Ireland’s 2018 Abortion law is now up for review. Freedom of conscience is the major issue writes Dr Brendan Crowley
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.
This is in line with the expectations of patients, whose relationship with their doctor depends on trust. 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.
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.
The medical profession is enriched by the participation of individuals with deeply rooted ethical principles. Healthcare workers are required to make important value judgements which are underpinned by their firmly grounded ethical principles.
The recently released report arising from a statutorily-required review into Ireland’s abortion laws 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.
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.
The Report’s idea of a ‘balance of rights’, whereby a hospital could undermine freedom of conscience in cases where they need to ‘uphold the right to healthcare’ completely degrades 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.
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.
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 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.
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.”
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.
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.