Fallout from the Glasgow Midwives case continues to roll out. This month the Royal College of Midwives (RCM) released (rather quietly) their new position statement on abortion. The case of Doogan & Wood highlighted an issue with the conscientious objection clause in the 1967 Abortion Act. Specifically this was around what constituted actually being involved in an abortion procedure.
The two senior midwives at a Glaswegian maternity unit made it clear that they did not wish to be responsible for supervising junior staff involved in termination of pregnancy procedures on the basis of a conscientious objection to abortion.
Although the Scottish Court of Appeal upheld their claim, The Supreme Court eventually ruled that they had no right to opt out of supervision, delegation or support of junior staff, as the right to conscientious objection only applied to those involved in direct, clinical procedures. Supervisory roles or other areas of care could not be subject to the right to conscientious objection in the Abortion Act.
The new RCM statement states that midwives should be involved in all care of a woman undergoing a termination, but that they have the right to opt out on the basis of conscience from only those clinical procedures directly involved in the abortion. This further hardens clause 4.4 of the NMC Code that likewise allows for conscientious objection in only limited circumstances. Furthermore, both the NMC and RCM make referral to another competent practitioner an obligation. The RCM justifies this with reference to the GMC guidelines, stating that these guidelines say a doctor who objects must refer.
Actually, the GMC says no such thing. Its guidance specifically says ‘Make sure that the patient has enough information to arrange to see another doctor who does not hold the same objection as you.’ No referral is required if the patient is able to make their own arrangements, just information to allow the patient to make that choice.
The RCM stance comes on the back of their public support for the campaign to fully legalise abortion throughout the UK. This campaign is largely led by The British Pregnancy Advisory Service (BPAS), the UK’s leading abortion provider, of which the RCM’s CEO is also Chair. It is worrying that an organisation representing professionals most concerned with the safety and wellbeing of both mother and child should be so closely allied with one of the main abortion providers in the UK. Even more so that it is joining with them to actively campaigning for the liberalisation of the few remaining safeguards in current legislation.
However, leaving that to one side, my big concern is that once again, freedom of conscience is being constricted. While care for all women facing tough choices in pregnancy is something about which all midwives will be rightly concerned, many share a strong objection to being involved in terminations of pregnancy. Over two hundred midwives signed a letter to the RCM objecting to its support of the BPAS campaign. Many more may well be ignorant of the new RCM position statement. It is not featured prominently on their website, despite being published in its latest iteration in just the last few days.
As ever, our concern is that once one area of freedom of conscience is constrained, it will be easier to constrain it in all other areas.