Some doctors argue that handing patients an abortion choices brochure will harm their soul, writes Dr Kimberley Ivory
The question of conscientious objection in medicine becomes visible at times, such as the abortion law reform debate in Victoria, when some doctors argued that even handing a patient a brochure about abortion choices in order to comply with the conscientious objection amendment was committing a mortal sin.
While it seems unlikely to most of us that a benevolent God would consider the provision of patient information worthy of an eternity in hell, some people firmly hold this belief, and demand our legislations defer to it, usually by arguing “religious freedom”.
Our approach to conscientious objection is somewhat Orwellian. Some objections are apparently more equal than others. Conscientious objection to conscription on any grounds, including religion, landed you in jail. But on the whole, religious conviction is privileged over any other kind of strongly held conviction. Our constitution does respect freedom of religion, but it also allows for freedom from the imposition of religion by the State. It is this secular side of the equation that is rarely acknowledged or respected.
This topic has reared its head again in the endless debate over marriage equality. George Brandis has suggested that should marriage equality go ahead there will need to be amendments to allow for conscientious objections by clergy and celebrants who disagree with the law. Of course, this ignores the fact that religions already decide who they will or will not marry for a whole range of reasons other than gender, while also enjoying many legislative loopholes that allow them to ignore anti-discrimination legislation, and that legally marriage can get along just fine without religion.
However, the secular side of the argument was highlighted in a recent letter to the editor. The author defended Brandis’ proposed amendments, saying that people who disagree with same sex marriage shouldn’t have to participate because they shouldn’t be “forced to live by other people’s religious, ethical beliefs”. The writer did, however, hope that those same people defend his right to a dignified death at the time of his choosing should he develop a terminal illness. Surely, they wouldn’t then be hypocritical enough to force their religious, ethical beliefs on him?
Hypocrisy is indeed the problem. One person’s conscientious objection is another person’s strongly held belief, whether it’s about the right to marry, the right to die, the right to oppose war or the right to autonomy over reproduction. How do we draw the line on whether the right not to choose trumps the right to choose?
As doctors we need to be constantly vigilant of our motives for advising for or against a certain course of action. Is this about me or the patient? Conscientious objection has the power to do harm. It is one thing to hold strong anti-abortion beliefs for oneself and choose not to have or perform an abortion under any circumstances, but it is quite another for a doctor to prevent a patient from obtaining accurate, balanced health information so they can make an informed choice, which may, of course, include not having an abortion at all.
But next Brandis suggested bakers and wedding venues should also be able to express a legal conscientious objection to same sex marriage. I am sure that commercial ventures often choose whose money they take in all sorts of subtle ways. But enshrining that right to discriminate in law? Towards one particular group? Where does it end? Will we slowly but surely wind back the clock on every advance in equality and anti-discrimination legislation we have made until the only people with any rights are white, Christian male landowners?
I’d like to be able to say “be like Switzerland” – if it doesn’t affect you, leave it alone – but history shows that even Switzerland was never completely neutral. None of us is. We all have biases and beliefs, personal values and ethics that rub up against other people’s. At the moment the extreme religious minority are beating the secular majority into submission via our elected representatives in too many arenas. In order for this minority to have free exercise of their religion, the rest of us are having their religion imposed upon us.
While the Australian Constitution is not a Bill of Rights, Australians are entitled to believe the constitution implies protection of the right to freedom of thought and conscience and freedom from the impositions of others’ thoughts and conscience via legislation. No one is insisting that anyone have a gay marriage, perform an abortion or deliver euthanasia. But the first ethical obligation of medicine is to do no harm.
If you genuinely believe something will harm your patient (as opposed to your own soul) then your obligation must be to provide that person with sufficient information to make an informed choice, or find someone else who will. Anything else is an abuse of power.
Dr Kimberley Ivory is a GP, medical academic and writer