In the latest bid to circumvent the increasing number of younger doctors being unwilling to perform abortions, a new report has challenged the need for some surgical abortions to be undertaken by doctors at all.
Sally Sheldon, a Law Professor at the University of Kent, has published a study into the 1967 Abortion Act and subsequent legal opinions to argue that in the case of vacuum aspiration (VAs), midwives or nurses should be able to carry out the procedure.
This, she argues is congruent with ‘recognition of nurse competences, follows government policy that patients should receive the right care, in the right place at the right time by appropriately trained staff, fits with guidance offered by relevant professional bodies, and offers the potential for developing more streamlined, cost-effective abortion services’
Doctors, she says, should still make the decision, but an appropriately trained nurse or midwife is technically capable of undertaking the procedure, meaning that abortions can be carried out more readily, quickly (and presumably, cheaply – given the current pay differential between doctors and nurses).
This is attractive to the ear of the government health minister, as it increases the supply to meet the demand without a massive increase in cost. It is joy to the ear of the Royal Colleges of Nursing and Midwifery (RCN and RCM), because it further recognises the extended role of the nurse and midwife. And it is a delight to the ear of the abortion industry, which stands to profit financially.
Sheldon has long been an ardent campaigner for abortion law reform and has received government funding of over half a million pounds for research into the ‘biography’ of the 1967 Abortion Act. So her findings should come as no surprise. She is hardly a disinterested legal practitioner.
There is one, big caveat in all this. As Sheldon notes, only practitioners who have been awarded the appropriate qualification by the Faculty of Sexual & Reproductive Healthcare (FSRH) of the Royal College of Obstetricians and Gynaecologists (RCOG) can perform VAs. At present FSRH will not train nurses and midwives to perform surgical abortions. However, this study may lead to a change of mind, although it is equally likely that the RCOG will not be too keen to break the medical monopoly on this area of training.
But the real concern will be over freedom of conscience. If nurses and midwives are legally empowered to train and perform VAs and, in time, other surgical terminations of pregnancy, how long before it becomes a fundamental part of their job description? Even if the Abortion Act allows for freedom of conscience in performing terminations, the FSRH training could become essential to some posts in obstetric nursing and midwifery.
However, as we have reported before, the FSRH currently refuses to award its family planning qualifications to any nurse, midwife or doctor who has a conscientious objection to certain (especially abortifacient) contraceptives. Given this stance, it is likely it will refuse to train any midwife or nurse who has any conscientious objection to abortion in any clinical area.
We are already aware of family planning nurses facing this issue with employers and the FSRH. How long before nursing and midwifery practitioners find their conscientious objection blocks their access to any specialist training?
In Sweden we have already seen a midwife effectively barred from employment because she has expressed a clear conscientious objection to being involved with abortions. How long before similar issues arise in this country?
Well, we are already seeing an erosion of the freedom of conscience for health professionals in the UK. The Glasgow Midwives ruling and subsequent changes to the Nursing & Midwifery Council (NMC) Code has put strict boundaries on areas in which midwives and nurses can exercise freedom of conscience. The recent changes in General Pharmaceutical Council (GPhC) guidance have effectively removed the right of freedom of conscience from pharmacists.
Will we start to see areas of healthcare becoming effective no go areas for Christians and others who have conscientious objections to abortion? And if it starts with abortion, in which other areas of healthcare will we in time find freedom of conscience effectively outlawed.
The findings of the Sheldon study seem to be seeking to shift the responsibility for clinical abortions further on to midwives and obstetric nurses, the majority of whom did not go into the profession to be involved in terminating the lives of unborn babies. Furthermore, individual nurses and midwives tend to be more vulnerable to dismissal. Nursing and midwifery unions and wider professional bodies are usually a lot less supportive on issues of conscience than those of the medical professions.
This legal study is, I strongly suspect, part of a concerted move to get a ‘less troublesome’ professional group ‘empowered’ to undertake abortions. We need to be standing together to challenge any such discrimination and potential erosion of freedom of conscience.