We breach this law if we fail to provide a pregnant woman with an abortifacient pill, or refuse to refer her for an abortion (or to another doctor whom [sic] we know will do so).The National Health Service Act 1977 Section 29 says:
(1) It is every Area Health Authority's duty, in accordance with regulations, to arrange as respects their area with medical practitioners to provide personal medical services for all persons in the area who wish to take advantage of the arrangements.
(2) Regulations may provide for the definition of the personal medical services to be provided and for securing that the arrangements will be such that all persons availing themselves of those services will receive adequate personal care and attendance, and the regulations shall include provision
(a) for the preparation and publication of lists of medical practitioners who undertake to provide general medical services;
(b) for conferring a right on any person to choose, in accordance with the prescribed procedure, the medical practitioner by whom he is to be attended, subject to the consent of the practitioner so chosen
There does not seem to be anything contrary to this in the National Health Service Reform and Health Care Professions Act 2002 or the National Health Service Act 2006. It seems that Dr Sapsford is wrong in thinking that this is the law.
In fact, there is an explicit exception for those with conscientious objections in the Abortion Act 1967
§ 4 Conscientious objection to participation in treatment
(1) Subject to subsection (2) of this section, no person shall be under any duty, whether by contract or by any statutory or other legal requirement, to participate in any treatment authorised by this Act to which he has a conscientious objection:
Provided that in any legal proceedings the burden of proof of conscientious objection shall rest on the person claiming to rely on it.
(2) Nothing in subsection (1) of this section shall affect any duty to participate in treatment which is necessary to save the life or to prevent grave permanent injury to the physical or mental health of a pregnant woman.Nevertheless, the GMC adds (and this may be what is worrying Dr Sapsford):
- If carrying out a particular procedure or giving advice about it conflicts with your religious or moral beliefs, and this conflict might affect the treatment or advice you provide, you must explain this to the patient and tell them they have the right to see another doctor. You must be satisfied that the patient has sufficient information to enable them to exercise that right. If it is not practical for a patient to arrange to see another doctor, you must ensure that arrangements are made for another suitably qualified colleague to take over your role.
Doctors with a conscientious objection to abortion should make their views known to the patient and enable the patient to see another doctor without delay if that is the patient's wish.
A spokesman for the Department of Health quoted in The Daily Mail for 3rd May 2007 said: "If GPs feel their beliefs might affect the treatment, this must be explained to the patient who should be told of their right to see another doctor."
What does 'ensure that arrangements are made' mean? And what does 'enable' mean? Is it permissible to ensure that arrangements are made for a patient seeking an abortion to be seen by a doctor that will grant her what she seeks? If it is immoral to sell guns to drunks would it be permissible to ensure that arrangements are made for the drunks to see a gunsmith without scruples? Would it be permissible merely to inform the drunk of the whereabouts of a gunsmith without scruples? Would it be permissible merely to inform the drunk that he could go elsewhere? I guess as follows: no, no, no, yes.
I was interested to read about the case of Janaway v Salford Health Authority in 1988 when a doctor's secretary (Janaway, a Roman Catholic) was sacked for refusing to type a letter of referral. The courts held that ‘the task asked of Janaway did not constitute participation in the actual abortion procedure’. (I can see that the case is referred to in a 1988 edition of Law and Justice: The Christian Law Review by one David Poole, but that is all I know about it.) Is typing a letter of referral permissible? I'm inclined to think not; one is co-operating in evil, albeit without intending that the evil be done. Those Germans that typed letters about the movement of Jews in WWII may not have committed a legal offence, but surely they are morally guilty of aiding and abetting a terrible crime?
One final point: I think that it is impermissible to perform an abortion even to save the mother's life. Is it then morally permissible to be a doctor? I regretfully think not: in becoming a doctor (at least of a certain sort: obs and gyny, and perhaps even a GP) one would be accepting a duty that one couldn't morally discharge. Of course, it is (thankfully) very rare that such a duty would arise, but surely it is immoral to accept a duty knowing one could not discharge it?