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New South Wales healthcare workers who object to abortion and voluntary assisted dying face growing pressure, raising serious questions about conscience rights, employment and moral injury.

New South Wales doctors and nurses who have a conscientious objection to participating in abortions or voluntary assisted dying are under threat, Liberal MLC Susan Carter told a gathering of doctors and lawyers recently.

She disclosed that she has detected hostility towards conscientious objection and a growing endorsement of “authoritarian majoritarianism” among her constituents and her colleagues in Parliament.

“Anyone who would stand in the way of health care — for example, by declining, on conscience grounds, to participate in a surgical abortion — must be an obstruction to be removed by any effective health system, rather than a practitioner with a strong ethical compass who should be supported,” she observed.

“And this is the language we hear from health bureaucrats all the time.”

Conscience Rights Under Pressure

Addressing members of the St Thomas More Society and the NSW Catholic Medical Association, Carter said that both in theory and in practice, conscientious objection for healthcare workers is at risk in the state’s healthcare system.

Greens MLC Dr Amanda Cohn, for instance, once told Parliament in connection with abortion that “conscientious objection must not be weaponised to restrict access to care by whole departments or institutions.”

And last year the CEO of Murrumbidgee Health District told the budget estimates committee that they would prefer to employ people in key roles based on their views on whether or not they object to abortion.

Where does this leave people who believe that abortion and VAD are unethical? On very shaky ground, Carter warned.

“Doctors with a conscientious objection are obstacles to be designed around — and employment conditions structured in such a way that they are unemployable,” she said.

“From a purely administrative perspective, this is understandable. From a view of conscience as representing a perceived majoritarian view, this makes perfect sense. But from any other understanding of conscience? It is denial of a conscience right.”

Three panellists commented on Carter’s sombre message.

Bioethicist Professor Megan Best, of the University of Notre Dame Australia, told The Catholic Weekly that it can be very difficult to be a conscientious objector to abortion and to VAD, even if hospitals give it lip service.

“In practice, it’s very hard for a junior member of staff in hospitals to exercise conscientious objection if they are working for someone who doesn’t have an objection,” she said.

However, there do need to be limits, Best said. Otherwise, doctors could refuse to treat certain classes of patients by invoking their “conscience”.

“Perhaps what we need is some external verification of the conscientious objection in terms of membership to a religious group or even limiting conscience to a certain number of issues,” she said.

“This is a black-and-white lawyer’s job to work out where you draw the line. But I think it is reasonable to say that we need to put something in place to make sure that conscientious objections aren’t allowed on an arbitrary basis.”

Michael Quinlan, an emeritus professor of law at UNDA, pointed out that doctors and nurses are not the only people affected.

“The problem here is that there are lots of other people who interact with abortion and VAD, such as students, pharmacists, nurses, pastoral care workers, personal care workers, hospital and residential facility staff and administrators or interpreters,” he told The Catholic Weekly.

Everyone is entitled to freedom of thought, conscience and religion, not just registered health practitioners. Conscientious objection rights should be clearly available to everyone, not just registered health practitioners.”

The Threat of Moral Injury

A novel idea for protecting conscience rights emerged from Carter’s talk — treating conscientious objection as a workplace safety issue. Being forced to violate one’s conscience could cause “moral injury”.

“Moral injury raises the possibility that the underlying moral nature of traumatic and significant events can lead to lasting psychological, biological, spiritual, behavioural and social impacts,” Carter explained. It could be “an OH&S risk which employers have a legal obligation to avoid.”

Quinlan agreed.

“Whilst when we think of workplace injuries we might think of physical injuries, injuries can include psychological injuries resulting, for example, from bullying, trauma, work-related stress and moral distress.

“Conscientious objectors can face these kinds of psychosocial injuries, if they are bullied or forced to participate in — or witness — activities like abortion or VAD which are contrary to their conscience,” he told The Catholic Weekly.

He believes more research in this area is “critical”.

The third panellist at the seminar, Dr Xavier Symons, of The Plunkett Centre at Australian Catholic University, is one of Australia’s leading experts on conscientious objection in institutional settings.

He said that the danger of moral injury is a key argument in his recent book, Why Conscience Matters: A Defence of Conscientious Objection. “Health professionals are liable to experience moral injury if they are pressured into acting against their deeply held beliefs,” he said.

The seminar on conscience in healthcare at Club York in the Sydney CBD was attended by about 40 people. It was the first collaborative event organised by the Catholic Medical Association and St Thomas More Society.

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Republished with thanks to The Catholic Weekly. Image courtesy of Adobe.