www.klice.co.uk Summer2010(Vol.16No.

1)

AbortionandConscientiousObjection
DanielJ.Hill

Abstract
InthisarticleIdonotseektodiscusswhen,ifever,abortionismorallypermissible.RatherIseektoanalysethe
preciselegalstatusoftheexemptionsaffordedunderBritishlawtothosewithaconscientiousobjectiontoabortion.
IthenarguethatthelegalstatusquoinBritainisnotmorallysatisfactory,andthatthelawurgentlyneedstobe
changed.

Introduction
Christiansdisagreeonthesubjectofabortion.SomeChristiansthinkthatallintentionalabortionsare
morallyimpermissible.OtherChristiansthinkthatallintentionalabortionsthatarenotintendedtosave
themotherslifearemorallyimpermissible.OtherChristiansbroadenthistoincludeaspermissible
thoseabortionsthatareintendedtosavethemothershealth,evenifherlifeisnotindanger.Afew
Christiansthinkthatalmostallabortionsuptoacertainperiod(e.g.thecurrentlegallimitoftwenty
fourweeks)arepermissible.Ratherthanenteringdirectlyintothisdebatehere,Iwanttoexaminehow
farthelawaccommodatestheconsciencesofthoseChristians(andothers)thatareopposedtoabortion.
ItseemstomethateventhoseChristiansthatarenotopposedtoabortionoughttosupportlegal
tolerancefortheconscientiousobjectionsoftheirfellowChristiansthataresoopposed.Thisisimportant
notjustforreasonsofsupportingourbrothersandsistersinChrist,butalsobecausethesamedebate
willbeplayedoutinthefutureconcerningeuthanasia,wheremanymoreChristiansmayfindtheir
consciencesbeinginfringedbythelaw.

Thelegalstatusquo
InGreatBritain(butnotNorthernIreland),thelawonabortionissetoutintheAbortionAct1967
(hereinaftertheAct).TheActlegalizedsomeabortions,anditalsoaffordedpermissionfor
conscientiousobjectorstooptout.Thesocalledconscienceclause,Clause4,isasfollows:

4.
Conscientiousobjectiontoparticipationintreatment.
(1)Subjecttosubsection(2)ofthissection,nopersonshallbeunderanyduty,whetherby
contractorbyanystatutoryorotherlegalrequirement,toparticipateinanytreatmentauthorised
bythisActtowhichhehasaconscientiousobjection:
[...]
(2)Nothinginsubsection(1)ofthissectionshallaffectanydutytoparticipateintreatmentwhich
isnecessarytosavethelifeortopreventgravepermanentinjurytothephysicalormentalhealth
ofapregnantwoman.1

Participation
So,thecurrentlegalstatusinBritainisthat
nobodyneedstoparticipateinanytreatmentto
terminateapregnancyifheorshehasa
conscientiousobjectionandiftheabortionisnot
necessarytosavethemotherslifeortoprevent
gravepermanentinjurytoherphysicalormental
health.Thequestionarisesastowhatismeantby
participateinthistreatment,and,infact,this
questionhasbeenconsideredbytheCourts,inthe
caseofReginav.SalfordAreaHealthAuthority
(Respondent)exparteJanaway.2MrsJanawaywasa
RomanCatholic,andworkedasareceptionistfor
aGeneralPractice.Shewasaskedtotypealetter
referringapregnantwomanseekinganabortion
toaconsultant.MrsJanawayrefusedtodothis,
andwasdismissedfromherpost.Hercasewent
allthewaytotheHouseofLords,whereitwas
dismissed,withtheirLordshipsholdingthat
participateinanytreatmentmeantactually
takingpartintreatmentadministeredinahospital
orotherapprovedplace.
Referrals
So,thelawholdsthattypingupalettertoa ItwillbenotedthattheRegulationsheredonot
consultantisnotcoveredbyparticipateinany
treatmentfortheterminationofpregnancy.The
questionarisesofwhetheraGPsreferringa
patienttotheabortionclinicortoaconsultant
woulditselfbecoveredbythephraseparticipate
inanytreatment.Thegovernmenthasexpressed
theopinionthatparticipateinanytreatment
doesnotcoverthesigningoftheform/certificate
bytheGP.LordWarner(thenMinisterofStateat
theDepartmentofHealth)saidon20July2005:
TheHouseofLordsruledin1988thatthis
exemption[theconscienceclauseoftheAct]
doesnotextendtogivingadvice,
performingthepreparatorystepstoarrange
anabortionwheretherequestmeetslegal
requirementsandundertaking
administrationconnectedwithabortion
procedures.Doctorswithaconscientious
objectiontoabortionshouldmaketheir
viewsknowntothepatientandenablethe
patienttoseeanotherdoctorwithoutdelay
ifthatisthepatientswish.3
So,itwouldappearthatthesigningoftheform/
certificateisnotcoveredorwouldinfuturebe
heldnottobecoveredbytheconscienceclause.
Isthere,though,anydutyontheGPtosignthe
form/certificate?TheNationalHealthService
(GeneralMedicalServicesContracts)Regulations
2004state:
3.
(1)Acontractorwhosecontractincludesthe
provisionofcontraceptiveservicesshall
makeavailabletoallitspatientswho
requestsuchservicestheservicesdescribed
insubparagraph(2).
(2)Theservicesreferredtoinsubparagraph
(1)are
[]
(e)theprovisionofadviceandreferralin
casesofunplannedorunwantedpregnancy,
including[...]whereappropriate,wherethe
contractorhasaconscientiousobjectionto
theterminationofpregnancy,prompt
referraltoanotherproviderofprimary
medicalserviceswhodoesnothavesuch
conscientiousobjections;4
statethattheGPhastosigntheformsendingthe
womantoaconsultantorclinic,butdosaythatifa
contractor(ageneralpracticeorindividual
generalpractitioner,forourpurposes)has
decidedtooffercontraceptiveservices,that
contractorhastobepreparedtoreferapregnant
womanseekinganabortionontoanotherGPthat
doesnothavetheconscientiousobjection.
TheEthicsoftheSituation
Wehaveseenthelegislationandhowthecourts
interpretit.Thequestionarisesastowhetherthey
drawtheboundariesintherightplacemorally.I
shallnowarguethattheydonot.Theargument
thatIwishtomakeisputbrieflybyJennifer
JacksoninherEthicsinMedicine:
[I]sitnotarbitrarytoallowdoctorsand
nursestorefusetoassistonconscientious
grounds,butnottoallowdoctors
secretaries,pharmacistsorotherstorefuse?
ImagineapersonalsecretaryofJosef
Mengelefendingoffcriticismofherrolein
arrangingformoreconcentrationcamp
prisonerstobedeliveredforuseinlethal
experiments,protesting:Youcantcriticize
 me,Imerelytypedtheletters.5
Letustakeasourstartingpointtheethicalview
heldbytheconscientiousobjector.Thisisagood
pointtostartbecauseourinquiryinthispaperis
notwhetherthisviewistrueorfalsebuthow
much,ifanything,shouldbeconcededtoit
legally.Ishallrestrictmyattentioninthispaperto
abortionsinwhichitisnotthecasethatthe
motherslifeorhealthisingravedangerIshall
callthesenonemergencyabortions.Theviewof
theconscientiousobjectoristhatitismorally
wrongintentionallytoperformanonemergency
abortion.
Letusthinkaboutthefollowingethicalquestions:
(1)Isitmorallywrong,absentspecial
circumstances,toreferapregnantwoman
ontothehospitalorabortionclinicinthe
knowledgethatshewillreceiveanon
emergencyabortionthere?
(2)Isitmorallywrong,absentspecial
circumstances,toreferapregnantwoman
ontoaGPintheknowledgethatshewillbe
referredbythisGPontothehospitalor
abortionclinicandthatshewillreceivea
nonemergencyabortionthere?
(3)Isitmorallywrong,absentspecial
circumstances,totypealetterreferringa
pregnantwomanontothehospitalor
abortionclinicintheknowledgethatshe
willreceiveanonemergencyabortion
there?
(4)Isitmorallywrong,absentspecial
circumstances,totypealetterreferringa
pregnantwomanontoaGPinthe
knowledgethatshewillbereferredbythis
GPontothehospitalorabortionclinicand
thatshewillreceiveanonemergency
abortionthere?
ConsideranextensionofJenniferJacksons
analogywithJosefMengele.Woulditbemorally
acceptabletosendpeopleontoAuschwitz,
knowingwhatwouldbefallthemthere?Orwould
itbemorallyacceptablemerelytotypethe
transferletterforonessuperior,againknowing
whatwouldbefallthemthere?Orwoulditbe
morallyacceptabletosayIamnotmorally
preparedtosendthesepeopletoAuschwitz,butI
ammorallypreparedtosendthemontosomeone
lessscrupulous,who,Iknow,willinturnsend
themontoAuschwitz?OrtosayIamnot
morallypreparedtotypealetterformysuperior
sendingthesepeopletoAuschwitz,butIam
morallypreparedtotypealettersendingthemon
tosomeonelessscrupulous,who,Iknow,willin
turnsendthemontoAuschwitz?Itseemstome
clearthat,absentspecialcircumstances,noneof
thesewouldbemorallypermissible.Nevertheless,
ifonehadaguntoonesheaditmightbe
permissibletodooneofthesethingstosaveones
life,orthelivesofonesfamily.Anditmightbe
permissibletodooneofthemaspartofdeep
coverinordertobeabletosavemorelivesinthe
longtermbysabotagingtheNazimachinefrom
within.
Toapplytheanalogy,itseemstomethatthe
conscientiousobjectorislogicallycommittedto
answeringyesto(1)(4)above.Ifitisnot
morallypermissibletoperformanonemergency
abortion,then,absentspecialcircumstances,itis
notmorallypermissibletoreferthemotheron
directlyorindirectlyforanonemergency
abortion,ortoplayanypartinassistingthis
referralprocess.Ofcourse,ifspecial
circumstancesobtained,itmightbepermissible:
forexampleiftheGPortheGPsfamilywere
beingthreatenedwithaguntotheirheads.A
morerealisticexamplemightbeiftheGPwere
keentoreducethenumberofabortionsand,
indeed,tosavelivesquitegenerally,andthought
thatheorshewouldbestruckoffifheorshe
refusedtoreferontotheabortionclinic.Inthis
case,itmightbepermissiblefortheGP,whilenot
intendingthatanyabortiontakeplace,reluctantly
tosigntheformononeortwooccasionssolelyin
ordertokeephisorherjobinorderthatmore
livesmightbesavedinthelongterm.
Thepointis,however,thatthesearespecial
circumstances,and,inthecontextofthesecond
example,circumstancesthatthestatehasthe
powertoprevent.Thismeansthatitis
unsatisfactorytolegislatethatnobodymaybe
legallyobligedtoparticipateinthetreatment
(understoodasperthecourts)foranon
emergencyterminationofpregnancywhilesimultaneouslyinsistingthatsomemaybelegallyobligedto
referpeopleonforsuchatermination:thelogicallyconsistentpersonthathasaconscientiousobjectionto
participatinginanonemergencyabortionwillalsohaveaconscientiousobjectiontoreferringonfor
suchanabortioniftheenvisagedspecialcircumstancesareabsentastheyusuallyare.

Finallyweshouldconsiderthequestionofhowfartheconscientiousobjectionshouldbe
accommodated.Itseemstome,inthelightoftheabove,thatanylogicallyconsistentpersonopposedto
anonemergencyabortionwillalsobeopposedtobeinganaccessoryinanywaytononemergency
abortions.Inotherwords,suchapersonwillopposeanycounselling,procuring,aiding,abetting,
helping,orcooperationwithnonemergencyabortions.Forexample,referringontotheabortionclinic,
referringontoanotherGPthatisknownwillreferoninturntotheabortionclinic,andclerkingin
preparatorytoanabortion,wouldallcountascounsellingorprocuringoraidingorabettingorhelping
orcooperatingwiththeabortion.Ontheotherhand,thegivingofmedicaladviceortreatment
concerningaseparateconditiontoawomanseeking,orhavingjusthad,anabortionshouldnotcome
withintheambitoftheconscienceclause.7Eveniftheabortioninquestionwereclearlyimmoralthat
wouldnotmakeimmoralthegivingofadviceortreatmentforaquiteseparatecondition(unless,of
course,theadviceortreatmentweregivenwiththeintentionofenablingthemothertoreceivethe
abortion).Iconcludethatthelawurgentlyneedstobechangedtoallowforaconsistentconscientious
objectionalongthelinessketchedoutabove.

_____________________________________________

1.AbortionAct1967,1967c.87(27thOctober1967)[cited2009September9].Availablefrom:http://
www.statutelaw.gov.uk/content.aspx?activeTextDocId=1181037.
2.Reginav.SalfordAreaHealthAuthority(Respondent)exparteJanaway[1988]2W.L.R.442;HA[1988]3AllER1079
249.
3.Hansard[HL]vol673colWA20(20Jul2005)[cited2009October2].Availablefromhttp://
www.publications.parliament.uk/pa/ld200506/ldhansrd/vo050720/text/50720w01.htm.
4.TheNationalHealthService(GeneralMedicalServicesContracts)Regulations2004[cited2009September9].Available
from:http://www.opsi.gov.uk/si/si2004/20040291.htm#3a.
5.JenniferJackson,EthicsinMedicine,(Cambridge:Polity,2006),p.48.
6.GeneralMedicalCouncil[Internet].PersonalBeliefsandMedicalPractice[March2008;cited2009September9].
Availablefrom:http://www.gmcuk.org/guidance/ethical_guidance/personal_beliefs/personal_beliefs.asp#F.
7.IdliketothankfortheirhelpJaniceAllister,JamesBogle,ClareCarlisle,JamieDow,CharlesFoster,LucyFrith,Harry
Lesser,SimonLeighton,MichaelMcGhee,SteveMichael,IanSapsford,PeterSaunders,TomSimpson,SteveTaylor,and
DemianWhiting,aswellasofficialsfromtheBMA,GMC,andDepartmentofHealth.MygreatestdebtistoJosephShaw
andHelenWatt,whohavebeenextremelygenerouswiththeirtimeandexpertisetohelpme.Obviously,noneofthe
abovementionedshouldbeheldresponsibleforanydefectsinthisessay.

Forfurtherreading:
CharlesFoster,ChoosingLife,ChoosingDeathTheTyrannyofAutonomyinMedicalLawandEthics,Hart,2009.
JenniferJackson,EthicsinMedicine,Polity,2006.[introduction]
HelenWatt,ed.,Cooperation,Complicity&Conscience:Problemsinhealthcare,science,lawandpublicpolicy,Linacre
Centre,2006.[moreadvanced]

Dr.DanielJ.HillisateachingfellowintheDepartmentofPhilosophyattheUniversityofLiverpool,
andSecretaryoftheTyndaleFellowshipsStudyGroupinthePhilosophyofReligion.Hegainedhis
PhDin2001fromKingsCollege,London,forathesisontheconceptofGod.Hehasalsowrittenanar
ticlearguingthattorturetogaininformationisnevermorallypermissible,evenintickingbombsitua
tions.

TheKirbyLaingInstituteforChristianEthics,
TyndaleHouse36SelwynGardens,Cambridge,CB39BA,UK
T01223566619/566625F01223566608EEthics@Tyndale.cam.ac.ukWwww.klice.co.uk