Tensions Between Ethics and the Law: Examination of a Legal Case by Two Midwives Invoking a Conscientious Objection to Abortion in Scotland

HEC Forum - Tập 33 - Trang 189-213 - 2019
Valerie Fleming1, Lucy Frith2, Beate Ramsayer1
1School of Nursing and Allied Health, Liverpool John Moores University, Liverpool, UK
2University of Liverpool, Liverpool, UK

Tóm tắt

This paper examines a legal case arising from a workplace grievance that progressed to being heard at the UK’s Supreme Court. The case of Doogan and Wood versus Greater Glasgow and Clyde Health Board concerned two senior midwives in Scotland, both practicing Roman Catholics, who exercised their perceived rights in accordance with section 4(1) of the Abortion Act not to participate in the treatment of women undergoing abortions. The key question raised by this case was: “Is Greater Glasgow and Clyde Health Board entitled to require the midwives to delegate, supervise and support staff in the treatment of patients undergoing termination of pregnancy?” The ethical issues concerning conscientious objection to abortion have been much debated although the academic literature is mainly concerned with the position of medical practitioners rather than what the World Health Organization terms “mid-level professionals” such as midwives. This paper examines the arguments put forward by the midwives to justify their refusal to carry out tasks they felt contravened their legal right to make a conscientious objection. We then consider professional codes, UK legislation and church legislation. While the former are given strong weighting the latter was been ignored in this case, although cases in other European countries have been prevented from escalating to such a high level by the intervention of prominent church figures. The paper concludes by stating that the question put to the courts remains as yet unanswered but offers some recommendations for future policy making and research.

Tài liệu tham khảo

Abortion Act. (1967). London: Her Majesty’s Stationary Office. http://www.legislation.gov.uk/ukpga/1967/87/pdfs/ukpga_19670087_en.pdf. Accessed 19 June 2019. Antommaria, A. (2010). Conscientious objection in clinical practice: Notice, informed consent, referral, and emergency treatment. Ave Maria Law Review, 9(1), 81–99. Baker, R. (2009). Conscience and the unconscionable. Bioethics, 23(5), II–III. Bowman, M., & Schandevel, C. (2012). The harmony between professional conscience rights and patients´ right of access. Phoenix Law Review, 6, 31–62. British Broadcasting Corporation (2014). Scotland 2014. Wednesday 17 December 2014. Caston, V. (2004). Aristotle on conscientiousness. Mind, 111(444), 751–815. Center for reproductive rights (2013). The world’s abortion laws. Map 2013 update. http://www.reproductiverights.org/sites/crr.civicactions.net/files/documents/AbortionMap_Factsheet_2013.pdf. Accessed 19 June 2019. Chavkin, W., Leitman, L., & Polin, K. (2013). Conscientious objection and refusal to provide reproductive healthcare. International Journal of Gynecology and Obstetrics, 123(Suppl 3), 541–556. Cignacco, E. (2002). Between professional duty and ethical confusion: Midwives and selective termination of pregnancy. Nursing Ethics, 9(2), 179–191. Code of Canon Law (1983/1989). Latin-English Edition. Washington DC: Canon Law Society of America. Coriden, J. (1986). Commentary on canon 1398: Canonical penalty for abortion as applicable to administrators of clinics and hospitals. The Jurist, 46, 652–658. Council of Europe (1950). The European Convention on Human Rights. http://www.hri.org/docs/ECHR50.html. Accessed 19 June 2019. Curlin, F., Lawrence, R., Chin, M., & Lantos, J. (2007). Religion, conscience, and controversial clinical practices. New England Journal of Medicine, 356(6), 593–600. Doogan, M. & Wood, C. v Greater Glasgow and Clyde Health Board (2012). Case P876/11. Outer House. Court of Session Edinburgh, 29 February. https://www.scotcourts.gov.uk/search-judgments/judgment?id=6fb28aa6-8980-69d2-b500-ff0000d74aa7. Accessed 19 June 2019. Doogan, M. & Wood, C. v Greater Glasgow and Clyde Health Board (2013). Case P876/11. Inner House Court of Session Edinburgh, 24 April para 13. https://www.scotcourts.gov.uk/search-judgments/judgment?id=428f8aa6-8980-69d2-b500-ff0000d74aa7. Accessed 19 June 2019. Feltham, C. (2014). The value of preceptorship for newly qualified midwives. British Journal of Midwifery, 22(6), 427–431. Fleming, V. (1998). Women-with-midwives-with-women: A model of interdependence. Midwifery, 14(3), 137–143. Fleming, V., Frith, L., Luyben, A., & Ramsayer, B. (2018). Conscientious objection to participation in abortion by midwives and nurses: A systematic review of reasons. BMC Medical Ethics, 19(1), 31. https://doi.org/10.1186/s12910-018-0268-3. GGCHB letter dated 14 June 2011 to Mary Doogan and Concepta Wood. Greater Glasgow and Clyde Health Board (Appellant) v Doogan and Another (Respondents) (Scotland) (2014). Case UKSC 2013/0124. UK Supreme Court, London, 5 November. https://www.supremecourt.uk/decided-cases/docs/UKSC_2013_0124_Judgment.pdf. Accessed 19 June 2019. Green, T. (2000). Commentary on Canon 1329. In J. Beal, J. Corriden, & T. Green (Eds.), New commentary on the Code of Canon Law (pp. 1547–1548). New Jersey: Paulist Press. Grimmark vs Landstinget i Jönköpings Län (2014). Case Number 19760930-2406. Alliance Defending Freedom Amicus Brief to District Court. Gutmacher Institute (2018). Abortions: Fact sheet. https://www.guttmacher.org/fact-sheet/induced-abortion-worldwide. Accessed 19 June 2019. Heino, A., Gissler, M., Apter, D., & Fiala, C. (2013). Conscientious objection and induced abortion in Europe. The European Journal of Contraception and Reproductive Health Care, 18, 213–233. Information Services Division Scotland (2018). Abortion Statistics year ending 31 December 2017. https://www.isdscotland.org/Health-Topics/Sexual-Health/Publications/2018-05-29/2018-05-29-Terminations-2017-Report.pdf. Accessed 19 June 2019. International Confederation of Midwives (2013). Essential competencies for basic midwifery practice. http://internationalmidwives.org/what-we-do/education-coredocuments/essential-competencies-basic-midwifery-practice/. Accessed 19 June 2019. International Confederation of Midwives (2014). Position Statement: Collaboration for healthy partnerships. http://www.internationalmidwives.org/assets/uploads/documents/Position%20Statements%20-%20English/Reviewed%20PS%20in%202014/PS2008_002%20V2014%20Collaboration%20and%20Partnerships%20ENG.pdf. Accessed 19 June 2019. International Federation of Gynaecology and Obstetrics (2006). Conscientious objection: position statement. http://www.figo.org/sites/default/files/uploads/OurWork/2006%20Resolution%20on%20Conscientious%20Objection.pdf. Accessed 19 June 2019. Kane, R. (2009). Conscientious objection to termination and pregnancy: the competing rights of patients and nurses. Journal of Nursing Management, 17, 907–912. Letter dated March 5 2009 from labor ward manager to Mary Doogan. Letter from Udruga Vigilare Dr. sc. Vice John Batarelo to Prof. dr. sc. Rajko Ostojić Croatian Minister of Health translated Teja Zaksek. Marazoa, Á. (2004). Commentary on Canon 1329. In Á. Marzoa, J. Miras, & R. Rodriguez-Ocafla (Eds.), Exegetical commentary on the Code of Canon Law Vol IV/I (pp. 311–316). Wilson & Lafleur: Montreal. McHale, J. (2009). Conscientious objection and the nurse: A right or a privilege? British Journal of Nursing, 18(20), 1262–1263. Neal, M. (2014). The scope of the conscience-based exemption in section 4(1) of the Abortion Act 1967: Doogan and Wood v NHS Greater Glasgow Health Board [2013] CSIH 36. Medical Law Review, 22(3), 409–421. Neal, M. (2015). In good conscience: Conscience-based exemptions and proper medical treatment. In Paper presented at a seminar in the Law School University of Sheffield, January. Newell, C. (2002). Response to Cignacco. Nursing Ethics, 9(2), 191–193. Nordström, R. (2014). Letter from Ruth Nordström to Ombudsman for discrimination, Jönköping re Ellinor Grimmark. 21 May. Nursing and Midwifery Council (2013). Conscientious objection by nurses and midwives. http://www.nmc-uk.org/Nurses-and-midwives/Regulation-in-practice/Regulation-in-Practice-Topics/Conscientious-objection-by-nurses-and-midwives-/. Accessed 19 June 2019. Nursing and Midwifery Council (2015). The Code: Professional standards of practice and behavious for nurses and midwives. http://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/revised-new-nmc-code.pdf. Accessed 19 June 2019. Page, M. (2014). Midwifery care with women in labour in an institution. In R. Mander & V. Fleming (Eds.), Becoming a midwife (pp. 28–36). Edinburgh: Routledge. Paul VI Pope. (1968). Humanae Vitae. In A. Flannery (Ed.), The Vatican collection, Vatican Council II the conciliar and post conciliar documents (pp. 397–416). New York: Costello Publishing Company. Pellegrino, E. (2014). La conciencia del medico, cláusulas de conciencia y creencia religiosa: una perspectiva católica. Cuadernos de Bioética, XXV (1), 25–40. Pérez-Madrid, F. (2004). Commentary on canon 1398. In Á. Marzoa, J. Miras, & R. Rodriguez-Ocafla (Eds.), Exegetical commentary on the Code of Canon Law Vol IV/I (pp. 553–558). Wilson & Lafleur: Montreal. Pius XII, Pope (1951). Nature of their profession. Allocution to Italian midwives, http://www.ewtn.com/library/PAPALDOC/P511029.HTM. Accessed 19 June 2019. Rankin, J. (2017). Physiology in Childbearing with Anatomy and related Biosciences (4th ed.). Edinburgh: Elsevier. Religious Freedom Restoration Act (1993). Pub. L. No. 103-141, 107 Stat. 1488. Royal College of Midwives (1997). Position Paper No.17, Conscientious Objection. London: RCM. April. Royal College of Midwives (2014). High quality midwifery care. https://www.rcm.org.uk/sites/default/files/High%20Quality%20Midwifery%20Care%20Final.pdf. Accessed 19 June 2019. Royal College of Nursing v Department of Health and Social Security (DHSS) (1981). Case number HL/PO/JU/18/241. http://www.bailii.org/uk/cases/UKHL/1980/10.html. Accessed 19 June 2019. Salford Area Health Authority v Janaway (1988). Case UKHL 17. http://www.bailii.org/uk/cases/UKHL/1988/17.html. Accessed 19 June 2019. Sanchis, J. (2004). Commentary on Canon 1314. In Á. Marzoa, J. Miras, & R. Rodriguez-Ocafla (Eds.), Exegetical commentary on the Code of Canon Law Vol IV/I (pp. 238–240). Wilson & Lafleur: Montreal. Southern General Hospital. (2005). Job description midwife (Vol. 7). Scotland: Glasgow. St. Thomas Aquinas (ca. 1270) Summa Theologica first part. Question 79 article 13. http://www.newadvent.org/summa/1079.htm#article13. Accessed 19 June 2019. Statistics Department Scotland (2018). Report of abortion statistics for 2013. https://isdscotland.scot.nhs.uk/Health-Topics/Sexual-Health/Publications/2014-05-27/2014-05-27-Abortions2013-Report.pdf?26597231627. Accessed 19 June 2019. Sulmasy, D. (2008). What is conscience and why is respect for it so important? Theoretical Medicine and Bioethics, 29(3), 135–149. Sulmasy, D. (2017). Tolerance, professional judgment and the discretionary space of the physician. Cambridge Quarterly of Healthcare Ethics, 26, 18–31. The Holy See. (2000). Catechism of the Catholic Church (popular and definitive edition). London: Burns & Oates. Weinstock, D. (2014). Conscientious refusal and health professionals: Does religion make a difference? Bioethics, 28(1), 8–15. Westeson, J. (2013). Reproductive health information and abortion services: Standards developed by the European Court of Human Rights. International Journal of Gynecology and Obstetrics, 122(2), 173–176. Wicclair, M. (2000). Conscientious objection in medicine. Bioethics, 14(3), 205–227. World Health Organization (2012). Safe abortion: Technical and policy guidance for health systems. Geneva: WHO. http://apps.who.int/iris/bitstream/10665/70914/1/9789241548434_eng.pdf?ua=1. Accessed 19 June 2019. Zampas, C. (2013). Legal and ethical standards for protecting women’s human rights and the practice of conscientious objection in reproductive healthcare settings. International Journal of Gynecology and Obstetrics, 123(Suppl 3), 563–565.