briefing /
comment
CONSCIENTIOUS OBJECTION
Patients’ needs trump
beliefs in abortion care
Nurses’ right to abstain from any role in a termination is at odds with
the duty to provide non-judgemental care
Michael Nevill
is director of nursing at
the British Pregnancy
Advisory Service
m
Should midwives be
forced to participate
in abortions even if
they oppose them?
rcni.com/abortion-
object
iStock
nursingstandard.com
A
s director of nursing at BPAS, I believe
it is of the utmost importance that the
staff we employ are comfortable with
all of the services we provide. This
includes termination of pregnancy up to 24 weeks.
Nurses are entitled to conscientiously object to
taking part in certain activities on the grounds
of freedom of thought, conscience or religion. In
English law there are two statutory provisions
for conscientious objection. The first relates to
abortion and the other to in vitro fertilisation and
embryo research; the Abortion Act (1967) and the
Human Fertilisation and Embryology Act (1990)
have these clauses built into them.
Generally, nurses are not at liberty to refuse
care to anyone. Patients see nurses as kind, non-
judgemental and caring, and they expect them to
demonstrate these qualities when providing care.
Nurses must also act as advocates for patients
by providing support in difficult circumstances,
and often set aside their own views to respect their
patient’s values and beliefs. Some nurses however
choose to abstain from certain areas of practice,
citing their conscience. This means there will be
times when patients are not able to rely on these
nurses for the care and support they require.
It is not known how many nurses exercise this
legal right, but it is not uncommon, even among
staff in gynaecology, despite abortion being one of
the most common gynaecological procedures.
I believe there is a conflict between the
fundamentals of nursing practice, in having a
non-judgemental approach to care, and the
right to conscientiously object. Staff who
conscientiously object are being allowed to
override the beliefs and values of their patients.
The Nursing and Midwifery Council stipulates
in the Code that registered staff must:
» Treat people with kindness, respect
and compassion.
» Deliver the fundamentals of care effectively.
» Avoid making assumptions and recognise
diversity and individual choice.
» Make sure treatment, assistance or care is
delivered without undue delay.
» Respect and uphold people’s human rights.
The Code also stipulates that nurses must
tell colleagues, their manager and the
person receiving care if they have a conscientious
objection to a particular procedure and arrange
for a suitably qualified colleague to take over.
‘There is a conflict between the
fundamentals of nursing practice
– having a non-judgemental
approach to care – and the right to
conscientiously object’
The NMC has acknowledged the provision
of conscientious objection in law. But there is
a dichotomy between these two positions: on the
one hand, suggesting nurses and midwives need to
deliver care effectively without delay, recognising
individual choice; on the other, suggesting that
if they don’t agree with a patient’s choice then
someone else can take over their care.
Nurses are free to choose not to work in certain
areas. However, they should not be able to
override a patient’s beliefs and values. Instead of
conscientious objection, clinicians should consider
a conscientious commitment to providing all the
services and information their patients require.
I sometimes hear patients’ stories about not
being treated in a kind, non-judgemental way
when trying to access abortion services. So
perhaps, conversely, conscientious objection may
actually protect patients from being cared for by
staff who do not share their values and beliefs.
But nurses should think carefully before
exercising this right, reflecting on what it really
means and how it may be in conflict with some of
the basic principles of nursing.
volume 33 number 8 / November 2018 / 13
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