ABSTRACT

INTRODUCTION The practice of discriminating between applicants for posts within obstetrics and gynaecology on the basis of their beliefs about the status of the embryo is becoming increasingly common. This affects not only the individual discriminated against, but also medicine and society as a whole. When this discrimination is faced because of a desire to please the God of the Bible it is more accurately described as persecution (Matthew 5:10-12).

EFFECTS ON THE INDIVIDUAL The effects of this persecution on the individual may be vocational, social, financial, emotional or spiritual. These include influencing ultimate choice of career, rejection by colleagues, unemployment in extreme cases, disappointment, disillusionment and temptation towards compromise. The only positives may be the maintenance of personal integrity and promise of heavenly reward.

EFFECTS ON MEDICINE & SOCIETY Excluding all those who refuse to end a human life simply because its existence happens to be inconvenient to another does medicine a disservice. It is antithetical to historical medicine which calls for self-sacrifice on the part of the doctor in order to preserve the patient according to an established ethical code. It seems that contemporary medicine only wants doctors who follow the status quo by changing their ethical framework to suit the wishes of their patients. The logical outcome of this kind of thinking is that autonomy may be considered to be of greater value than human life in a variety of clinical situations. But medical practice will become unethical if doctors are expected to give treatment which they consider to be inappropriate, such as killing an unborn child. The practice of medicine is in danger of becoming a commodity marketed with the expedient business ethic of supply on demand, where the value of human life can fluctuate as a relative integer. Denying employment to those who seek to preserve life instead of destroying it is a logical step of pragmatism in a culture where abortion is on demand. But medicine should not be a business designed to supply every demand indiscriminately when the demand may not be in the patient's best interests. If medicine evolves by defining good practice simply as what the patient wants then society will ultimately become a victim of its own unethical requests (cf. Romans 1:28-32).

CONCLUSION Discrimination against those who refuse to include ending human life as part of their job description is becoming increasingly common. However, this serves neither doctors nor patients and is a symptom of a relativistic view of medical ethics. Its detrimental effects are far-reaching, affecting individuals, the medical profession and society in general. Those who see the dangers in this trend have a duty to protect society, the future of medicine, their colleagues and themselves from wrongly redefining beneficence and non-maleficence.

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PROLOGUE

Thank you for the invitation to attend this international conference and also for the privilege of addressing you for a few short minutes. Before launching into my presentation I thought it would be good to give you some background information on who I am and how I came to be here.

I am 26 years old and graduated in medicine from Glasgow University in 1999. In March 2000 I was interviewed for a post on a 3 year General Practice Vocational Training Scheme which included a 6 month attachment in obstetrics & gynaecology. When the interview panel learned that not only was I unwilling to perform abortions, but also to prepare women for them I was denied a job, solely on that basis. After contacting the British Medical Association and an organisation called CARE (Christian Action Research & Education) I was interviewed by a journalist and ended up on the front page of a national newspaper. This one article led to further media attention in other newspapers, radio, television and (of course) the internet. The organisers of this conference came across my story and invited me to attend.

I represent two organisations. The first is called the Christian Medical Fellowship, which is made up of Christian doctors and medical students throughout the UK. Its aim is to equip Christian doctors and medical students to be the best they can be, both spiritually and professionally. The second is the Scottish Council on Human Bioethics, which is made up of around 20 doctors, nurses, midwives, lawyers and teachers who provide information on bioethical issues from a Christian perspective to the government and the media. The website addresses for these two organisations are www.cmf.org.uk and www.schb.org.uk respectively.

INTRODUCTION

My subject is "The Effect of Discrimination on Careers". I believe that the effects should be considered under two subheadings.

1. The effects of discrimination on the individual concerned

2. The effects of discrimination on medicine and society

My remarks are primarily applicable to the UK and therefore may not necessarily be true in the various countries represented at this conference.

"Discrimination" is a word we come across on a daily basis. Usually it carries with it connotations of injustice and prejudice. However, I believe it is important to note that discrimination itself is morally neutral. Discrimination is good or bad, right or wrong depending on the criteria on which judgments are made. For example, good medical practice demands discrimination on the part of the doctor. It would be a bad (and even dangerous) practitioner who did not discriminate properly between a fulminating bacterial pneumonia and influenza, or between cellulitis and a deep venous thrombosis. And, of course, God Himself discriminates between good and evil, the righteous and the unrighteous, the sheep and the goats (John 5:28-29, 1 Peter 3:12, Matthew 25:32-46). Discrimination is good and right when the appropriate criteria are used.

However, the kind of discrimination which this conference has been called to address is based on unacceptable and politically incorrect criteria. It does not choose between candidates interviewed for posts within obstetrics and gynaecology on the basis of their competence, training, experience, career intentions, postgraduate qualifications nor any other recognised professional standard but rather on the basis of their beliefs related to the status of the human zygote, embryo and fetus. This is discrimination based solely on the beliefs of the individual candidates. As such, it is a problem not only for Catholics, but also for Protestants, followers of some other religions and those whose beliefs are held independently of any religious worldview.

The main criterion used by this discrimination process is attitude to abortion. Ever since the Abortion Act was introduced in the UK in 1967 employment within gynaecology has become more difficult for those with conscientious objection. Those who survive discrimination in the interview will inevitably face it in the job when they feel unable to join in "the provision of termination services". Other issues on which those who believe that life begins at fertilisation may face opposition are so-called "contraceptives" which may act after conception (including "emergency contraception"), gynaecological treatments which may block implantation of a zygote as a "side-effect" and fertility treatments such as IVF which discard unwanted embryos. This discrimination is understandable from a pragmatic viewpoint: if all the gynaecological and "family planning" services allowed by law and demanded by patients are part of the job then why should a doctor who will refuse to provide all the "services" be employed rather than one who will?

But what kind of discrimination is this? While justifiable on the grounds of pragmatism, it is undeniable that this is fundamentally religious discrimination. If a doctor fails to get a job because of laziness, incompetence or stubbornness then we would think that the interviewers had done a good job. Failing to get a job because you refuse to do certain things which your God, religion and conscience all tell you are wrong is unquestionably discrimination on the basis of religion and according to current UK legislation this is unacceptable. Moreover, now that the European Convention of Human Rights has come into force protecting the individual's right to their beliefs (even when not part of a formalised religious system) this issue should disappear overnight, at least in theory.

Three points should be noted at this stage. The first is that whilst religious convictions and freedom of belief are now recognised as "human rights", freedom of practice is another matter. We can believe what we like as long as we have no integrity and "toe-the-line" in our practice.

The second point is that our conscientious objection is reasonable and acceptable as evidenced by current legislation. The Abortion Act itself recognises that there will be those with conscientious objection and that this must be respected. No persons should be under any duty "to participate in any treatment authorised by this Act to which he has a conscientious objection." One could understand (perhaps) if "active" conscientious objection was discriminated against (those seeking to prevent abortions or change unit policy). But we are facing discrimination because of "passive" conscientious objection (we do not stand in the way of those who request or perform abortions but we do expect to be free of any personal obligation to or involvement in the termination process).

The third point is that those who base their objection to abortion on what the Bible teaches should not be surprised when they face discrimination because of these beliefs. God promised that we would, but He called it PERSECUTION (Matthew 5:10-12).

There is no doubt that this kind of discrimination has increased in the UK since 1967. In 1996 the Christian Medical Fellowship (CMF) carried out a survey of its members and discovered that around 14% of the responders believed that they had been discriminated against at some point in their careers because of their faith. This may well be an underestimate of the true figure as only CMF members were surveyed and there is no obligation for interviewers to explain their decisions to unsuccessful candidates. This increase in discrimination is related to underlying medical attitudes which have been evolving in the UK. Understanding how we got to where we now find ourselves is vital in fully appreciating the effects that this discrimination has on careers.

BACKGROUND

I found it interesting to read a few quotes from historical statements on medical ethics to see how thinking has changed over the years. Consider the following:

I will not give to a woman a pessary to produce abortion Hippocratic Oath ~400 BC

The spirit of the Hippocratic Oath can be affirmed by the profession. It enjoins ... the duty of caring, the greatest crime being destruction in the co-operation of life by murder, suicide and abortion British Medical Association Statement 1947

I will maintain the utmost respect for human life from the time of conception even against threat The Declaration of Geneva 1948

[the child deserves] legal protection before as well as after birth The United Nations Declaration of the Rights of the Child 1959

Therapeutic abortion [may be performed in circumstances] where the vital interests of the mother conflict with those of the unborn child Declaration of Oslo 1970

I will maintain the utmost respect for human life from its beginning The Declaration of Geneva (amended) 1983

Abortion is a basic health care need Royal College of Obstetricians & Gynaecologists 2000

Note the change in the amended Declaration of Geneva (1983). We respect human life from its beginning now, not from the time of conception as in 1948. And it's convenient to leave the time when life begins undefined if we want to justify abortion.

Medical attitudes to abortion remained fairly static for around 2000 years, from the time of Hippocrates to just after the Second World War. Then they began to evolve at an exponential rate. Hippocrates view of medical ethics can be described as "deontological" from the Greek word "deon" meaning duty. Hippocrates believed that he had a duty to do certain things and a duty not to do other things, including abortion, euthanasia, breach confidentiality and have sex with his patients. For him, it was wrong to kill simply because killing was wrong. Deontological ethics are based on abstract absolutes; final statements about what is right and wrong made without reference to an external source of authority.

In contrast, modern medical ethics are based more on a utilitarian approach, where something is "right" or "wrong" only insofar as it results in the most happiness for the most people (happiness being undefined). It is therefore obvious that the deontological and utilitarian approaches are at opposite ends of the same spectrum. Deontologists are concerned with means and methods, not ends and consequences (the ends never justify the means), whereas utilitarians emphasise ends and consequences (the ends always justify the means).

The Biblical view stands in stark contrast to these extremes. It makes it clear that in God's ethics, both the ends and the means, the methods and the consequences are all of vital importance. Thus Biblical ethics make absolute and final statements about what is right and wrong as in deontological ethics but with clear reference to an external source of authority (God Himself). But as this is God's world and God's commandments are designed to be for our ultimate good, we are persuaded that Biblical ethics will also ultimately bring the most happinness to the most people (happiness being defined in God's terms).

In the UK the current thinking in the medical world is different in the respective areas of treatment and ethics. "Evidence-based medicine" has come to the forefront of British medical thinking in an attempt to ensure that only treatments which have been shown to be effective and safe (in terms of their risk:benefit ratio) are used. Thus treatment is based on science so that we can assure our patients (and ourselves) that their management is the best that modern medicine can manage according to a source of authority outside our personal opinions and experience.

This thinking, however, does not extend into the sphere of medical ethics. Ethical decisions are not made with reference to evidence or any other form of external authority. Rather ethics are being based on utilitarianism, which is nebulous, undefined and relativistic in nature. How do we determine if something should be done or not? What constitutes "good" practice, as opposed to "bad" practice, in terms of ethics? "Good" practice is being determined by a combination of public demand and relativism when defined under a utilitarian ethical framework. The public ask for what they want according to their perception of what will make them happy; how can we know if their request is a "good" one or not if our source of authority is public demand?

The corollary of all this is that "bad" practice is then also defined in terms of what the patient wants. It is only one step from this to a doctor being viewed as a "bad" practitioner when he or she, for conscience' sake, refuses to manage a patient according to their demands.

The consequences of the above situation can be predicted using simple logic, as well as observed. Whilst it is almost universally accepted that everyone should have freedom of belief, it does not automatically follow that everyone, therefore, has freedom of practice. In an ideal world I'm sure that conscientious objection would be respected in practice as well as in law; freedom of practice would thus be assured. However, when there are finite resources, when patients demand a service they are legally entitled to and when only a limited number of doctors may be available to provide that service it is inevitable (and pragmatically justifiable) that applicants without conscientious objection to a large proportion of general elective gynaecology will be chosen over those who have. Most of the time discrimination is not based ultimately on ethical judgments but rather on expediency and resource provision.

The problem with this is the underlying assumption that abortion is not "wrong" in the Biblical, theistic or deontological senses of the word. Doctors with conscientious objection have been accused of "asserting the moral high ground" in believing abortion to be wrong. But surely the boot is on the other foot; those who believe abortion is justifiable and discriminate against those who do not are the ones who stand guilty of their own charge of ethical snobbery and imperialism. Are they not, after all, saying that their viewpoint is better than ours?

And so we have reached the stage where conscientious objection to abortion is verbally respected, but rejected in practice. This is ultimately due to the underlying assumptions about what constitutes good practice according to a utilitarian ethical code. The unthinkable has happened; doctors who refuse to kill are being viewed as second rate practitioners. But to think that this is the bottom line is to miss the real point. It is God Himself who is being rejected by the medical profession at large. This itself is no surprise to those who know His Word.

EFFECTS ON CAREERS

Effects on the individual concerned

The effects of discrimination on the individual are fairly obvious and indeed have been experienced by many people attending this conference. I believe that most of them come fall into the categories of vocational, social, financial, emotional or spiritual effects. These include failing to get a job or failing to be promoted, damage to relationships with colleagues, unemployment and loss of income, disillusionment and disappointment. The only encouragements may be the comfort of an intact conscience and the anticipation of heavenly reward as promised by God (Matthew 5:10-12).

Effects on medicine & society

By embracing utilitarian ethics we have reached the stage where patient autonomy is valued more than human life. A "mother's" right to abortion is now favoured over her fetus' "right to life". This has resulted in a radical change in how we define beneficence and non-maleficence. Abortion is viewed as beneficent and refusal maleficent. This change has been driven by a paradigm shift in doctor-patient relationships from paternalism to the opposite extreme, a "business model" of medical practice where supply is matched almost unquestioningly to demand.

This will ultimately result in the exclusion of those with conscientious objection from working within obstetrics and gynaecology if they refuse to compromise. The specialty thus evolves from being one primarily concerned with bringing new lives into the world to one which is as equally focussed on ending lives. This is the antithesis of historical ethics. The very ones who took an oath to make personal sacrifice in order to preserve life have become those who destroy it. Left unchecked this results in society becoming a victim of its own unethical requests (cf. Romans 1:28-32).

This means that there is a real possibility that obstetrics and gynaecology may become a specialty closed to those who refuse to kill. It may not reach that destination alone; others such as geriatrics and palliative care may follow as there is ethically no difference between abortion and euthanasia.

CONCLUSION

Discrimination against those with conscientious objection to abortion who wish to train and work in obstetrics and gynaecology is increasing. This is having and will continue to have detrimental effects on individuals, medicine and society. While it appears to be fundamentally intolerance and religious bigotry the thinking Christian knows that it is just one form of the persecution which he or she is promised when seeking to follow Jesus Christ. But is there something we should and can do to protect not only ourselves but also the millions of young lives which are being so cruelly and thoughtlessly ended throughout our world? Of course there is.

PROACTIVE STRATEGIES

Before outlining some of the strategies I believe we should use in tackling this issue, I believe it would be helpful to summarise the problem. Doctors who have a conscientious objection to abortion are less likely to get a job and/or promotion within obstetrics and gynaecology than those who do not; this is discrimination on the grounds of belief and/or religion and is therefore illegal in most countries. However, the reason for this discrimination is usually not simply religious prejudice on the part of the interviewers. In the vast majority of cases it is simply an issue of resources. Just as you would employ a laboratory technician who is happy to analyse blood samples overnight when on-call before one who is not, so it appears reasonable to employ doctors who will not disrupt "termination services" before those who might. The problem with this analogy, however, is that the underlying assumption in both cases is that the provision of lab. services and abortions are morally comparable, i.e. they are both good and desirable. The problems must therefore be dealt with on three levels.

1. Conscientious objection to abortion should be established as being a viewpoint which is at least as valid as believing that abortions are acceptable.

2. No doctor should be denied employment because of their beliefs in this area, either on the basis of moral prejudice or resource issues.

3. As this situation has arisen only because abortion has been legalised, the focus of our energies should be on the political and public level.

How can we do this?

Evidence & education

We need to know the facts about every area of sexual and contraceptive health. Only then can we claim to be able to judge what treatment is best for our patients and only then can we engage in meaningful debate with our pro-abortion colleagues. Both scientific studies and Biblical theology show that the healthiest lifestyles are based not only on healthy diet, exercise and not smoking but also on lifelong heterosexual monogamy in the context of marriage. The best contraceptive is abstinence; the only sure way to avoid STDs is celibacy or mutual monogamy. Doctors know this but are afraid to say it in case they are accused of being judgmental and condemnatory. The public by and large are ignorant of all this and those who find out (often in a way deleterious to their health) are upset that they weren't told in the first place. Whose agenda are we following, God's or Satan's? We need to establish the facts - the risks and treatments and disseminate them to each other, to our patients, to church leaders, to the authorities and to our schools. If we don't do this, then who will?

Co-operation & integrity

One person saying "No" can make a difference, as I found out. But when many voices from around the world join together who knows what will result? If we can work in hospitals and clinics with colleagues who are abortionists then we can work with those who believe that abortion is wrong. Protestant and Catholic, Muslim and Jew do not have to worship together or pretend that they believe the same things, but we can work together publicly, politically and professionally in an attempt to end the mass genocide of unborn children. This conference is a start. But above all we must be prepared to suffer for our stand. If our actions and lifestyles fail to match up to the message we proclaim and the protest we mount then we will be exposed as hypocrites. This means that we have a duty to educate and encourage others in our respective faiths so that the usefulness of our testimonies will not be diluted by the beliefs of our uninformed or ill thought-out religious associates.

Publicity & politics

By establishing the facts and a credible testimony we can have strong political influence, both through sympathetic politicians and publicity. The media loves controversy and discrimination can soon become "high-profile", generating public sympathy and resulting in pressure being brought to bear on politicians. As the discrimination has only come into existence through legislation at the political level, this must be our primary target if we want to change the current situation.

Around 2000 years ago a group of 11 frightened men sat in a locked room, afraid of their countrymen (John 20:19). But after being empowered by the Holy Spirit they went out into the world with great courage and boldness and were soon described as the men who turned the world upside down (Acts 2, Acts 17:6). One with God is a majority. Human lives, the medical profession and society in general are in grave need of salvation. What are we waiting for?