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Doctor says freedom of conscience on abortion must not be barrier to hiring

Doctors have called for the government to act to strengthen freedom of conscience for medical practitioners who do not wish to take part in abortion, opposing a move to allow discrimination against doctors in the hiring process if they do not wish to carry out abortions.

The issue has been highlighted repeatedly by medics with Doctors for Life insisting on “the need to uphold and strengthen freedom of conscience, to ensure it applies across the board to all healthcare professionals and that nobody is compelled against their principles to perform an abortion.

“Any attempt to erode freedom of conscience and bludgeon doctors into violating their principles by providing abortions against their will would rightly prompt a massive reaction from doctors,” they wrote.

Now, in an opinion piece published in the Irish Medical Times, Dr Brendan Crowley has taken aim at the suggestion in the Abortion Review that discrimination against doctors who did not want to perform abortions would be permissible in the hiring process of the Department of Health. 

“Medical practitioners are responsible to professionally set healthcare standards and legal statute. In order to exercise this responsibility honourably, they are first and foremost answerable to their own conscience, and to an ongoing commitment to patient beneficence,” Dr Crowley wrote.

He said that the relationship of patients with their doctor “depends on trust” and the freedom of conscience is a “major issue”.

“Without the principle of freedom of conscience, it is impossible for authentic trust to exist. Its absence implies compulsion, which transforms the role of the doctor from caregiver to that of a medical automaton,” he wrote.

The Cork-based doctor said that: “On the contentious issue of abortion, the duty of a doctor to exercise their freedom of conscience must be recognised and strengthened.”

“When a healthcare worker forms the opinion that an abortion is not healthcare but is the deliberate ending of human life, it is abhorrent to compel them to perform an abortion against their will. It violates the Hippocratic character of medicine as providing a social good, which has a downstream negative impact on social cohesion and trust,” he said.

Dr Crowley said that the medical profession is “enriched by the participation of individuals with deeply rooted ethical principles”, adding that “healthcare workers are required to make important value judgements which are underpinned by their firmly grounded ethical principles.”

He wrote that the report arising from the Abortion Review undertaken by the state, “raises several worrying points which would have a negative impact on freedom of conscience.”

“Its author and the Minister for Health have stated they intend to compel the eight remaining maternity hospitals into providing abortions. It’s clear that eroding freedom of conscience is a key means to achieve this,” he said.

“The report’s author herself stated at the Oireachtas Health Committee on May 31 that she would have no compunction about discriminating against doctors in the hiring process who indicated they may wish to exercise their right to consciously object to the abortion process, which they are entitled to do, under section 22 of the 2018 Act.”

At the Oireachtas hearing in May, Marie O’Shea, the Chair of the Abortion Review, was quizzed by Michael McNamara TD on the issue of employing medics who conscientiously object to abortion.

In a revealing exchange, Ms O’Shea justified the proposal by saying that the State has “a statutory obligation to provide termination of pregnancy services”.

Deputy McNamara said that his question was specific: “Does Ms O’Shea accept that it would lessen the chance of somebody with conscientious objection being recruited into the Irish health service?”

“Yes, I would imagine so,” she replied.

“Does she think that is acceptable?” the Independent TD then asked. “If you have to meet the needs of the service, yes it is,” Ms O’Shea responded.

In his piece in the Irish Medical Times, Dr Crowley said that the Report put forward an idea of a ‘balance of rights’, whereby, he said – “a hospital could undermine freedom of conscience in cases where they need to ‘uphold the right to healthcare’”.

He said that this would completely degrade the principle of freedom of conscience.

“Indeed, it undermines Article 9 of the European Convention on Human Rights on freedom of thought, conscience and religion – a fundamental right. Fundamental rights cannot be ‘balanced’, as they are basic and fundamental,” he said.

“The 2018 Act sets the parameters for legal abortion in Ireland. It provides for freedom of conscience for medical practitioners, nurses and midwives. This definition is too restrictive. During the Covid-19 pandemic there was a widespread appreciation of the valuable role played by all those involved in the healthcare sector, not just doctors,” he wrote.

“Nurses, pharmacists, hospital staff, and others who play a vital part in the provision of healthcare must also have their freedom of conscience protected. Unfortunately, whilst the report mentions how some people believe freedom of conscience should be expanded beyond just doctors and nurses to other medical professionals, the author [Marie o’Shea] simply states it, without considering it further as part of her recommendations.”

“Essentially this allows a key point of importance to wither on the vine in her report. Tolerance and understanding of various perspectives on contentious ethical issues like abortion must be paramount. Negatively caricaturing those who object to performing abortions is not conducive to a fair debate, and will inevitably produce division and misunderstanding.”

“In addition, the report’s emphasis on ‘values clarification workshops’ for hospital staff to persuade them to drop their conscientious objection to abortion is applying unfair social pressure on medical staff who are exercising their legal rights.

“The review and media commentators have constantly talked about the need for best practice, and have often cited extreme pro-choice resolutions adopted by the likes of the UN Universal Periodic Review,” he continued.

“Meanwhile, resolutions such as the 2010 Council of Europe Parliamentary Assembly resolution 1763 have been ignored. It stated that: “No person, hospital or institution shall be coerced, held liable or discriminated against in any manner because of a refusal to perform, accommodate, assist or submit to an abortion”,” Dr Crowley said.
“This is a reasonable and moderate position. It does not curb the legality of abortion, but simply recognises the diversity of perspectives in society on this most contentious of issues. Its principles should be incorporated into Irish abortion legislation.”
“A robust freedom of conscience option should not be seen as a partisan pro-life proposal. If abortion proponents are sincere about their belief in tolerance, diversity, and choice, then they should begin by respecting the rights of all medical professionals.”

He concluded that as “legislators return to Leinster House and begin to consider the recommendations of the Three-Year Review against freedom of conscience, they must bear in mind how this would impact on medical professionals who are dedicated to saving human life and view abortion as the converse of this responsibility.”

Supporting the call to oppose discrimination, Dr Ronan Cleary of Doctors for Life said that “freedom of conscience for any individual is vital. To compel anyone, doctors included, to act against their conscience is draconian.”

“The practice of medicine is not only about clinical acumen, but also about exercising one’s judgement. At a time when the country is finding it difficult to find suitably qualified doctors, the Department of Health and the HSE should be mindful of attempting to compel doctors to act against their conscience ; whether it be regards abortion or euthanasia,” he said.

“If it does start to openly discriminate against doctors because of their moral stance on abortion then I believe it will dissuade medics from working in the HSE and may lead to litigation,” he added.

At this point in time, some 90% of GPs do not provide abortions and many doctors, nurses, midwives and healthcare practitioners want nothing to do with ending a life. It remains be seen how the government will proceed, given their obsessive commitment to abortion. They might find, however, that even as the crisis in healthcare in general continues, this is a fight they would be wiser not to pursue.

Forcing medics to go against their conscience, or punishing them for doing so, has historically been a stance that was plainly shown not just to be on the wrong side, but the dark side, of history.


This originally appeared in Gript and is printed here with permission

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