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The law clearly states the right of health-care professionals to act
according to their ethical beliefs, in order to prevent their personal moral
compromise, yet it would appear that a variety of interpretations of this
right exist. This paper seeks to clarify the situation regarding a midwife’s
conscientious objection to participation in the process of abortion.

BRITISH JOURNAL OF MIDWIFERY, NOVEMBER 1999, VOL 7, NO 11

to risk of injury to the physical or mental
health of the pregnant woman or any existing
children in her family. The other amendments
involve three categories for which
there is no gestational limit for abortion:

678

This is incorrect. A midwife cannot have a
duty of care to every woman in the maternity
unit. Her duty of care will be to those for
whom she is the named midwife, this could
be for one shift only, and those who she
attends on request of the woman or another
practitioner. If she is not allocated to the
woman undergoing an abortion then there is
no professional relationship with her, therefore,
initially there is no duty of care. The Act
itself states that she can be under no legal
duty to take part in the process. It is also said
by some that, regardless of the Act, a midwife
has a duty to care in accordance with her
Code of Professional Conduct (UKCC, 1992)
and Midwives Rules and Code of Practice
(UKCC, 1998). In the normal situation this
would be correct, however, point 8 in the
Code of Professional Conduct (UKCC, 1992)
allows for conscientious objections, therefore,
a midwife could not be guilty of failing in
her practice, as long as she had followed the
procedure and abided by Section 4 subsection
(2) of the Act with regard to emergencies.
It is important to remember that the Act is
primary legislation and the UKCC rules are
secondary legislation. Usually this creates
no difficulties, but where there is any dispute
between primary and secondary legislation,
primary legislation (the law of the
land) is more powerful.
Another defence raised by managers and
Supervisors of Midwives, is that midwives
must not be judgmental in their care of
clients. The issue is not about judging individual
clients. It is about the moral effect
that the abortion process has on the individual
midwife. By submitting an objection
to her manager before such a case arises,
the midwife cannot be seen to be judging
any individual, especially as each woman’s
case is essentially different. The objection
would cover all abortions, late and early, it
could not be used in selected cases as this
would definitely be discriminatory.
The Code of Professional Conduct (UKCC,
1992) states that the objection should be
reported as soon as possible. This has been
interpreted by Dimond (1994a) as being at
the time of interview, however, this could
lead to discriminatory practices such as offering
jobs to those without objections, but giving
different reasons. According to an agreement
between the Department of Health
(DoH) and the medical profession (Morgan
and Lee, 1991), there should be no mention of
termination duties at interview, unless explicitly
stated in the job description. If this is thought
appropriate for doctors, then surely it is also
appropriate for midwives. There is also the possibility
that someone develops a conscientious
objection after taking up a post. There is nothing
to say that people are born with one set of
views that see them through a whole lifetime —
people have experiences, at various stages of
their lives, which serve to change or develop
their thinking.
Having submitted the objection, the midwife
is then exempt from the procedure in the
future. However, here is another area of contention:
exactly what it is from which she is
exempt. Perhaps the problem is created by different
definitions of what constitutes abortion
or termination of pregnancy. Induction of
labour at term is termination of a pregnancy
but while there might be room to argue about
some aspects of this process, there is no problem
related to conscientious objection. It is
probably safe to say that there is no such problem
with regard to any termination of pregnancy
where the intention is to do the best for
the fetus during labour and delivery and the
baby after birth. The problems arise when the
intention is for the fetus not to survive.
The Act uses the phrase termination of
pregnancy, but at what point is the pregnancy
terminated? Some managers insist that it is
once the prostaglandins are administered and
they then expect their midwives to care for
the woman from that point on. Others consider
that, where feticide is carried out, possibly
in the ultrasound department, the midwives
should consider the case to be the same as a
spontaneous intrauterine fetal death once the
woman reaches the delivery suite. Does a
woman consider that her pregnancy is over
before delivery takes place? Or, when a late
termination takes place for pre-eclampsia,
does anyone consider the pregnancy to be
over once the induction has begun? The
answer to both questions has to be no.
In 1958 Professor Glanville Williams stated,
with regard to abortion:

BRITISH JOURNAL OF MIDWIFERY, NOVEMBER 1999, VOL 7, NO 11

In the English Oxford Dictionary (Allen
1984), abortion is defined as the ‘natural or
induced

This appears to be contradictory. If
Section 4 of the Act is brought together with
the definitions used above, then this should
clarify the situation for all involved.
Someone who registers a conscientious
objection to participate in abortion, where
the intention is for the fetus not to survive,
should be exempt from caring for any such
woman from the start of the abortion
process (feticide, insertion of pessaries etc)
until the products of conception have been
cleared away. A midwife cannot refuse to
care for the woman at any stage before the
start of the process, or following completion
of the ‘delivery’. She must also be prepared
to act in an emergency, such as haemorrhage
or cardiac arrest, in the same way as
she would for any other woman.
It is not unusual for midwives to report that
live births are occurring from such terminations,
certainly from about 22 weeks gestation,
and paediatricians are refusing to attend. The
law, even the Abortion Act, does not permit the
killing of a baby and, regardless of the woman’s
views, the midwife must fulfil her duty of care
to this baby (Dimond, 1994b). It appears essential,
therefore, that medical staff ensure that
feticide is conducted before the induction of
labour in abortions beyond 24 weeks, perhaps
even earlier. Failure to do this could result in
midwives being placed in unacceptable dilemmas.
The conscience clause is not new, yet it
would seem that some trusts have not yet
developed their policies in accordance with the
rights afforded to professionals by law. Surely it
is time to amend this oversight.

Allen RE (1984)

Quartet Books, London
Mason and McCall Smith (1994)

Oxford University Press, Oxford
Morgan D, Lee R G (1991)

UKCC, London
UKCC (1998)

Butterworths, London 921

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