Protection of Life During Pregnancy Act 2013 and physician freedom of conscience (2022)

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Irish health care has a long-held tradition of in cases of pregnancy treating both patients, the expectant mother, and her developing child. We are concerned with the current legal position which doctors and health care professionals, who hold an ethical objection to abortion find themselves. It is our interpretation of the Protection of Life During Pregnancy Act 2013 that if an expectant mother presents with suicidal ideation and requests an abortion, as their doctor we are placed in the unenviable position of collaborating in facilitating that mother to procure that abortion either directly by sending her for assessment for the abortion or indirectly by referring her to another clinician who we know will send her for the abortion- this is despite the wealth of evidence showing that abortion is extremely detrimental to the mental health of the mother if she is in any of the at-risk groups (list) and that there is no evidence of any beneficial effects from abortion. We have a duty as doctors, and health care professionals, to do what is in the best interests of our patients yet the law is obliging us to facilitate the killing of one patient and possibly causing inestimable damage to the other.

The Protection of Life During Pregnancy Act 2013 in reference to Conscientious objection outlined the following:

17. (1) Subject to subsections (2) and (3), nothing in this Act shall be construed as obliging any medical practitioner, nurse or midwife to carry out, or to assist in carrying out, any medical procedure referred to in section 7(1) or 9(1) to which he or she has a conscientious objection.

(2) Subsection (1) shall not be construed to affect any duty to participate in any medical procedure referred to in section 8(1).

(3) A person who has a conscientious objection referred to in subsection (1) shall make such arrangements for the transfer of care of the pregnant woman concerned as may be necessary to enable the woman to avail of the medical procedure concerned.

This is in direct contradiction to Bunreacht na hEireann Article 44.2.1º : Freedom of conscience and the free profession and practice of religion are, subject to public order and morality, guaranteed to every citizen.

Doctors for Life Ireland are concerned about implications for healthcare professionals who wish to exercise their right to conscientious objection.

In formulating this statement, we have been guided by the first principle of medical practice, primum non nocere (first, do no harm). We have also drawn on such sources as the UN Universal Declaration of Human Rights, the European Convention on Human Rights, and the codes of medical ethics of the British General Medical Council, the American Medical Association and the Medical Council of Ireland. The latter is currently being updated.

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Statement on Conscientious Objection (9 December, 2018)

Every person has a right to freedom of conscience, whereby they cannot be compelled to perform or facilitate an action which they believe to be morally wrong.  The right to freedom of conscience acknowledges the fact that we are responsible for our free actions and their consequences inasmuch as we can foresee them. It also acknowledges the fact that we cannot disclaim responsibility for our free actions simply because we are obeying the will of another person.

Because freedom of conscience is respected in a democratic society, there is also the right to conscientious objection, which is the right to refuse to perform or participate in an action with which the person does not agree.

Doctors, like everyone else, have the right to freedom of conscience. They are entitled to refuse to provide treatment which they consider to be morally wrong because to provide it would make the doctor responsible for the outcome. They are also entitled to refuse to help the patient access that treatment because that too would mean the doctor shares responsibility.

In the case of abortion, many doctors have profoundly held convictions about the right to life of the unborn child and they have the right not to perform any procedure which would deliberately end the child’s life. They also have the right not to facilitate abortion by giving information about or contact details of abortion providers.

Furthermore, doctors have the right to refuse to refer patients for abortion procedures. This is because, when a doctor refers a patient to another doctor for treatment, the referring doctor is agreeing that the treatment is necessary and in the patient’s interest.  This is usually because the referring doctor does not have the required specialist training and so has to request another doctor to look after the patient. In the case of abortion, however, the referring doctor may have the required training but still, object in conscience. Referral for abortion would be asking another doctor to do something which the referring doctor believes to be wrong. It does not lessen the referring doctor’s responsibility for the outcome and goes against his or her freedom of conscience.

Abortion legislation must recognise that doctors have the right not to perform abortions AND the right not to refer or provide information.  Abortion legislation must also acknowledge the right of medical students and doctors-in-training to refuse to participate in procedures which they do not intend to perform as professionals because of conscientious objection.

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Statement on Conscientious Objection (March, 2017)

1. The practice of medicine is a service to human dignity and doctors must adhere to the highest standards of professional competence in treating, protecting and advocating for patients.

2. In the course of their work on behalf of patients, doctors have the right not to participate in procedures which, in conscience, they believe to be wrong.

3. Doctors should not, by action or omission, deliberately shorten a patient's life. Doctors must respect a patient's fully-informed decision to refuse life-sustaining treatment or to request withdrawal of medical treatment.

4. Doctors have the right to refuse applications for referral for treatments to which they object in conscience.

5. Doctors have an obligation to provide care in emergencies, even if the condition results from a procedure to which the doctor has a conscientious objection.

6. Doctors have an obligation to explain the reasons for their conscientious objection with clarity and courtesy to patients and colleagues. Patients have a right to see another doctor and to be given impartial information as to how they can exercise that right.