Abortion and Conscientious Objection
Nucleus, January, 1996
Christian Medical Fellowship (United
Reproduced with permission
In my work among medical students, I am frequently
asked about the practicalities of conscientious objection. The vast majority
of students are not asking whether abortion is right and wrong. Rather they
are asking: 'Given that abortion is wrong, how should I handle the
situations where pressure is being put upon me to participate?'
During a quiet tea-break as a surgical house officer, I was summoned to
the medical superintendent's office. My O&G colleague was busy. Would I
please admit some patients for elective termination of pregnancy?
In accepting my appointment I had signed a form saying that I would be
willing to take on extra duties from time to time at the medical
superintendent's discretion. However, on this occasion, I politely refused
and he accepted my right to conscientious objection.
Throughout Europe, the opportunity for such action may soon be over. The
legal situation in several Western European countries has recently been
reviewed in the Journal of CMF's Swedish counterpart, Kristna Lakare Och
Medicinare i Sverige, and makes disturbing reading
Swedish law provides no right of conscientious objection to doctors and
both doctors and other health personnel have contractual obligations to
assist in the termination of pregnancy. In France, Norway and Italy, doctors
are not legally required to perform abortions, but are obliged to
participate in pre-operative care. In Denmark and the Netherlands one can
conscientiously object to being involved in pre-operative care, but there is
nonetheless a legal obligation to refer the woman seeking an abortion to
The law in Britain
The situation in the UK is less clear and has been the subject of recent
debate in the British Medical Journal.[2,3,
4, 5, 6] The
Abortion Act 1967 carries a conscientious objection clause which allows
doctors to refuse to participate in terminations but which obliges them to
provide necessary treatment in an emergency when the woman's life may be
jeopardised. The British Medical Association (BMA), which is frequently
asked for an opinion on the matter bases its advice
 on two legal precedents.
The first of these was a Parliamentary answer on the matter
 which made clear that
conscientious objection was only intended to be applied to 'participation in
The second was the Janaway case
concerning a doctor's secretary (Janaway) who refused to type the referral
letter for an abortion and claimed the protection of the conscience clause.
Lord Keith in his summing up of the case said that 'the regulations do not
appear to contemplate that the signing of the certificate would form part of
the treatment for the termination of pregnancy'.
The BMA document observes that 'it would seem that GPs cannot claim
exemption from giving advice or performing the preparatory steps to arrange
an abortion if the request for abortion meets the legal requirements'. At
the same time it admits that 'the full legal position is not entirely clear,
since it requires interpretation of case law, GP terms of service, good
practice and the NHS Act 1977'.
What then should a doctor do? The BMA concludes that 'completing the
statutory form'(HSA1) for abortion falls morally within the scope of the
conscience clause, but that doctors who feel unable to sign still have an
ethical duty to refer the patient expeditiously to another practitioner, and
that unnecessary delay in referral is contrary to good practice. However it
adds that 'other preliminary procedures such as clerking in the patient or
assessing the patient's fitness for anaesthetic' are 'incidental to the
termination' and are considered outside the scope of the conscience clause.
In other words, although specific cases have not yet been brought to
court, (and there is disagreement over what will happen when they are[5,6]
the BMA regards the situation in the UK as similar to that in France, Italy
and Norway. Doctors are not legally required to authorise or perform
abortions, but are obliged to be involved in pre-operative care and
Had my own case been brought to court in this present climate, I may well
have been found guilty.
In my work among medical students, I am frequently asked about the
practicalities of conscientious objection. The vast majority of students are
not asking whether abortion is right and wrong. Rather they are asking:
'Given that abortion is wrong, how should I handle the situations where
pressure is being put upon me to participate?' Let us consider the biblical
principles relevant to the discussion and their practical implications.
Conscientious objection - Biblical principles
The Bible teaches us in both Old and New Testaments that it is God
himself who institutes human authorities:
'..the Most High is sovereign over the kingdoms of men and gives them to
anyone he wishes.' (Dan 4:25)
'The authorities that exist have been established by God.' (Rom 13:1)
Furthermore he expects us to obey them, not only because of possible
punishment but also because of conscience. (Rom 13:1-7; Tit 3:1; 1 Pet
This raises the issue of what we should do in circumstances where obeying
the authority involves disobeying some other command of God. It seems in
Scripture that there is a place for godly civil disobedience. Let us
consider some examples.
The Hebrew midwives when ordered by the king of Egypt to kill all male
Hebrew children refused to do so and as a result we are told that God
commended and rewarded them (Ex 1:15-22). Rahab the harlot similarly refused
to co-operate with the king of Jericho in handing over the innocent
Israelite spies (Jos 2:1-14). She is later praised for her faith in so doing
(Heb 11:31; Jas 2:25). The prospect of death as a consequence of
disobedience to state law did not stop Shadrach, Meshach and Abednego
refusing to bow down to the image (Dan 4:6-8), or Daniel persisting with
public prayer (Dan 6:1-10). They were defiant and their obedience was
rewarded when God intervened miraculously on both occasions to save them.
In the New Testament when Peter and John were commanded by the Jewish
authorities not to preach the Gospel they replied 'We must obey God rather
than men' and went right on doing it (Acts 5:29). Many of the prophets and
apostles and of course Jesus himself were killed precisely because they
chose to obey God in what they said and did, in situations where his
commands and those of human authorities conflicted.
In John's vision described in Revelation 13 the beast which is given (by
God) authority over every tribe, people, language and nation is clearly not
to be obeyed in the matter of receiving a mark to enable buying and selling
(Rev 13:15-16). To the contrary, those who take the mark ultimately share
the fate of the devil himself (Rev 14:9-12).
So while recognising that we have an obligation to obey the governing
authorities God has instituted, our obedience to God himself takes
precedence when rulings conflict.
If we decide that as Christians we should not be shedding innocent blood
(and personally I believe Scripture leaves us no other option; as previously
argued) it must follow that in spite of what
governments and medical associations may decree, we must obey God first. Any
suffering that may follow simply has to be accepted as part of the cost of
following Christ in an increasingly godless world. To disobey God for fear
of losing career, reputation or respect is surely to make idols of these
things. We cannot say that in our hearts we worship God if our actions
betray that we don't. Can we imagine Daniel, Shadrach or Jesus himself
bottling out at the last moment on the grounds that the cost was too high?
What then of our involvement at other levels? If we decide that as
Christian doctors we should not participate in the shedding of innocent
blood, then surely this must have implications for other levels of
involvement. If we fill out forms authorising abortions, prepare patients
for the procedure or refer to others whom we know will do the same aren't we
giving tacit approval to the whole process? Shouldn't we rather observe the
'Do not be partners with them' (Eph 5:7)?
Hasn't the time come to:
'Come out of her my people, so that you will not share in her sins' (Rev
Taking innocent human life is contrary to the whole strategy of medicine.
It runs not only counter to Christian ethics but to the Hippocratic Oath and
the Declaration of Geneva, which the BMA not so long ago embraced. It is not
we who are advocating change, but rather the legal and the medical
establishment who have betrayed their own ethics. Why should we allow them
to squeeze us into the same mould?
On the basis of the above, my own personal advice to medical students and
junior doctors is as follows. Do what you can to persuade women not to
choose abortion and be aware of all the excellent facilities that now exist
in this country (such as those provided by LIFE and CARE for Life) to
provide counselling, practical help, advice and support to those with crisis
pregnancies. However, don't participate in the abortion process itself, by
signing forms, admitting patients, helping in theatre or arranging for
someone else to 'do the deed'. Whatever the cost to your career,
conscientiously object. If, on the other hand, you have been asked to be
involved in the care of patients with post-abortion complications, oblige
willingly. I should add that it is wise (if possible) to make your position
known to colleagues, before the event arises.
I am well aware that such advice, even if followed with tact and
sensitivity, will bring some into conflict with medical, NHS and legal
authorities. Many may find, as I and others have, that threats of reprisal
often come to nothing. Authorities, be they persons or parties, frequently
back off, fearing confrontation even more than we do.
However it is inevitable, given the slide in morals in society generally
and the move towards medical care being yet another market commodity, that
some of us will face discrimination, dismissal and even criminal conviction.
I am aware of a Christian general practice recently being denied
certification for training purposes because the partners were not prepared
to provide 'the full range of services' (see below) including abortion
referral and contraceptive prescription for unmarried couples. Another CMF
member was recently denied the Diploma of the Faculty of Family Planning and
Reproductive Health Care of the Royal College of Obstetricians and
Gynaecologists (RCOG) on the basis that he had refused to fit IUCDs.
When an enquiry was made on behalf of CMF the Chairman of the College
Faculty concerned informed us that there was
'a considerable onus on the Faculty to ensure that its qualifications
should be recognisable by service purchasers and patients alike as
distinguishing doctors who were able to ensure that their patients had
access to a full range of contraceptive services'. (Italics mine.)
Regardless of what personal convictions we may hold on the morality of
IUCDs, or even for that matter abortion, there is a most worrying precedent
here. Rather than being subject to an independent code of ethics and gaining
qualifications purely on the basis of medical competence, doctors are being
barred from practice in certain fields of medicine because they are
unwilling to provide, for ethical reasons, what the market-place is
demanding. The irony is that in the two cases cited doctors were
discriminated against for insisting on abiding by the Declaration of Geneva
which enjoins 'the utmost respect for human life from the time of
conception'. Just twelve years ago
they would have had the BMA and indeed the World Medical Association (WMA)
on their side.
What of the future?
When further NHS trusts are under the control of non-medical interests,
and market forces hold even more sway in an environment of diminishing
health resources, one wonders whether 'the full range' of geriatric,
psychiatric, intensive care or even general medical services might include
euthanasia. Why not? What then?
One thing is certain. Junior doctors who hold Christian convictions are
finding it more and more difficult to enter careers in certain specialties
and the phenomenon is spreading. Convictions and disciplinary proceedings
are inevitable if current trends continue and presently they show no sign of
abating. The days of the Christian doctor with strong moral convictions may
well be numbered. If the tide is to turn at all (it may already be too late)
it will not happen unless those of us in positions of responsibility within
the Royal Colleges, NHS Trusts and the BMA speak out. If such members of CMF
remain silent, Christian witness in medicine, at least in the form it is
practised in this country, may well come to an end. Mordecai's words to
Esther, who occupied a position of privilege and responsibility at a similar
time of national crisis, are a sober challenge to us:
'Do not think that because you are in the king's house you alone of all
the Jews will escape. For if you remain silent at this time, relief and
deliverance for the Jews will arise from another place, but you and your
father's family will perish. And who knows but that you have come to royal
position for such a time as this?' (Es 4:13-14)
1. Ars Medicina 1:18. 1994. A copy of this article (in
English) is available from the CMF Office on request.
2. Dooley D. Conscientious refusal to assist with
abortion. BMJ 1994;309:622-3. (10 September)
3. Simpson CGB. Doctors' right to refuse to perform
abortions.(letter) BMJ 1994;309:1090 (22 October)
Cox D. Doctors' right to refuse to perform abortions.
(letter) BMJ 1994;309:1582. (10 December)
5. McCallum RW. Doctors' right to refuse to perform
abortions. (letter) BMJ 1994;309:1582. (10 December) [BMJ] ["disagreement"]
Jarvis G. Doctors' and Nurses' right to refuse to
participate in abortions. (letter) BMJ 1995;310:669. (11 March) [BMJ-]
7. Medical Ethics Today. Its practice and philosophy.
BMA's Ethics, Science and Information Division.1993. BMA. pp107-109.
8. Official Report, vol 201; No 37, Part II, 20 December
1991, col 355.
Janaway v Salford Health Authority  AC,  3
All ER 1079 (HL).
10. Saunders P. Abortion- Time to Reconsider. JCMF,
October 1994, 40:4, 160:12-17
. Declaration of Geneva adopted by General Assembly of
World Medical Association, Geneva, Switzerland, 1948.
12. The WMA, with the BMA's consent, in 1983 amended the
words 'from the time of conception' to 'from its beginning'.