South Africa Changes Abortion Law (1996): Warnings ignored
Letter to the South African Medical Journal
4 April, 1997
Reproduced with permission
Harvey R.G. Ward
Bsc (Med). MBChB. DipMidCOG Registrar OBGYN
Dear Sir,
Abortion Objectors: Rights and Responsibilities
The Choice of Termination of Pregnancy Act passed recently in Parliament
has brought with it some major logistic problems particularly as a result of
doctors and nurses at many hospitals having moral objections to being
involved. These objections range from not wanting to have anything to do
with women requesting abortions to agreeing to all but the handling of the
manual vacuum aspirator themselves. Many if not most objections are based on
the reluctance to take or participate in the taking of an innocent baby's
life. Often however, zeal for the cause may result in avoidance of careful
history taking, a full and dignified examination resulting in the sloppy
handling of a patient who has made a choice albeit not one with which the
attendant concurs. This is inexcusable and may be medicolegally negligent. I
have occasioned to find that a woman requesting an abortion was not even
pregnant, and another had an ectopic gestation. I do not object to
confirming the presence of a normal pregnancy and declaring the woman
medically fit although I do feel that had she wished to keep her pregnancy
she would have been assessed at any antenatal booking clinic by a qualified
midwife. Preliminary evaluation for these women should really therefore be
performed at any antenatal clinic prior to referral.
Clearly and simply explained options and alternatives to abortion should
be made available in Gynae Outpatient departments (in the appropriate
languages) for women before they are seen and examined by staff. She may
then be able to inquire further from at least a better informed position.
An objecting doctor has every right to refuse to write up or administer
an abortifacient such as Misoprostol. If this service is to be provided,
then appropriate arrangements should be made by the medical superintendent
or regional director of Hospital services.
I think it is indefensible for an objecting doctor or nurse to refuse to
see a patient arriving at hospital as a threatened, inevitable or incomplete
abortion even with the knowledge that an abortion had been procured.
Certainly once the baby has been delivered, retained products constitute a
grave risk to her future health and fertility. Refusal to attend to her
would surely be medico legally culpable. If the objector feels that the
method by which she aborted constituted grounds for refusal to treat then
the corollary exists that he/she must refuse to see injured drunk drivers or
attempted suicide patients.
Compliance with seeing these patients on an emergency basis, however,
ensures that what used to be regarded as an "emergency" now becomes
"routine" and hence forces staff who object strongly, to participate in
abortion service to keep the system running. This is stressful and highly
unsatisfactory for the staff and should serve to motivate administrators to
designate separate staff and facilities for fetocidal purposes.
Some doctors and nurses attempt to stigmatize and even persecute
colleagues who are prepared to do abortions and run the risk of allowing
their difference of opinions to spill over into interpersonal relationships
affecting cooperation on other work. This only polarizes the profession and
generates more heat than light. The fact of the matter is that abortionists
and objectors exist, are employed in the same institutions and will not
resign their jobs. A clear statement of one's moral position does not mean a
call to arms. The need to fully cooperate to provide the vast remainder of
O&G responsibilities is critical and should not be threatened by this
divisive issue. To expect one willing member to fulfill routine duties plus
deal with the abortion load is grossly unfair and may be construed as merely
avoiding work.
With the passing of the new legislation, rights have been afforded
without the means to accede to them for many women. Little if any attempt
was made to assess the willingness of current medical staff to fulfill the
requirements of the new Act. If the Government does not take the issue of
conscientious objection seriously we face a very bleak and divided future.
Any official attempt to discriminate against objectors will inevitably end
up in the Constitutional Court at significant cost to all. If the current
impasse is not broken with creative cooperation, the stalemate may threaten
the very survival of our fragile medical network to the eventual detriment
of all.
Yours sincerely,
Dr.Harvey Ward
Registrar OBGYN