The abortion Bill presented by Minister Simon Harris is now before the Oireachtas where numerous amendments have been tabled. Some deal specifically with the issue of conscientious objection and want to offer it better protection.
The Bill envisages that doctors won’t have to perform abortions, but they must refer patients on to those who will. Pro-life medics believe they cannot do this as it means their second patient – the unborn baby – will be deliberately killed.
Opponents of conscientious objection complain that the ‘personal preferences’ of doctors and nurses (and the pharmacists who have to hand out the abortion pill or the lethal component to be injected in the baby’s heart) should not prevail over their ‘duty of care.’ Conscientious objection, they claim, is an unacceptable exception to professional duties taken in the name of religious, and therefore irrational, beliefs. Morality is personal and should not interfere with someone else’s medical needs.
These arguments are based on a misunderstanding of the relationship between conscience and professional duty. They reduce the doctor to a mere ‘service-provider’ rather than a morally responsible decision-maker in their own right.
Medicine is a value-laden endeavor by its nature. It is intrinsically ethical because it is based on the moral judgement that health is a good and has to be preserved, while illness and suffering are bad and have to be avoided. Medicine combines scientific knowledge with ethical purposes. Scientific knowledge provides the means of preserving the good of health, or at least of reducing pain. Ethics means health-care must be provided in a way that does no deliberate harm to a patient.
Without ethics, a health professional is reduced to a mere technician. They perform certain medical activities well, but are allowed no real opinion as to whether their action is moral or immoral. The State, or their patient, simply tells them what to do.
But true healthcare is relational. The carer and the cared-for enter into a dialogue that enable them to take together the best decision, and each one contributes according to their expertise, experience and moral values. Professional conscience plays a fundamental role here, as it evaluates what is best.
The peculiarity of care in pregnancy is that there is a third component, i.e. the voiceless child. Doctors have duties of care towards the second patient as well, and this is the simple reason why elective abortion is not acceptable from a medical point of view, because it denies and annihilates the second patient.
We hear that endorsing conscientious objection means endorsing the principle that individual beliefs trump the health and lives of people who need a medical service. It is an excuse for doctors to exert personal power over the patient by imposing their own views.
These arguments are based on the fallacious assumption that conscientious objection is a category of religious freedom. It is sometimes the case that objectors are motivated by their religious faith, but this is not necessary to justify objection, as professional conscience is always present in identifying what course of action is appropriate in a specific case.
Refusal of care’ is a new term used to negatively refer to conscientious objection. This derogative expression is a miserable attempt to portray abortion as a form of care, and to stigmatise those who do not want to be involved in its provision. But medical professionals refuse abortion precisely because it doesn’t take care of the second patient, i.e. the unborn child. According to the Bill recently proposed by Minister Harris, abortion is “a medical procedure which is intended to end the life of a foetus.” How is this care?
Conscience is an ordinary element of medical decision making. It is inseparable from the routine, day-to-day practice of medicine. Those who present objection to abortion as a refusal to treat forget that there are two, and sometimes more patients in a pregnancy, and the doctors and other professionals have a duty to care for all of them, particularly the most vulnerable.
Conscientious objection to a medical intervention can be justified if it conflicts with the doctor’s oath to do no harm and to respect life. The same considerations apply in the debate about assisted suicide. When an action is not aimed at preventing or curing a disease, it can be hardly considered as medical.
In forcing doctors to be involved in abortion, directly or indirectly (by referral), the State treats them as mere instruments without a conscience. Their scientific knowledge is not at the service of the good, i.e. health, but of an ideology of absolute autonomy of the patient.
This betrayal of medicine is grounded on the disregard for the role of professional conscience in all medical decision-making, and not only when ethical dilemmas arise. If conscience is a fundamental component of medical decision-making, then there is no medicine without conscience.