Protection of Conscience Project
Protection of Conscience Project
Service, not Servitude

Service, not Servitude

South Africa Changes Abortion Law (1996): Warnings ignored

Letter to the South African Medical Journal

4 April, 1997

Reproduced with permission

Harvey R.G. Ward
Bsc (Med). MBChB. DipMidCOG Registrar OBGYN

Dear Sir,

Abortion Objectors: Rights and Responsibilities

The Choice of Termination of Pregnancy Act passed recently in Parliament has brought with it some major logistic problems particularly as a result of doctors and nurses at many hospitals having moral objections to being involved. These objections range from not wanting to have anything to do with women requesting abortions to agreeing to all but the handling of the manual vacuum aspirator themselves. Many if not most objections are based on the reluctance to take or participate in the taking of an innocent baby's life. Often however, zeal for the cause may result in avoidance of careful history taking, a full and dignified examination resulting in the sloppy handling of a patient who has made a choice albeit not one with which the attendant concurs. This is inexcusable and may be medicolegally negligent. I have occasioned to find that a woman requesting an abortion was not even pregnant, and another had an ectopic gestation. I do not object to confirming the presence of a normal pregnancy and declaring the woman medically fit although I do feel that had she wished to keep her pregnancy she would have been assessed at any antenatal booking clinic by a qualified midwife. Preliminary evaluation for these women should really therefore be performed at any antenatal clinic prior to referral.

Clearly and simply explained options and alternatives to abortion should be made available in Gynae Outpatient departments (in the appropriate languages) for women before they are seen and examined by staff. She may then be able to inquire further from at least a better informed position.

An objecting doctor has every right to refuse to write up or administer an abortifacient such as Misoprostol. If this service is to be provided, then appropriate arrangements should be made by the medical superintendent or regional director of Hospital services.

I think it is indefensible for an objecting doctor or nurse to refuse to see a patient arriving at hospital as a threatened, inevitable or incomplete abortion even with the knowledge that an abortion had been procured. Certainly once the baby has been delivered, retained products constitute a grave risk to her future health and fertility. Refusal to attend to her would surely be medico legally culpable. If the objector feels that the method by which she aborted constituted grounds for refusal to treat then the corollary exists that he/she must refuse to see injured drunk drivers or attempted suicide patients.

Compliance with seeing these patients on an emergency basis, however, ensures that what used to be regarded as an "emergency" now becomes "routine" and hence forces staff who object strongly, to participate in abortion service to keep the system running. This is stressful and highly unsatisfactory for the staff and should serve to motivate administrators to designate separate staff and facilities for fetocidal purposes.

Some doctors and nurses attempt to stigmatize and even persecute colleagues who are prepared to do abortions and run the risk of allowing their difference of opinions to spill over into interpersonal relationships affecting cooperation on other work. This only polarizes the profession and generates more heat than light. The fact of the matter is that abortionists and objectors exist, are employed in the same institutions and will not resign their jobs. A clear statement of one's moral position does not mean a call to arms. The need to fully cooperate to provide the vast remainder of O&G responsibilities is critical and should not be threatened by this divisive issue. To expect one willing member to fulfill routine duties plus deal with the abortion load is grossly unfair and may be construed as merely avoiding work.

With the passing of the new legislation, rights have been afforded without the means to accede to them for many women. Little if any attempt was made to assess the willingness of current medical staff to fulfill the requirements of the new Act. If the Government does not take the issue of conscientious objection seriously we face a very bleak and divided future. Any official attempt to discriminate against objectors will inevitably end up in the Constitutional Court at significant cost to all. If the current impasse is not broken with creative cooperation, the stalemate may threaten the very survival of our fragile medical network to the eventual detriment of all.

Yours sincerely,

Dr.Harvey Ward
Registrar OBGYN