Understanding the extent of and limitations to conscientious objection by health care practitioners to abortion

Project title
Understanding the extent of and limitations to conscientious objection by health care practitioners to abortion
Context
The 1967 Abortion Act, which was the first legislation on abortion to cover Scotland, England and Wales, has had a significant impact on social norms and healthcare practice. There was substantial controversy around the introduction of the Act and now with its Act's 50th anniversary, the topic is once more being brought to society's attention through various radio and television programmes and workshops and conferences being held in a number of locations. These have shown that the 'abortion debate' still has the power to be socially-divisive today.
However, another question has come to the fore and that is the right by health care practitioners (HCPs) to 'conscientious objection' under section 4 of the Act. At the time of its enactment, this right was granted without question but in more recent times, especially with changes to the practice of carrying out abortions, it has been called into question and its limits have become blurred.

Aim, research questions and objectives.
Aim
Our research aims to identify the appropriate parameters of conscientious objection (CO) to abortion, and communicate the findings to a range of national and international beneficiaries.

Key research questions
1. What do health care practitioners understand as constituting 'participation in abortion'?
2. Which elements of the abortion process should professionals be permitted to withdraw from on grounds of conscience?

Main objectives
1. To explore what HCPs understand as constituting 'participation in abortion' by gathering empirical evidence from HCPs working in two geographical areas, both of which provide the full range of abortion services
2. To synthesise this evidence with that already available in academic literature, policy documents and legal proceedings
3. Ultimately, to produce recommendations and guidance on the appropriate parameters of CO to abortion by HCPs

Potential application and benefit
Through the dual approach grounded in empirical and philosophical enquiry the key deliverable from this study will be the identification and delivery of specific recommendations of appropriate parameters for CO to abortion to health care institutions throughout the UK. The findings will thus have the potential to inform governance, management, and practice in medicine, midwifery, nursing and pharmacy; to impact upon regulation of CO by the UK and devolved governments; and to influence policymaking by international organisations such as the WHO and the international professional bodies. We will then provide clear guidelines for national use.
Our study will be unique in several respects:

(I) it will be truly multi-disciplinary and will involve academics and HCPs with diverse expertise;
(II) it will proceed upon a purposive premise, whereas most academic enquiry about CO proceeds on the basis of an ideological commitment to defending/opposing CO;
(III) it will be the first research in its field to employ parallel empirical and philosophical methodologies; whereas most academic study of CO is either heavily empirical or heavily philosophical, our study will start at ground level, collecting perspectives from HCPs whose roles bring them into contact with the abortion process, and subjecting the data gathered to philosophical analysis.
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The Abortion Act 1967 has had a significant impact on social norms and healthcare practice in the United Kingdom. There was substantial controversy around the introduction of the Act, and the 'abortion debate' still has the power to be socially-divisive today. One subject which continues to generate social, professional, and academic controversy is the appropriate parameters of the right to conscientiously object to abortion. In 2014, the UK Supreme Court determined the scope of the right by enquiring into the meaning of the word 'participate' in the text of the Act, with the presiding judge deciding that to participate meant taking part in a 'hands-on' capacity. However the court neglected to engage with the purpose of conscience rights: namely, to shield health care practitioners (HCPs) from moral responsibility. There is an urgent need, therefore, to understand what 'participation' means to practitioners themselves in the context of abortion, and to explore the appropriate parameters of conscientious objection ('CO'), i.e. precisely what HCPs should be permitted to withdraw from, and under what circumstances.

In meeting this need, the proposed research will:

Reach evidence-based conclusions about the appropriate parameters of CO, drawn from both empirical and philosophical-legal analysis of the issues (this is the overarching research goal)

Feed our evidenced-based findings into international academic debates on CO (see Impact Goal 9)

Engage with, and communicate our findings to, the following beneficiaries:
Bodies that represent, regulate, and provide ethical guidance to the health professions, such as the General Medical Council, Nursing and Midwifery Council, General Pharmaceutical Council, British Medical Association, and the relevant Royal Colleges (see Impact Goals 1, 3, and 4)
International bodies such as the WHO, and international professional federations (see Impact Goal 7)
Campaigners and legislators considering changes to current UK abortion law (see Impact Goal 6)
Managers responsible for planning service-provision in the UK NHS, both nationally and locally (see Impact Goal 5)
Individual HCPs whose roles might bring them into contact with the abortion process (see (see Impact Goal 4)
Those considering entering professions such as medicine, midwifery, nursing or pharmacy (see Impact Goal 2)
Women considering seeking abortion (see Impact Goal 3)
Religious faiths which provide guidance to their members around the issue of CO (see Impact Goal 2)

Inform discussion about CO not only to abortion, but also to other controversial practices, such as activity involving the destruction of human embryos, and assisted suicide/euthanasia (in the first instance, this will be accomplished in the course of our academic impact under Impact Goal 9)

Allow for the development of further networks in the field, e.g. a COST action comprising a multi-disciplinary group from several EU and partner countries (see Impact Goal 8)