The unsettled status of conscientious objection in the UK

BioEdge

Michael Cook

What are the rights of doctors who have a conscientious objection to certain procedures in the United Kingdom? The slightly confusing status quo is the subject of an article in the Journal of Medical Ethics by a Cambridge University academic, John Adenitire.

Dr Adenitire sketches a gradation of hostility towards conscientious objection.

1. At the very top there are Julian Savulescu and others who have argued that conscientious objection is “a door to a Pandora’s box of idiosyncratic, bigoted, discriminatory medicine” and has little place in modern medical practice. This is not a widely shared view.

2. Then there is the British Medical Association (BMA), the profession’s “trade union”, which defends conscientious objection only in three specific scenarios. It “should ordinarily be limited to those procedures where statute recognises their right (abortion and fertility treatment) and to withdrawing life-prolonging treatment from patients who lack capacity, where other doctors are in a position to take over the care.”

3. And then there is the General Medical Council (GMC), the profession’s regulator in the UK, which allows conscientious objection, albeit with a number of caveats. According to its 2013 policy statement, Personal beliefs and medical practice: “You may choose to opt out of providing a particular procedure because of your personal beliefs and values, as long as this does not result in direct or indirect discrimination against, or harassment of, individual patients or groups of patients. This means you must not refuse to treat a particular patient or group of patients because of your personal beliefs or views about them.‡ And you must not refuse to treat the health consequences of lifestyle choices to which you object because of your beliefs.”

4. Most accommodating of all is a ruling of the European Court of Human Rights (ECtHR) in the British case of Eweida in 2013. It applied Article 9 of the European Convention on Human Rights to several cases of discrimination in the UK. Article 9 guarantees “the right to freedom of thought, conscience and religion”, “subject only to such limitations as are prescribed by law and are necessary in a democratic society in the interests of public safety, for the protection of public order, health or morals, or for the protection of the rights and freedoms of others”.

It is Dr Adenitire’s contention that the Eweida ruling “effectively provides that medical professionals have the right to conscientiously object to providing certain healthcare services well beyond the scope endorsed by the BMA”.

This implies that “Given the unsettled nature of the law on the topic, [National Health Service] employers will have to proceed very cautiously as it will not always be clear whether denying a request will be considered lawful by a court. This entails that NHS bodies may be at risk of expensive legal challenges by medical professionals whose requests have been denied.”

Dr Adenitire therefore believes that the BMA’s policy should be changed to align more closely to the Eweida ruling.

However, the law is still unsettled and Dr Adenitire is not necessarily hostile to proposals for legalised assisted dying which are currently being debated in the UK. In an unpublished paper he goes on to argue that in certain circumstances doctors already have a “conscience-based right to provide assistance in dying”.


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Canary in the Coal Mine: Mounting Religious Restrictions in Europe

Religious Freedom Project
Berkley Center for Religion, Peace and World Affairs

Roger Trigg

On January 15, 2013, the European Court of Human Rights issued judgments on four cases of great significance for the cause of religious freedom. What they say could well have repercussions beyond Europe itself. . .

These four cases all came from the United Kingdom, and concerned the place of religion, and a religiously formed conscience, in modern European society. . . The point of principle at stake is how much importance should be given publically to religiously based principles, particularly in societies that are growing increasingly secular. [Read on]

 

Medicine, Strasbourg, and conscientious objection

European Court of Human Rights decision

Julian Sheather*

. . .Conscientious objection is a live issue in medicine. . . Given the prevailing political pluralism—given the co-existence in our culture of different value systems—to what extent should medicine accommodate such objections? Should those whose consciences differ be treated differently? What forms of conscientious objection should be tolerated and on the basis of what criteria?
[Full Text]

‘Obsessive Political Correctness’ Trumps Freedom of Conscience

 European Court of Human Rights Gives Ruling on Religious Freedom Cases

ROME, January 16, 2013 (Zenit.org).

Today, the Fourth Section of the European Court of Human Rights has issued an important ruling on freedom of conscience and freedom of religion. While it contains some positive language regarding the wearing of religious symbols, the ruling is deeply worrisome with regards to the freedom to act according to one’s individual conscience. [Read on]

 

Polish law and conduct of Polish physicians, clergy, activists and authorities leads to adverse judgement

Sean Murphy*

The European Court of Human Rights has issued a judgement adverse to freedom of conscience and ordered Poland to pay two complainants, a mother and daughter, a total of 61,000 Euros in damages and costs.  Subject to the possibility that the English translation of the judgement is faulty, the use of the term “anti-choice activist” by the judges brings their impartiality into question.  However, the facts of the case outlined in the judgement suggest that the conduct of Polish health care personnel, anti-abortion activists, clergy and state authorities effectively guaranteed an adverse outcome.

A 14 year old girl, P. supported by her mother, S.,  sought an abortion for a pregnancy alleged to have been the result of a rape.  While she obtained the necessary prosecutor’s certificate for the procedure, mother and daughter received contradictory information from two public hospitals in Lublin.  Further, health care personnel clearly violated principles of patient confidentiality and informed consent in an effort to dissuade the girl from having an abortion.  These violations included clearly coercive and manipulative tactics.  P and S experienced

  • the intervention of a priest and anti-abortion activists, unsolicited and unwanted,
  • importuning by anti-abortion activists that included confrontations in public,
  • national media attention, including a press release issued by a hospital concerning P,
  • detention and six hours of questioning by the police,
  • apprehension of the girl by state authorities, apparently for the express purpose of preventing the abortion,
  • posting on internet by the Catholic News Agency of the girl’s travel to Gdansk for an abortion,
  • the filing of criminal charges against the girl for having had unlawful sexual intercourse with a minor (i.e., the rape that resulted in pregnancy)

While the court found that objecting physicians had a legal obligation to refer patients for abortion, the source of that legal obligation was Polish law.  Article 39 of Poland’s Doctor and Dentist Professions Act imposes a legal obligation of referral.  The imposition is objectionable in principle, but the European Court of Human Rights can hardly be criticized for applying Polish law to Polish citizens.

‘Expert panel’ on abortion generates controversy in Ireland

A panel of 13 ‘experts’ chaired by Mr. Justice Seán Ryan of the High Court of Ireland is to study a European Court of Human Rights ruling on abortion and advise the government what should be done in response [News release; Irish Times].  Four members of the panel – Mary O’Toole, Dr. Peter Boylan, Dr. Deirdre Madden, and Ailish Ní Riain – have been identified by anti-abortion groups in the country as having previously indicated that they favour legalizing abortion or reducing restrictions on it.   [Life Institute 16 Jan 2012, 20 Jan 2012]