Conscientious Objection (Medical Activities) Bill [HL]

Baroness Chisholm of Owlpen Excerpts

2nd reading (Hansard): House of Lords
Friday 26th January 2018 Lords Chamber

[Baroness Chisholm of Owlpen (Con)]

My Lords, I congratulate the noble Baroness, Lady O’Loan, on securing this Second Reading of her Bill, which aims to clarify the extent to which a medical practitioner with a conscientious objection may refrain from participating in certain activities relating to abortion care, assisted reproduction and fertility treatment, and withdrawal of life-sustaining treatment. As is usual with these sensitive matters, the Government are taking a neutral approach to the Bill.

As the noble Baroness, Lady O’Loan, and the right reverend Prelate the Bishop of Peterborough mentioned, it is of course right that medical practitioners and other health professionals should have their personal beliefs respected. As the noble Lord, Lord Dholakia, said, the right to object to participating in treatment is enshrined in the Abortion Act 1967 and the Human Fertilisation and Embryology Act 1990. As the noble Lord also mentioned, while medical practitioners are within their rights to refrain from participating in certain medical activities on the basis of conscientious objection, this should cause no detriment or barrier to the care patients are entitled to. Section 4 of the Abortion Act 1967 allows those with a conscientious objection to opt out of participating,

“in any treatment authorised by this Act”,

unless that treatment is immediately,

“necessary to save the life or to prevent grave permanent injury to the physical or mental health of a pregnant woman”.

The noble Baroness, Lady O’Loan, mentioned private clinics. Interestingly, two-thirds of abortions are carried out by the independent sector, where staff actively choose to work in abortion care.

The courts, including most recently the Supreme Court, have considered whether participation in treatment should include activities ancillary to the actual procedure, such as managing ward resources, supervising other staff and providing post-operative care to women on the ward. In December 2014, the Supreme Court held that “participate” should be construed narrowly and the conscientious objection provision should cover only those activities that involve actually taking part in the termination procedure. Section 38 of the Human Fertilisation and Embryology Act 1990 regulates the provision of certain fertility treatments, services and research involving use of human embryos. It already allows staff to withdraw from participation in an activity covered by the Act if they have a conscientious objection to it. However, similarly to the Abortion Act, that Act does not define participation. The department therefore relies on guidance issued to medical practitioners by regulatory bodies such as the General Medical Council. This helps ensure that rights of conscientious objection are exercised within the parameters set out by the current legislation and in line with the principles of good medical practice. In addition, each of the nine regulatory bodies that regulate health and care professionals in the UK has its own publication, setting out the standards, behaviour and conduct expected of the professionals on its register. The Act provides protection for all staff who feel unable to take part in an activity regulated by the Act to which they have a conscientious objection.

Life-sustaining medical treatment benefits the patient by restoring or maintaining health as far as possible. If, however, all suitable treatments fail or cease to provide benefit to the patient, they may ethically and legally be withheld or withdrawn and the focus of treatment changed to the relief of symptoms. As noble Lords know, in practice the decision to withhold or withdraw life-sustaining treatment is often very difficult. It is also very stressful for the patient’s family and the staff who have been looking after them. The noble Baroness, Lady Richardson of Calow, talked movingly about her experiences with the treatment of her husband. Guidance from the GMC states that doctors may withdraw from providing care if their beliefs about providing life-prolonging treatment lead them to object to complying with either a patient’s decision to refuse such treatment or a decision that providing such treatment is not of overall benefit to a patient who lacks capacity to decide. However, as the noble Baroness, Lady Meacher, mentioned, the guidance is also explicit that doctors must first ensure that arrangements have been made for another doctor to take over their role and that it is not acceptable to withdraw from a patient’s care if this would leave the patient or colleagues with nowhere to turn. The noble Baroness, Lady Young of Old Scone, and the noble Lord, Lord Dholakia, mentioned the importance of patients’ views for their end-of-life care. The Government’s commitment to everyone at the end of life is to focus on the perspective of the dying person and those important to them.

Before I end, I will answer a couple of questions raised during the debate. The right reverend Prelate the Bishop of Peterborough mentioned pharmacists. The General Pharmaceutical Council informed us that it is currently analysing responses to its recent consultation on religion, personal values and beliefs in delivering person-centred care. The GPC will then make a decision on any changes to standards for pharmacy professionals. My noble and learned friend Lord Mackay of Clashfern asked if there was data on the number of conscientious objectors. The data on the number of staff with these views is not held centrally.

As the noble Baroness, Lady Meacher, said, these are difficult and challenging issues. I have listened with interest to the range of views expressed today. I join noble Lords in paying tribute to the noble Baroness, Lady O’Loan, for bringing forward the Bill and for highlighting the complex issues surrounding conscientious objection. I have heard and taken note of all that noble Lords have said today. The department will want to reflect on the points raised. I thank her, and other noble Lords, for their contributions on this important issue.