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Submission from the Christian Medical Fellowship to the Department of Health, Social Services and Public Safety of Northern Ireland on their consultation on Guidance on the Termination of Pregnancy: The Law and Clinical Practice in Northern Ireland

Published: 25th October 2010

Introduction

The Christian Medical Fellowship (CMF) is an interdenominational organisation in the UK with over 4,000 doctor members and around 1,000 medical student members. Of these, 240 doctors and 106 students are members in Northern Ireland. All members are Christians who desire their professional and personal lives to be governed by the Christian faith as revealed in the Bible. Members practise in all branches of the profession, and through the International Christian Medical and Dental Association are linked with like-minded colleagues in over 100 other countries.

CMF regularly makes submissions on ethical matters to Government committees and these may all be seen at www.cmf.org.uk/publicpolicy/submissions/. Perhaps most relevant to the subject matter of this consultation is our 2007 submission to the House of Commons Science and Technology Committee's new Inquiry into Scientific developments relating to the Abortion Act 1967:

We note the history of the legal requirement to revise the guidance: 'The Department has revised the sections on counselling and conscientious objection and has incorporated them into the Guidance document and is now issuing them for consultation'. We therefore comment briefly on these sections only.

4. Conscientious objection

4.2 describes circumstances where the practitioner 'may not refuse' to participate in a termination, and emphasises 'where the life of the woman is in danger'. We understand that Girvan LJ in his November 2009 High Court judgment felt the Guidance here was insufficiently clear, and it remains unclear whether a threat to life on mental health grounds is included?

For example, if a woman threatened to commit suicide unless a lawful termination were given, a practitioner exercising conscientious objection declined, and she then acted upon her threat, would the practitioner be liable?

4.3 and 4.4 elaborate the threat of criminal liability, but in our view the Guidance has not adequately addressed the meaning of 'where the life of the woman is in danger', particularly with regard to mental health grounds.

4.5 addresses General Medical Council guidance, but does not adequately consider the significance of the later expansions in the 2008 Personal Beliefs and Medical Practice, on the subject of a conscientious objector being obliged to refer to another who does not have such an objection.

When that guidance first appeared, CMF obtained clarification regarding conscientious objection in the question of abortion from the Chair of the GMC Ethics and Standards Committee as follows:

'You ask three specific questions about whether our guidance obliges doctors to provide particular services:

1. Will doctors be obliged to sign abortion authorisation forms? 2. Will doctors be obliged to clerk patients for abortion (i.e. carry out pre op examination and assessment)? 3. Will doctors be obliged to refer patients seeking abortion to other doctors who will authorize it?

The answer to all three questions is 'no' – see Good Medical Practice and paragraph 21. Reading paragraph 26 in the context of Good Medical Practice and the preceding paragraphs of the supplementary guidance (particularly paragraph 21), should ensure that readers understand our intention in this guidance. This is to distinguish between doctors refusing to participate directly in, or facilitate the execution of, procedures to which they have a conscientious objection on the one hand, and on the other, refusing to provide any other care on the grounds that the patients concerned were about to undergo, or had undergone such a procedure. It is the procedure to which the doctor objects, not the patient.'
(PDF of original letter)

The GMC therefore clearly does not insist on referral. The inference of 4.5 (and 4.6 quoting the High Court) is that a practitioner with a conscientious objection should refer to another who does not have one, which makes a mockery of the principle and constitutes a breach of Article 9(1) of the European Convention on Human Rights. This inference should be removed by a revision of the draft.

Particularly with regard to this mistaken requirement to refer, Section 4 erodes the right to object on conscience grounds, one which arises from the medical ethical tradition and is guaranteed in international instruments of human rights. This erosion unacceptably undermines the individual practitioner's fundamental convictions. The Guidance should be changed accordingly.

5.7 – 5.17 Counselling

5.14 Girvan LJ made clear in his judgment that, in keeping with the law in Northern Ireland, abortion should always be discouraged, and this has not been recognised adequately in this consideration of women in Northern Ireland having a termination of pregnancy outside Northern Ireland. We hold that the language of a 'grey area' yet to tested by the courts could be interpreted as a veiled encouragement to test this very issue, and is therefore outside the spirit of the judgment. 5.14 should be revised.

5.15 seems too loaded towards counsellors not advising a woman to refuse to have a termination which has been recommended by a medical practitioner. Dispassionate, non-judgmental counselling requires that it might be equally right to advise to refuse, and the Guidance should be completely balanced.

5.16 Given the growing evidence, much in peer-reviewed journals as well as anecdotal, of serious physical, psychiatric, psychological, social and spiritual difficulties after abortion (see CMF File 35: Consequences of Abortion www.cmf.org.uk/publications/content.asp?context=article&id.85), the provision of specialised counselling should be emphasised more strongly than 'should be offered' and 'should…be made available'.

5.17 We commend the recognition of the benefit of spiritual help.

7 Providing information to women

7.1 We include this comment on another section, because it relates to the concept of 'counselling'. We are surprised by the inclusion of the words 'in full': either the legal criteria for termination are met, or they are not. The words in 'who does not meet the criteria in full' imply that the criteria can be met in part. They introduce ambiguity and we suggest they be removed.

Conclusion

Christian Medical Fellowship, and particularly our members in Northern Ireland, is grateful for this opportunity to comment. We are willing to help further if asked.

On behalf of the whole Fellowship,
Dr Andrew Fergusson Head of Communications,
Christian Medical Fellowship
020 7234 9675
andrew.fergusson@cmf.org.uk
21 October 2010

For further information:

Philippa Taylor (CMF Head of Public Policy) 020 7234 9664
Steven Fouch (CMF Head of Communications) 020 7234 9668

Media Enquiries:

Alistair Thompson on 07970 162 225

About CMF:

Christian Medical Fellowship (CMF) was founded in 1949 and is an interdenominational organisation with over 4,000 British doctor members in all branches of medicine. A registered charity, it is linked to about 65 similar bodies in other countries throughout the world.

CMF exists to unite Christian doctors to pursue the highest ethical standards in Christian and professional life and to increase faith in Christ and acceptance of his ethical teaching.

Christian Medical Fellowship:
uniting & equipping Christian doctors & nurses
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