Matters of Conscience

I am troubled about matters of conscience. When I was first qualified in 1967 the British government brought in a law permitting abortion in certain circumstances. As a medical student I had campaigned against it on the scientific grounds that life begins at the fusion of sperm and egg and deliberately eliminating a life is murder whether the life is one day old, 9 months old or 9 years old. Looking back, I would not call my then-self a Christian, though my belief system was heavily influenced by Christian teaching. In my view a case could be made for saving the mother if the pregnancy endangered her life, but even in those circumstances an attempt should be made to save the life of the baby.

At a medical school debate I was opposed by a journalist, Daniel Farson, who was campaigning for abortion. He admitted, when challenged, that the figures on back street abortions were quite bogus, but since his cause was just, what did that matter? "In any case," he argued, "you will be alright. There will be a conscience clause for those who have religious views against abortion, so that they will not be forced to take part."

The same conscience clause was there when they introduced Sunday trading. Shop workers who were already employed would not be forced to work on Sundays if their religion forbade it. However, the strength of the conscience clause was weakened. New workers would not be able to escape Sunday working. If they objected, they should find a job elsewhere.

More recently, new legislation has not included this conscience clause. Catholic adoption agencies were not able to opt out of considering gay couple as adoptors and when civil unions were brought in for homosexuals, Registrars of Births, Deaths and Marriages were expected to conduct ceremonies for gay couples, even if they had religious objections to them. And just last week an employee of Relate, the renamed Marriage Guidance Council, was told by a high court judge that he had no escape from giving advice on sexual techniques to gay couples, even if it was against his conscience.

It is interesting that both the injured parties in the last two cases were black evangelical Christians.

This issue has also raised its head in America. In November 2007, the American College of Obstetrics & Gynecology (ACOG) Ethics Committee issued position statement #385 entitled "The Limits of Conscientious Refusal in Reproductive Medicine."

The first recommendation is: Any conscientious refusal that conflicts with a patient's well-being should be accommodated only if the primary duty to the patient can be fulfilled.

This may sound innocuous, except for the fact that 'patient's well-being' is self-defined. Thus according to ACOG a doctor is required to provide, either by himself or by a proxy, all medical services that are legal, whether or not he has moral objections to a procedure. In Oregon, for example he would be obligated to assist a patient's desire for suicide, if the legal requirements were satisfied. In resource-poor areas where there was no local abortionist, a gynecologist would be obliged to perform the operation if it were withing his competence, according to ACOG. It is notable that there is no other area of medicine where there is a duty to provide for elective procedures; not dermatology; not neurosurgery; not cardiac surgery.

Because of objections to this directive from faith-based organizations ACOG have agreed to look at the issue again. It cannot be stated to strongly that people of faith must contend for what is right. Thomas Paine and Thomas Jefferson, both supported the right of conscience to prevail. We should do no less.