Abortion crisis in the UK

The Royal College of Obstetricians and Gynaecologists today issued a statement to say that the number of doctors prepared to carry out abortions is gradually falling and will lead to a crisis in the service. They recognise any doctor's right to refuse to carry out abortions but equally are aware that it is an essential service. They go on to say that family planning and gynaecological services should have adequate funding to ensure that abortions are kept to a minimum.

There is an extensive and what seems to be a well-balanced report in the Independent. By the time the BBC reported the story, the situation was threatening the National Health Service.

The report I find interesting though, is also in the Independent, "Issue that goes to the heart of our differences with America". I've said in the past on other blogs that there just doesn't seem to be nearly as much emotion on this side of the Atlantic, but faced with the discussions that seem to abound, sometimes I have wondered if I was missing something here. A case of selective awareness perhaps, and only noticing opinions that would reinforce my own point of view. Well if that is the case, the Independent article is another reinforcement. I particularly like the final sentence.

Conscientious objection in medicine, or paternalism

I came across a paper in the New England Journal of Medicine entitled Religion, Conscience, and Controversial Clinical Practices. The essence of it was that a survey was carried out on a random selection of doctors in the USA and it was found that many don’t feel an obligation to let their patients know about treatments which are legal but which they find morally wrong, nor do they feel they need refer them on to another doctor who may not have such views. The article asks whether it is right that doctors should refuse any information to their patients, to discuss it, or to refer them on, and where should the balance lie between the patients rights and the rights of healthcare providers not to have to carry out practices against their principles.

I remember when I was a student it was generally known not to go to such and such doctor at the university because she was Catholic and absolutely refused to prescribe contraceptives. I also remember being sent away from a family planning clinic of all places and being told not to come back until I had had a baby! Why did she think I had gone there in the first place? Because I didn’t know how to do it? She thought it was time, after 4 years of marriage, that I should have a child. I managed to hang on there for another three years, having found a different clinic in the meantime.

As a result of those relatively trivial experiences (though they didn’t feel like it at the time), on reading the paper I immediately thought that it was totally unjustifiable for a doctor to withhold treatment and/or information for any reason.

Reading further I found this article in the BMJ where the conclusions are

"Values are important parts of our lives. But values and conscience have different roles in public and private life. They should influence discussion on what kind of health system to deliver. But they should not influence the care an individual doctor offers to his or her patient. The door to "value-driven medicine" is a door to a Pandora's box of idiosyncratic, bigoted, discriminatory medicine. Public servants must act in the public interest, not their own."

It seems a reasonable view until you read one of the responses wondering whether he would have been able to have been a conscientious objector in Nazi Germany or Stalinist Russia. Then today I read NHS Blog Doctor: The extended role of the Health Care Professional which did make me think yet again. It really isn’t easy.