gynaecology, we may consider training elsewhere. I am concerned I may be better off training in a different state. This is very significant to me! In this state, we boast, “Victoria, the place to Be”.

Please, let legislation reflect this, and not stifle the students and doctors of the future!

Joanne Grainger (Registered Nurse, Bioethicist)

Speech delivered 6 October, 2008
Queen's Hall, Parliament House, Melbourne, Australia

I thank the Doctors' Conscience group for providing the opportunity for the voices of Victorian nurses to be heard hear today.

I am not here representing all Victorian nurses – that would be a presumptuous assertion. However, there are over 80,000 registered nurses in Victoria – and I speak on behalf of those many nurses who have a conscientious objection to their participation in an abortion on religious, cultural, personal or ethical grounds.

There is a Code of Ethics for Nurses in Australia.  The most recent version of this Code was released in August 2008. In this recent edition, the provisions for conscientious objection for nurses have increased. So the question must be asked, is this Code worth the paper that it is written on?

Through this legislation, it would appear that nurses will be forced to be accomplices in abortion against their reasoned conscience. This is completely in opposition to current practice in Victoria and limits the nurse’s freedom of thought, conscience and religion.

Why are nurses so unjustly treated by the provisions stated in this Bill?

The Victorian Law Reform Commission (VLRC) encouraged the general public and various interest groups to place submissions on the impact of decriminalisation in Victoria. There were over 500 submissions. Professional medical groups such as the AMA and various Royal Colleges presented their submissions on the impact of this Bill upon medical professionals in Victoria. However, out of these 500 submissions, not one was from a professional nursing body. Neither the Australian Nursing Federation, the Victorian Nurses Board, the Royal College of Nurses or Midwifery or the Australian Nursing and Midwifery Council placed submissions to the VLRC on behalf of the 80,000 registered nurses in Victoria.

It is clear that any nurse with a conscientious objection who is asked by a patient to advise on (or to perform, direct, authorise or supervise) an abortion is obliged to refer the patient to another nurse whom the first nurse knows does not have a conscientious objection. This is in clear violation of section 14(2) of the Victorian Charter of Human Rights and Responsibilities Act, as well as Articles 18.1 and 18.2 of the International Covenant on Civil and Political Rights. Therefore the Bill needs to include a statement that makes clear that nurses, and all other health workers, have the right to conscientiously object to playing any role in abortions.

Now all of this is legal speak. Let me placed all of this into clinical reality for the nurse using some possible scenarios – for I think that this has been missing in the discussions of this Bill and its clinical implications for the nurse.

You have already heard from the obstetric experts that the term ‘emergency abortion’ is a misnomer. However, if the Bill was to be enacted as is, all a medical practitioner needs to say to the nurse is that they deem the procedure as such an emergency and by law the nurse has to assist in the abortion despite holding a conscientious objection. We have heard that there is no such medical emergency, and with this proposed legislation doctors that perform the abortion do not even need any obstetric or gynaecological surgical experience.

Therefore a nurse may object on the grounds of they think the woman’s health may be compromised due to the lack of experience of the surgeon but still have to assist in the abortion. This is a reasoned and valid objection on behalf of being a patient advocate and a moral agent in the clinical setting. However, this Bill if enacted would place both the pregnant woman and the registered nurse in a vulnerable position both professional and medically.

In August 2008, the Herald Sun reported that the Premier, John Brumby stated that a school should have consulted a young student's parents before helping her get the contraceptive pill. In a Bill being supported by the same premier, a School nurse can be accredited by the Nurses Board of Victoria to administer an abortifacient drug to a teenage girl to procure an abortion without parental consent, or even a medical review. As one school nurse recently informed me when I was asking her about this scenario, she can’t even administer Panadol
to a student but now this law is permitting her to procure an abortion on a teenage girl, who may not much older that a child herself, without her parents knowledge. This same school nurse also made the valid point that in Government schools it may become a requirement for the role descriptions of the School Nurse to include accreditation to give abortifacients – should not the School then make it public to all parents that the school nurse in this education institution has this accreditation?

Again, as a duty of care to the girl and to the relationship the teenager has with her parents, a nurse through his or her reasoned conscience should be able to say no to not only the administration of the abortifacient but even a referral on the grounds that she does not believe that the abortion is in the best interest of the vulnerable teenage girl.

In both of these case scenarios, a claim for conscientious objection by the nurse is on the grounds of rational, reasoned objection to the abortion being harm to the woman.  A nurse may also hold religious, cultural or ethical objections also to such treatment.  Victorian Parliamentarians must consider that registered nurses are moral agents, not just automatons who undertaken an action under direction without thinking or reasoning the implications of their involvement in the procedure.

I would think that this is what is expected by the Victorian public of their nurses – and I hope that the same public will support those Victorian nurses who hold an objection to their direct and indirect participation in an abortion to be free to appeal to their conscience in their clinical practice.

Justine Armstrong (Victorian Division One Theatre Nurse)

Speech delivered 6 October, 2008
Queen's Hall, Parliament House, Melbourne, Australia

I am a happily married mother of two beautiful children and a skilled theatre nurse with over 15 years nursing experience. Prior to the birth of my second child I worked in a Victorian public hospital operating theatre. After spending the last 4 years in full time parenting I recently planned to renew my registration to return to work but have since placed the process on hold awaiting the outcome of this Bill.

If passed, this Bill would force me to directly participate in abortions as a theatre nurse. This is totally unacceptable to me and my family. It is immoral.  It violates my personal and professional ethical framework. It is an affront to my faith and it strips me of my fundamental rights as a human being and as a professional, to object to an action that contravenes my personal conscience.

In a letter to the ANF (Australian Nursing Federation) an advisor to the Health Minister states that, "Nurses employed in operating theatres in hospital will not have a direct relationship with the woman in question therefore the conscientious objection clause will not apply". To say that theatre nurses have no direct relationship with the woman demonstrates a serious lack of understanding of the role of a theatre nurse. I quote from the Victorian Perioperative Nurse’s Group's definition that, "the perioperative nurse clinician is responsible for both direct and indirect patient care during surgical intervention within the operating suite."

I am not a robot, I care for my patients in a holistic manner in regards to their emotional, physical and spiritual needs.

The future of my nursing career is under threat from this proposed Abortion Bill.  As a nurse my duty of care is to save lives, not to end life.

The other reason that I hold an objection to abortion is due to the surgical nature of the procedure that procures an abortion. I do not have to highlight to you the brutal nature of this surgery – you can look it up on the internet to find out more about this.

Two years ago, I personally suffered the grief and trauma of losing my third baby through miscarriage requiring surgical intervention. I will not relive my trauma again and again in assisting in the intentional death of the unborn that is similar to the surgery I underwent post my miscarriage. This is a fundamental reason for my conscientious objection to assisting in an abortion.  I have a right to function in a workplace that safeguards my emotional health.

Therefore the future of my nursing career is in the hands of Victorian Parliamentarians this week.

The Australian Egyptian Doctors and the Coptic Doctors

Delivered 6 October, 2008
Queen's Hall, Parliament House, Melbourne, Australia

The Australian Egyptian Doctors strongly appose the abortion bill. We feel this bill is being rushed with out adequate debate, in particular with the primary health care professionals and largely with the general public. . .

More over it coerces the health practitioner to behave or act in a manner which comprises his or her ethics, morals, culture and religious beliefs.

We strongly oppose this bill as it stands and recommend that this bill be referred for a proper discussion and public debate involving the different community groups and health professionals concerned.

Dr Magdy Ramzy, Dr Samir Ibrahin, Dr Safwat Messiha, Dr Emad Aboud, Dr Sarah Mikael, Dr Emil Bassilious, Dr Nabil Boulis, Dr Adel Farag, Dr Adel Assaad, Dr Safwat Hannah, Dr Younan Tosson, Dr Amir Malek 

[Full text.  Document includes statements by Islamic and Eastern Christian doctors affirming opposition to abortion.]