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By British Association for Nutrition and Lifestyle Medicine (BANT)

Why conscientious objection in the medical profession must be protected

5 min read

Accommodation of conscientious objection is a long-respected matter of liberty and equality in this country. This respect should be as relevant today as ever, writes Fiona Bruce

The Conscientious Objection (Medical Activities) Bill is scheduled for Committee Stage in the House of Lords this Friday, and I have been watching its progress with interest. The Bill’s sponsor is Baroness Nuala O’Loan – a widely respected legal mind in the Lords who served as first Police Ombudsman in Northern Ireland, and is a former Chair of the Equality and Human Rights Commission’s Human Rights Inquiry. Among those who spoke in favour of the Bill at Second Reading were the former Conservative Lord Chancellor, Lord Mackay of Clashfern, and senior Conservative Peers Lord Elton, Baroness Eaton and the renowned surgeon, Lord McColl of Dulwich.

Conscientious objection was first provided for in the UK in 1757. In the last century, we accommodated 76,000 conscientious objectors during the two world wars. Freedom of conscience appears in every major human rights treaty, and freedom of belief is a protected characteristic in the Equality Act 2010, alongside gender, age and disability. Reasonable accommodation of conscientious objection is therefore a long-respected matter of liberty and equality in this country, and this respect should be as relevant today as ever.

Yet recent interpretations of law and practice – see for example Greater Glasgow Health Board v Doogan – mean that Baroness O’Loan’s Bill is both timely and welcome, seeking as it does to clarify and affirm that, as a matter of law, no-one with a conscientious objection should be compelled to be involved in activities which they believe involve the taking of human life, such as the withdrawal of life-sustaining treatment.

All of us have moments when we feel that we would be deeply compromised if we took (or didn’t take) a particular course of action. That is why certain issues have traditionally been the subject of free votes in Parliament. Conscience can equally be informed by a person’s philosophy, morality, beliefs, or scientific understanding. To suggest that, for example, conscience is something applicable only to those with religious beliefs would be a grossly restrictive understanding of the concept.

I have also heard criticisms that allowing conscientious objection in the medical field undermines the professionalism of those involved in the provision of healthcare. But what kind of criticism is it to suggest that healthcare professionals should be obliged to ignore their moral compass; to exercise their skills merely as functionaries of the state – particularly in matters of life and death? A sense of moral duty is often what motivates individuals to enter – and remain in – caring professions in the first place.

As well as its prominence in the Universal Declaration of Human Rights, the European Court of Human Rights has emphasised the importance of freedom of conscience in numerous judgments. The Court has argued that provision for conscientious objection is a fundamental safeguard against majoritarian abuse, and ensures that society is able to be truly diverse, democratic, and inclusive.

The doctor-patient relationship is one that society has recognised as being particularly important, as the ability of the patient to fully confide in their doctor can often ultimately affect the quality of care delivered. Their relationship is built on trust, honesty and integrity. Conscience exists to protect patients, as well as the professionals caring for them.

How strange would it be if patients simply expected their doctor to ignore their deepest moral reservations and proceed regardless? Would it not concern patients to learn that the healthcare professionals caring for them were forced to participate in activity which they fundamentally disagreed with?

To anyone who would say that conscience is irrelevant in the context of medical care, may I encourage them to read the written submission of Professor John Wyatt, Emeritus Professor of Neonatal Paediatrics at University College London, to the All Party Parliamentary Pro-Life Group inquiry into Freedom of Conscience in Abortion Provision, which I chaired. Professor Wyatt wrote: ‘It is often assumed that the role of the conscience in medicine is relevant only to a few specialised and limited areas such as abortion or contraception. But in fact the concept of the conscience goes to the heart of what it means to be act in a moral way, to act with integrity… The word ‘integrity’ is used in medicine to mean ‘intact’, ‘functional’ or ‘healthy’. Orthopaedic surgeons talk about the integrity of a joint, for example. So to have moral integrity is to be morally intact, to be internally healthy.’

Sadly, our APPG’s report revealed that there are a number of significant shortcomings in relation to the protections for conscience which currently exist in practice. All too often, the ability of healthcare professionals to conscientiously object is entirely dependent on the sympathy of their line managers or colleagues. Some have even had to give up their chosen specialism as a result of exercising their conscience, as did two experienced midwives in Glasgow in the case mentioned above – at a time when we are told our country is short of some 3,500 midwives.

Baroness O’Loan’s Bill would take important steps to address these issues, and make strong improvements to the way in which conscience is protected widely in the medical profession. It would be a concrete example of our commitment to a diverse and inclusive society, and would serve to strengthen the morale of those involved in healthcare, something surely no-one – in all conscience – could deny is a good thing.

Fiona Bruce is Conservative MP for Congleton and a member of the Joint Committee on Human Rights. The House of Lords will debate the Conscientious Objection (Medical Activities) Bill on Friday 23 March.



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