I was very struck by the phrase “the abuse of conscience” used by Pope Francis in his apology for the abuse perpetrated on minors by members of the clergy and hierarchy; he apologised not only for sexual abuse and the abuse of power but also for the abuse of conscience (Letter to the People of God, August 20, 2018). The Catholic Church is not the only institution that has failed to protect people from the abuse of conscience. The Oireachtas has questions to answer in this regard too.
There is a section entitled ‘Conscientious Objection’ in the Health (Regulation of Termination of Pregnancy) Bill 2018 that the Government intends to enact within the next few weeks. It provides for a medical practitioner, nurse or midwife to opt out of carrying out, or participating in, a termination of pregnancy; but it obligates him or her to make the necessary arrangements for the pregnant woman to undergo the abortion elsewhere. It also envisages that abortion will generally be drug-induced in the first trimester and presumes that all pharmacists will routinely stock and dispense drugs whose specific purpose is to end human life, as the Irish Bishops noted in their recent statement ‘Abortion Referral: An Affront to Conscience’.
There is no provision in the Bill for pharmacists to opt out on the grounds of conscientious objection.
An amendment to the provision on conscientious objection was debated in the Dáil on December 5, but it was defeated by 75 votes to 30. That vote means that the abuse of conscience is now perpetrated by the Oireachtas on healthcare professionals who have a conscientious objection to taking part in any administrative or practical arrangements for abortion.
Using the law to compel doctors, nurses, midwives and pharmacists to co-operate with a law that flies in the face of the core ethic of the healthcare professions is an abuse of conscience. It takes the forms of coercion, manipulation and pressure. It is an abuse of conscience to use the law to coerce a healthcare professional into complying with acts contrary to her/his conscience.
It is an abuse of conscience to manipulate a healthcare professional into co-operation with the preparatory stages of arrangements for an act that is contrary to his/her conscience.
It is an abuse of conscience to pressurise healthcare professionals into keeping silent about the injustice done to them by refusing to hear their concerns. This is a violation of human dignity and freedom and its incorporation in legislation makes a travesty of the law.
The Irish Medical Council is tasked with the responsibility of fulfilling its functions by the Medical Practitioners Act. One of those functions is specifying the standards for ethical conduct – not abdicating that responsibility to legislators and then adopting the legislative provisions as if they were ethical standards. It has published eight editions of its code of professional conduct and ethics to date.
The first and second codes (1981 and 1984) are very much in the spirit of the Hippocratic Oath and state that “doctors must maintain the time-honoured medical principle that every effort should be made to preserve human life, both born and unborn”.
The reference to the time-honoured medical principle has been dropped from subsequent codes and the most recent code (2016) simply states: “You have an ethical duty to make every reasonable effort to protect the life and health of pregnant women and their unborn babies.”
Now, with abortion being legalised for the first time in Ireland, one wonders whether the Medical Council will incorporate into its next, revised code of ethics and professional conduct a legislative provision that compels doctors to act contrary to conscience?
Or will it support doctors who conscientiously uphold “the time-honored principle” articulated in its first code of ethics “that every effort should be made to preserve human life, both born and unborn”?
The same questions can be asked of the Irish Nurses and Midwives Organisation and the Pharmaceutical Society of Ireland. The attempt by politicians and legislators to set the boundary of ethical practice in healthcare needs to be challenged by these professional bodies in order to ensure the integrity of the healthcare professions and to safeguard patients at all stages of human life.
It should not be beyond the capability of the Oireachtas to draft legislation that does not abuse the conscience of members of the healthcare professions.
New Zealand provides such a model: it respects the conscientious objection of medical practitioners and requires only that they inform their patient that a service can be obtained from another healthcare professional.
It is incumbent on the Oireachtas to remove the ‘abuse of conscience’ provision from the Regulation of Termination of Pregnancy Bill 2018 and replace it with a provision that respects the conscientious judgement of doctors, nurses, midwives and pharmacists in all circumstances.
Dr Noreen O’Carroll lectures in medical ethics at the Royal College of Surgeons in Ireland and the views expressed in this article are personal.