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How the “conscience” objection for doctors is being used to threaten safe access to abortion

A new parliamentary report seeks to expand how far a doctor’s “conscientious objection” to providing abortion can stretch.

Getting an abortion in the UK is an exercise in hoop-jumping. You have to find a doctor willing to refer you (jump), convince them your case satisfies the conditions of the 1967 Abortion Act (jump), have a second doctor confirm this (jump), and get yourself to a clinic (jump). Given that the 1967 Abortion Act doesn’t apply in Northern Ireland, and provision varies by region depending on doctors’ expertise, jumping all these hoops will involve travelling hundreds of miles and spending hundreds of pounds for many women every year.

That, however, is still considered too much of an easy ride by the politicians and campaigners who’d like to close down women’s right to choose. With no prospect of achieving an end to legal abortion, anti-abortion activists have focused their efforts instead on tightening those hoops and adding a few more, in the hope that some women will get stuck on their way through. So far, they haven’t had any legislative success, but that hasn’t stopped them from trying.

In February 2015, Fiona Bruce tried to add an amendment to the serious crime bill to “make it clear that conducting or procuring an abortion on the grounds that the unborn child is a girl – or a boy (although this practice mainly affects girls) – is illegal”. It was, as the campaign group Abortion Rights (I’m on the executive committee) pointed out, a Trojan horse: using the pretext of a non-existent sex-selection problem, Bruce sought to reclassify the foetus in law as an “unborn child” and, by specifying that “procuring” an abortion should be illegal, implied that women who seek abortions for supposedly “bad” reasons should be criminalised.

Sensibly, Bruce walked back from the latter wording; thankfully, the amendment was defeated anyway. But she hasn’t given up, and now she’s back with a new hoop. Yesterday the All-Party Parliamentary Pro-Life Group, of which Bruce is a member, published its report on freedom of conscience in abortion provision. If the Trojan horse amendment was about restricting the remit of the 1967 Abortion Act, this new approach is about making it harder for women to find healthcare providers who will facilitate terminations at all.

Under the 1967 Act, medical staff can exercise a conscientious objection to involvement in “any treatment authorised by this Act”. The exemption is important – no doctor should be forced to act against their own conscience – and so is the specification that it applies directly to treatment. In 2014, two Glasgow midwives lost a case at the High Court in which they argued for an expanded interpretation that excluded them from delegating, supervising and supporting staff carrying out abortions: the court concluded that treatment meant only direct involvement in the procedure, and in doing so, protected women from incalculable interference in their ability to obtain abortions. This broader reading is a creeping, tendril-ish interpretation that would allow any anti-choice professional, however tangentially employed in the procedure, to obstruct it simply by making scheduling impossible.

Unsurprisingly, the All-Party Parliamentary Pro-Life Group would like this prohibitive reading of the law to stand. Among their recommendations are that “the Government should consider the feasibility of extending conscientious objection to indirect participation” and “no doctor who has a conscientious objection to abortion should be required to refer a patient to another practitioner”.

The general interpretation of the law now is that doctors with a conscientious objection to abortion should refer women to another practitioner who is able to consider the procedure. Without this convention, getting an abortion becomes a labyrinthine task for women, in which any path might turn out unexpectedly to become a dead-end. Retreat and start again. Count the time you have. Think about the other steps you have to get through. Think about how many more dead-ends there might be.

In the end, this will stop women from getting abortions. Not as surely as a ban would, but in its quiet way, it will ensure that some women who do not want to be pregnant are forced to remain pregnant because the first doctor they approach shuts the door on them. And that is immoral. The language of conscientious objection, as employed by the All-Party Parliamentary Pro-Life Group, assumes that morality is an exclusive property of those who object to abortion. This is incorrect.

Every day, practitioners perform abortions for women from the most deeply considered ethical reasons. Their training may well have dealt with this in detail (at UCL, for example, medical students explore the ethics of abortion in a series of seminars that introduce multiple perspectives). They do it because they know that denying women safe, legal abortion forces them to have recourse to unsafe, illegal means. They do it because they recognise that the actual life of a woman carries more weight than the prospective life of a foetus. They do it because they recognise that decisions about how a woman’s body is used are for her to make, and that to force an unwilling woman into maternity is a profound kind of violence.

Practitioners may recuse themselves from certain stages of the process. But an ethical medic does not prevent a woman from accessing the treatment she needs. And for those who can never be reconciled to the morality of abortion, there is a more definitive way out of involvement than conscientious objection: the UK government could simply remove abortion from criminal law, and treat it as healthcare.

There should be no more requirement for two doctors to authorise each procedure. No more unnecessary involvement of doctors in early-term abortions that could be safely overseen by a nurse or midwife. No more demand that women prove they are doing this for the “right” reasons. Just dismantle those hoops, and let women exercise their own consciences in concert with understanding doctors. Morality doesn’t belong solely to the authoritarian right, however much anti-choice campaigners would like that to be true. Matters of right and wrong direct all of us, and when it comes to abortion, the greatest wrong is for a woman to be denied the choice she makes for herself.

Sarah Ditum is a journalist who writes regularly for the Guardian, New Statesman and others. Her website is here.

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Can Philip Hammond save the Conservatives from public anger at their DUP deal?

The Chancellor has the wriggle room to get close to the DUP's spending increase – but emotion matters more than facts in politics.

The magic money tree exists, and it is growing in Northern Ireland. That’s the attack line that Labour will throw at Theresa May in the wake of her £1bn deal with the DUP to keep her party in office.

It’s worth noting that while £1bn is a big deal in terms of Northern Ireland’s budget – just a touch under £10bn in 2016/17 – as far as the total expenditure of the British government goes, it’s peanuts.

The British government spent £778bn last year – we’re talking about spending an amount of money in Northern Ireland over the course of two years that the NHS loses in pen theft over the course of one in England. To match the increase in relative terms, you’d be looking at a £35bn increase in spending.

But, of course, political arguments are about gut instinct rather than actual numbers. The perception that the streets of Antrim are being paved by gold while the public realm in England, Scotland and Wales falls into disrepair is a real danger to the Conservatives.

But the good news for them is that last year Philip Hammond tweaked his targets to give himself greater headroom in case of a Brexit shock. Now the Tories have experienced a shock of a different kind – a Corbyn shock. That shock was partly due to the Labour leader’s good campaign and May’s bad campaign, but it was also powered by anger at cuts to schools and anger among NHS workers at Jeremy Hunt’s stewardship of the NHS. Conservative MPs have already made it clear to May that the party must not go to the country again while defending cuts to school spending.

Hammond can get to slightly under that £35bn and still stick to his targets. That will mean that the DUP still get to rave about their higher-than-average increase, while avoiding another election in which cuts to schools are front-and-centre. But whether that deprives Labour of their “cuts for you, but not for them” attack line is another question entirely. 

Stephen Bush is special correspondent at the New Statesman. His daily briefing, Morning Call, provides a quick and essential guide to domestic and global politics.

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