This section of the site represents the viewpoint of the RCOG Trainees’ Committee on issues relating to termination of pregnancy, with particular reference to training and practice in O&G. It aims to provide clarification on moral conflicts, the law and the duties of a doctor within the context of the specialty training programme in O&G.
Termination of pregnancy and moral conflicts
All healthcare providers can be faced with situations where they may not agree with their patients’ decisions. In O&G, there are many examples where an individual trainee’s moral conscience can potentially conflict with their role as a clinician. In some circumstances, trainees may be presented with a challenge to their own beliefs in providing the specialist care expected by their patient; however, in all situations, trainees need to treat the patient with kindness and consideration and in a non-judgemental manner.
The conflict in conscience is particularly evident when considering parts of the Abortion Act 1967, which states: ‘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’.
This clause of conscientious objection refers only to participation in treatment authorised by the Abortion Act. It may be that some trainees have similar moral concerns regarding other aspects of the usual duties of an obstetrician and gynaecologist, such as counselling about and providing contraception; however, such trainees are still duty-bound to be competent in all areas of the curriculum, regardless of their personal beliefs.
There is already RCOG guidance in The care of women requesting induced abortion. This document highlights that doctors involved in the provision of abortion care are bound by the duties of a doctor as laid out by the GMC’s Good Medical Practice, in particular making sure that their personal beliefs do not prejudice their patients’ care.
It is important for trainees to understand that the conscientious objection clause only covers refusal to participate in terminations. To clarify, the rights of a professional to conscientious objection, as summarised by the BMA and presented in the RCOG guidance, are:
- Doctors may refuse to participate in terminations, but are obliged to provide necessary treatment in an emergency, when the woman’s life may be in jeopardy
- Doctors with a conscientious objection may not impose their views on others, but may explain their views to a patient if invited to do so
- A parliamentary answer in 1991 clarified that the conscientious objection clause was only intended to be applied to participation in treatment; however, subsequently hospital managers have been asked to apply the principle, at their discretion, to ancillary staff involved in handling fetuses and fetal tissue
- Refusal to participate in paperwork or administration connected with abortion procedures lies outside the terms of the conscientious objection clause
- Practitioners cannot claim exemption from giving advice or performing the preparatory steps to arrange an abortion where the request meets the legal requirements; such steps include referral to another doctor, as appropriate
- The conscientious objection clause may be used by medical students to opt out of witnessing terminations
Expanding current guidance
The RCOG Trainees’ Committee feels it is important for anyone entering the specialty of O&G to be aware of their rights as a professional to conscientious objection, and how these rights are balanced by their duties as a doctor. In training, the conscientious objection clause may only be used to opt out of witnessing or performing abortions.
Trainees still need to be able to demonstrate their competency in counselling about termination, whether this is done with patients or in a simulated environment. Trainees are also expected to be able to discuss and counsel women about contraception or sexually transmitted diseases.
Trainees have a responsibility to ensure they are wholly trained in all areas of O&G as set out in the RCOG curriculum. Any trainee or doctor who refuses to provide any other service on the grounds of conscientious objection may find themselves in breach of the GMC duties of a doctor, with potentially serious consequences.
Find out more
Read the answers to frequently asked questions about training and termination of pregnancy, which help to illustrate the issues.