Abortion and the Catholic Doctor
Advice and ideas on
How to follow the Church's teaching
One of a series of booklets aimed at helping young Catholic doctors. Written by Drs Adrian and Josephine Treloar, Dr Anne Marie Williams, Dr Peter Au-Yeung
Produced by the Catholics in Practice committee of the Guild of Catholic DoctorsPart One:- The working of the Abortion Act
The conscience clause in practice
The deliberate termination of a pregnancy has gained acceptance in society since the passing of the 1967 abortion act, initially for "serious" reasons, increasingly for "social reasons" (a euphemism for abortions of convenience). Laws...play a very important and sometimes decisive role in influencing patterns of thought and behaviour.'(Evangelium Vitae n.90) With the widespread expectation for abortion on demand, recently acknowledged by the House of Lords as fact, the position of any doctors opposed to abortion becomes increasingly difficult.
Although the Act makes provisions for conscientious objectors in Section 4(1); life may be made difficult for them by means of embarrassment, intimidation, threats of bad references, discrimination at appointment and the occasional dismissal. The Janaway case in which a medical secretary was dismissed for refusing to type referral letters for abortion, has resulted in a statement of the application of the letter of the law with regard to the Conscience Clause.
The 1967 Abortion Act
The 1967 Abortion Act legitimises medical abortions if two doctors are of the opinion
a) that the continuance of the pregnancy would involve risk to the life of the pregnant woman or of injury to the physical or mental health of the pregnant woman or any existing children of her family, greater than if the pregnancy were terminated;
b) that there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped."
The conscience clause (Section 4(1) states that "no person shall be under any legal 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: Provided that in any legal proceedings the burden of proof shall rest on the person claiming to rely on it". However this is subject to the next subsection (2) which maintains the duty to participate in treatment which is necessary to save the life or to prevent grave permanent injury to the physical or mental health of a pregnant woman.
It is common belief that the conscience clause allows all doctors nurses and other health professionals to opt out. The degree of participation of different workers varies and needs to be considered individually by each worker. A secretary writing a letter of referral is not as directly involved as a nurse passing instruments. In practice, only doctors, nurses and medical students have found themselves in a position requiring recourse to this clause, though as will be illustrated later, the clause may be found lacking.
If the law accords people a 'right', this implies a corresponding 'duty' for others. Evangelium Vitae recognises the problems and states 'Decisions that go against life sometimes arise from difficult or even tragic situations of profound suffering, loneliness, a total lack of economic prospects and anxiety about the future. Such circumstances can mitigate even to a notable degree subjective responsibility and the consequent culpability of those who make these choices which in themselves are evil. But today the problem goes far beyond the the necessary recognition of these personal situations. It is a problem which exists at the cultural, social and political level, where it reveals its more sinister and disturbing aspect in the tendency, ever more widely shared to interpret the above crimes against life as legitimate expressions of individual freedom, to be acknowledged and protected as actual rights. ...These attacks go directly against respect for life and they represent a direct threat to the entire culture of human rights. (Evangelium Vitae, n.18)
The Principle of Legitimate cooperation.
To actually intend the evil purpose is FORMAL COOPERATION, no matter how small one's share in the actual physical execution, this can include advising, counselling, promoting or condoning. MATERIAL COOPERATION does not intend the evil effects but because if it is IMMEDIATE i.e. a direct contribution to the act, the cooperator shares the responsibility for the act. On the other hand, MEDIATE material cooperation, which can be proximate or remote, can sometimes be justified and even necessary. The good achieved by the cooperation must outweigh the contribution of the cooperator to the act, for example, a porter whose livelihood depends on a job is justified in working in a place where abortions are performed provided he disapproves and does not immediately cooperate with an abortion. The scandal or bad example that can be set must also be weighed. Even the appearance of cooperation with evil helps this evil to continue. Any cooperation may contribute to the impression that abortion is a reasonable choice, that it is a normal part of therapeutic care, or that it is a neutral option.
Remote cooperation is easier to justify, for example the manufacture of temazepam is remote from drug abuse because it has legitimate medical uses.
The principle of double effect.
Indirect abortion results in the death of the foetus occasioned as an inevitable bad effect of a medical or surgical intervention. The principle of double effect states that an action, which must of itself be good, or at least morally indifferent, may be permissable even if it is foreseen to have a twofold effect: one that is good, which is sought and willed, another evil which is not. It is aimed at the cure of the mother's grave illness such as in the case of a cancerous womb. The interruption of the pregnancy is not sought nor desired and is avoided insofar as is possible; in short it is tolerated. The action itself is necessarily good as the good intention can never justify evil means. Also, the act itself cannot be justified by the evil effect. It is not the loss of the child which brings about the good but the removal of the womb. Therefore it may be licit to participate in such a procedure if there are no alternative cures and all is done to preserve the life of the child e.g. postpone delivery as long as possible to increase the chances of viability.
The Janaway case and its Implications
The situation has changed profoundly since the Janaway case. Common sense and moral theology will both agree that the cooperation of a medical secretary is remote rather than proximate, and even ex hypothesi arguments based on criminal law will tend to come out in favour of very little participation on the secretary's part. The initial judgement interpreted the letter of the law and ruled that only those who might participate in the hospital treatment for abortion are entitled to claim conscientious objection under section 4(1).
Must doctors sign the form?
The majority judgement of the Court of Appeal ruled that the spirit of the law would also cover the signing of the abortion form (the 'green form'). Lord Keith of Kinkel admitted in his judgement, relating to the Abortion Regulations 1968 setting out the 'green form' that "it does not appear whether or not there are any legal circumstances under which a doctor might be under any legal duty to sign an abortion form" and suggested that "none exist" ( 3 WLR 1355 G,H). Therefore, if a doctor does not believe that an abortion is in the best interests of a patient, it is not necessary to agree, in writing, to an abortion. It would be hard to see how one could possibly believe that encouraging a patient to commit the killing of innocent life could be in that patient's best interests.
Are people with a conscientious objection able to counsel patients?
Broadly this can apply to any counselling about any procedure with an ethical component. In 1991 the Annual Representatives Meeting of the British Medical Association passed a motion which in essence said that doctors with an ethical objection to abortion are not able to give counselling on this issue and so should refer the patient immediately to a colleague. The effect of this is to say that if you think abortion is wrong your voice should not be heard at all even if you counsel in a non directive way. Of course this is unacceptable to Catholic doctors as it means we must effectively agree that any patient who requests an abortion should not be spoken to but rather should be referred to a pro abortionist for effective abortion on demand.
As a result of this a motion was put forward at the 1992 conference which stated that any doctor can give counselling on abortion irrespective of his or her position on the matter. This was, thankfully, passed. It is well known that patients report being told by GP's that they should have abortions when they have never even suggested such a course of action and that they feel pressurised, by GP's and others, into abortions at an emotionally very vulnerable time. It is therefore essential that Catholic doctors are around to help patients who would rather avoid abortions and to try to ensure that patients are not just rushed into disastrous decision. By listening to the patient, with the benefit of our solid formation we are in an excellent position to understand what is going on in their troubled soul. It is important to give them time to realise their situation calmly and not just to panic and take rash decisions which they may later regret. The advice we give must be objective and true to their interests.
The reality for Conscientious Objectors
The reality is that there is little that any law framed like the Act can do to provide significant safeguards once the concept of abortion becomes acceptable. Even within the first few years of passing the law, obstacles were placed in the path of those who wished to progress in Obstetrics and Gynaecology, but who were not prepared to perform abortions. One promising candidate for a consultant post was turned down in the early seventies, with advice from a professor on the Appointments Committee telling him that there was no place in Britain for a Roman Catholic gynaecologist. He emigrated to Canada, was subsequently appointed an associate professor and wrote to the BMJ (1976,(i); 1456-8) expressing his dismay at the road that the profession is taking in the UK. The Lane commission which looked at the working of the Abortion Act were sent a dossier of some 8 cases of similar discrimination, but they argued that "the needs of the many must take priority".
It is thus not surprising that the situation has not altered for the better since that article was written. Discrimination, intimidation and all other forms of pressure are brought to bear on the conscientious objector. Pointed questions are asked at medical school interviews: an article looking at some of the failings of medical student selection cited an example of three candidates from the same Catholic school being asked how they would deal with an 18 year unmarried girl requesting an abortion and if their religion would raise any difficulties. They also observed that all three failed to gain admission.(J Roy Soc Med (1989) 82: 288-291)
Once qualified the trouble can start in earnest:
Obstetrics and Gynaecology has become a very difficult area for conscientious objectors. A career trainee in the field was refused an appointment because she would not perform abortions; she got another post, continued her training to the level of MRCOG and went into general practice.
Prospective consultants do not find it easy either. It is possible to require that consultant appointees will perform abortions. Such requirements merely have to be specified in the job description and the Department of Health notified. Although the latter was probably done in the past, very few such notifications have been made in the last ten years.
GP trainees can also end up in trouble: a consultant refused to sign up one trainee because of her persistent refusal to take part in abortions. The Guild took up her case and the situation was resolved. Another trainee was dismissed from her practice for refusing to sign an abortion form.
Anaesthetists can face many pressures. They may be scheduled for lists including abortions on their rota. Sometimes a less subtle approach is used:- intimidation. Two SHO's were told by a registrar that they were unlikely to get a registrars post if they did not change their attitude to abortion. Even the BMA feels that the Conscience Clause need not apply to preoperative care of abortion patients (see Catholic Medical Quarterly 1978 p98-99). Therefore it is not surprising that some individuals who disagree with the conscience clause are not afraid to impose their views on their junior colleagues.
It is thus clear that the so-called conscience clause does not live up to its original intention of allowing those with a moral objection to opt out without fear of professional ostracism. The pressure against the objector has made itself felt from the earliest application of the Act, and continues to do so with increasing menace to juniors. Nonetheless these pressures can be managed and minimised and doctors who respect the Church's teaching on Abortion (and for that matter contraception) continue to train in General Practice and Anaesthetics as well as (occasionally) in Obstetrics and Gynaecology.
Statements of the Church
'Abortion and euthanasia are thus crimes which no human law can claim to legitimize. There is no obligation in conscience to obey such laws; instead there is a grave and clear obligation to oppose them by conscientious objection. ..."we must obey God rather than men" (Acts 5:29).' (Evangelium Vitae, n.73).
'The passing of unjust laws often raises difficult problems of conscience for morally upright people with regard to the issue of cooperation, since they have a right to demand not to be forced to take part in morally evil actions. Sometimes the choices which have to be made are difficult; they may require the sacrifice of prestigious professional positions or the relinquishing of reasonable hopes of career advancement. ... In order to shed light on this difficult question, it is necessary to recall the general principles concerning cooperation in evil actions. Christians, like all people of good will, are called upon under grave obligation of conscience not to cooperate formally in practices which, even if permitted by civil legislation, are contrary to God's law.' (E. V., n.74)
'A unique responsibility belongs to health care personnel: doctors, pharmacists, nurses, chaplains, men and women religious, administrators and volunteers. Their profession calls for them to be guardians and servants of human life. ... Absolute respect for every innocent human life also requires the exercise of conscientious objection in relation to procured abortion and euthanasia.(Evangelium Vitae, n.89)
Part Two: Practical Suggestions for junior doctors
In this part we take a look at some of the every day problems caused by abortion for Catholics and at some of the possible solutions to these problems.
CHALLENGES TO CONSCIENCE
The teaching of the Catholic Church provides plenty of material for inspiration and guidance on the basic moral outlook that Catholics should have towards abortion. However, it is our experience that, many doctors and medical students, on being confronted with the issues face to face in clinical practice find that standing up for the Church's teaching, and remaining within what is ethical, can be both difficult and stressful. The reasons for this seem to be fairly simple.
Firstly, as Catholics we in fact only occasionally are obliged to stand up for what we believe. The majority of what is accepted as medical ethics is, even now, in good accord with the teaching of the Catholic Church. As a result of this, when the chips are finally down, as in a case of abortion, many doctors will suddenly find themselves unprepared and feeling unsure of their rights under the 1967 act as well as being unsure of how to explain their position to an unsympathetic audience around them.
Secondly, in a career structure where one's progress is almost entirely dependant upon the approval of consultants, refusing to participate can and, on occasion, does lead to failure of progression of one's career. In other words being truly Catholic can be profoundly career negative.
Thirdly, the attitudes of other staff, such as nurses and the fellow doctors, who end up doing the work which we have rightly refused to do can also be extremely stressful and upsetting. Part of this, has in our experience, appeared to be because many other staff do not feel easy about abortion and the statement that it is wrong can be as difficult for them to hear as it is for us to state.
Finally, there are the patients. Members of our committee have been warned that the patients will be upset by overt or covert statements that the operation they are seeking is wrong. Indeed when many believe that abortion is a woman's basic right we clearly need to be at least prepared to find some flak flying past our heads.
Following the natural law may not always be the easy way. Undoubtedly therefore there are enormous pressures which can, and we believe have, overwhelmed many and pushed them into performing abortions. What are the possible solutions to these problems?
STARTING A POST:
Probably the most common solution to the problem is to simply ignore it and to hope that it will go away. This solution probably works very well for much of the time and will allow us to avoid being labelled as religious zealots but it will at some stage need back up when the real crunch comes.
Questions about views on, or willingness to participate in, abortions are not licit at interview. If such questions were to be asked, as indeed they often are, it might be wise to evade the answer or point out that the question is unreasonable. Sadly, by expressing our position clearly, chances of appointment are greatly diminished. The decision not to appoint will not be attributed to the moral stance conveyed. Nonetheless, there will always be other interviews and opportunities and we hope that keeping our soul intact will seem more important than one lost job.
It is the experience of members of our committee that discussing the issues with consultants after appointment but before commencement in post can work well and appeared to enhance tolerance of one's position. This approach has also been successful in relation to the fitting of coils and signing green forms in general practice.
In the case of junior doctors it should not normally be necessary to discuss this until before the rotas are compiled, as the staffing requirements for junior doctors under the abortion act are required to be sufficient to cover for conscientious objectors.
Provided care is taken to point out that this is a moral standpoint, founded upon our deeply held convictions rather than a rather flimsy 'cop out' to get off a bit of work, it is our experience that others will respect someone who is seen to care about moral issues. It is hard to make firm statements about whether membership of the Catholic Church is the reason for refusing to be involved. Some of us avoid this issue and emphasise the moral argument. Others may say something like, "Well I am a Catholic but I also happen to think that the Church's teaching on this is very good." Certainly "I'm a Catholic and so I wont" would seem to risk failing to show that we have thought through or really care about this issue. Once established in a career in an area of medicine where these problems will arise regularly (ie Obs and Gynae, Anaesthetics and General Practice) it is advisable to discuss the implications of such a moral stand on service provision (i.e. inability to do lists with terminations on them) in advance of the commencement of each post.
A further alternative is to keep absolutely quiet until the problem finally appears, but this is asking for a rough ride. There will be risks of major arguments within a department by consequent emergency swaps or disturbances of the rota, or even, lack of cover. Strength of mind to keep cool in the crisis that will ensue is paramount. There are some advantages to this approach, both to the mother kept waiting and to staff, who may not have met someone prepared to stand up for what is right before.
While we may not hope to stop a woman from having an abortion, if that is what she is determined to have, this would be at least ensure that she has really thought through the issues again. Many women report never having had anyone to seriously suggest anything other than just go ahead with an abortion. They report only meeting doctors and nurses who encourage them to go ahead. Although saving the life of a child in this way would be marvellous, it may be that this in not achieved and the disruptive actions are either misconstrued as complicity or mischievous obstruction. Such action may also entail the sacrifice of any hope of accreditation (which is of course far less important than the life of a child) for that particular job. A very small number of people have, to our knowledge, had difficulty with accreditation for jobs. The Guild can help in some ways in such circumstances.
HOW MUCH INVOLVEMENT?
Some Christians and possibly some Catholics have performed abortions on the basis that they are wrong and that we must do everything possible to stop them happening. The argument then goes that by being available to counsel and be referred abortions they are not then sent to a proabortionist and they get the opportunity to hear a cautionary voice before going through with an abortion. The teaching of the Church is however that taking one life in such a way cannot be justified by arguments for the good of others. Each human life is uniquely special and God given and must be respected as such.
A question often asked by a junior hospital doctor is: "Can I 'clerk in' a patient who is about to undergo an abortion?" The answer is very complex. Anything which is a preparation for an abortion is cooperation in the act. However, if the woman would otherwise be subject to an anaesthetic without a medical check, it would amount to negligence on the part of the doctor responsible, not to screen for contraindications to anaesthesia. Anaesthetists are ultimately responsible , but rely on juniors to take the time they cannot afford. It can be argued, therefore that the patient is 'clerked in' for the anaesthetic and not for the abortion. Any decision regarding the latter was made prior to admission. The contact with the patient may also allow for last minute counselling.
It would be unethical to provide pre-medication or to sign the consent form as this would be direct preparation for the procedure and imply agreement. Any refusal to cooperate which may result in the cancellation of the abortion may be considered as a legitimate way of saving life. To be effective, however would necessitate teamwork and a combined approach. This has been done by junior doctors in New Zealand.
It is probably also possible to justify giving analgesia to a woman suffering pain, as a result of an abortion already initiated by someone else. The mini labour may take many hours and be very distressing to the woman. We may react initially by thinking "It serves her right!" or "This will teach her a lesson!" but this would be very judgmental and though we hate the sin we must love the sinner. There may be a valid argument in saying that this would prevent her wanting another abortion, but people forget.
The aftercare and treatment of complications provides less of an ethical problem. The deed is done, and the mother, whatever crime she has committed, needs care and respect as much as any human being. Certainly, if the mother were to collapse, a full resuscitative procedure must be implemented. It is better, however not to be involved with abortions routinely, as our very presence as a qualified member of staff facilitates the abortions and causes scandal. The continued proximity to such an evil may also constitute a danger to our souls, by reducing the shock and horror we feel at the killing of innocent life.
Refusing to be involved with abortions is difficult and does require determination and a large amount of grace from God as well as wherever possible the support of like minded colleagues. It is good to remember that most survive intact and are respected for such pro-life views in the end (especially once people had seen how firmly we hold them!). It is important to remember that the law is on our side and that God is too.
In many departments, no information is given to women when they are asked to attend for 'another routine test', despite the official recommendation of 'counselling services'. Some are consequently shocked when they are told they have a positive test for spina bifida or Down's syndrome and the only 'treatment' they are offered is a termination.
'When they do not involve disproportionate risks for the child and mother, and are meant to make possible early therapy or even to favour a serene and informed acceptance of the child not yet born, these techniques are morally licit. But since the possibilities of prenatal therapy are today still limited, it not infrequently happens that these techniques are used with an eugenic intention which accepts selective abortion in order to prevent the birth of children affected by various types of anomalies. such an attitude is shameful and utterly reprehensible, since it presumes to measure the value of human life only within the parameters of "normality" and physical well-being, thus opening the way to legitimizing infanticide and euthanasia as well.'(Evangelium Vitae,n. 63)
Many would therefore not be happy to take blood for prenatal testing when there is nothing other than abortion available.
FACING A REQUEST FOR AN ABORTION
When faced with a request from a patient for an abortion it is important to remain sympathetic. The patient has probably come with a lot of trepidation and after a great deal of soul searching, even if this is not very evident. It may be appropriate to state one's views fairly early on in the consultation. This aids any further questioning on the woman's plight and searching of her motives to be done openly. It may be prudent to ask what she really wants and what support she has. She may be in a state of confusion at the discovery of the pregnancy and it may be helpful to point this out to her. Even people in a secure situation often find they are shocked at the news of an unexpected pregnancy. She may feel terribly insecure as she has no-one else, except the doctor she can turn to. Thus the role of the doctor can be very important. She may have suffered coldness or rejection from her partner who may have refused to contemplate bringing a baby into the world (not realising that he had done so already even though it is unseen). It may have been him who suggested the easy solution to her of 'getting rid of it'. Women react in different ways;- some become very angry and hurt and still ask for an abortion as the love for her partner has died with his reaction, others think that by having the abortion they can forget and carry on the relationship as before. The contraceptive attitude, which is very prevalent now, can lead to a devaluation of human life and therefore to an acceptance of abortion. Sometimes the abortion is requested 'to save the relationship'. However as the abortion destroys the very fruit of the parents' love, their love will suffer and very often will die within a short time leading to a break-up of the relationship. The unhappy woman in front of you may be putting on a brave face in her determination to get what she has asked for, or she may be grateful to have the opportunity to cry and express her feelings of confusion. Only too often she has been unable to share her worries and grief with her parents or other members of the family for fear of losing face or shocking them.
'As well as the mother, there are often other people too who decide on the death of the child in the womb. In the first place, the father of the child may be to blame, not only when he directly pressures the woman to have an abortion, but also when he indirectly encourages such a decision on her part by leaving her alone to face the problems of pregnancy: in this way the family is mortally wounded and profaned in its nature as a community of love and in its vocation to be the " sanctuary of life". Nor can one overlook the pressures which sometimes come from the wider family circle and friends. Sometimes the woman is subjected to such strong pressure that she feels psychologically forced to have an abortion: certainly in this case moral responsibility lies particularly with those who have directly or indirectly obliged her to have an abortion.'(Evangelium Vitae, n.59) So, in summary she may be grieving, angry, confused and see no other way out.
COUNSELLING THE PATIENT
By going through the above points with a patient it may help her think about why she has reacted in such a way and help her to rethink her decision. If the patient can take more it may help her to ask:- What do you think you may feel about this in 5 years time? Who have you talked this over with? Do you realise that the horse has already bolted and that the baby is already there? It may be helpful to suggest alternatives and to have a list of local LIFE counsellors handy so that if she can go and discuss the matter further with them. She may be encouraged by the practical help which is available. This offer of help may be rejected outright or even laughed at. We need to be very alert to the verbal and non-verbal signs which tell us that a patient does not want to know. The body language can give very important clues as to whether the message we are giving is being welcomed or rejected. It can be a mistake to put across a strong pro-life message in such a delicate and emotionally charged situation. We need to be firm but compassionate. It is important to comfort her in her distress and assure her that even if she does go though with it she is welcome to come back and talk it over. It is important to convey the fact that she is not being judged; the action of abortion is clearly wrong but it is not our job to judge her. She is to be shown sympathy and understanding about all the suffering she is going through.
It may be worth pointing out that at the time when most women are seeking an abortion the baby's hands and feet are forming along with its brain. It is only fair that women are informed of teratogenicity of drugs and that they should avoid drugs which could be harmful to the baby. No woman who changed her mind about an abortion and who then had a handicapped baby would be pleased that her doctor had not warned her to avoid drugs and excessive alcohol.
SECOND OPINION OR REFERRAL
If the woman is definite in her wish for an abortion then she has a 'legal right' to see another doctor for another opinion. The BMA states that failure to refer for a second opinion is in breach of our terms of service. In general practice this could be a partner or a GP in another practice. In hospital it might be a colleague. We may not consider her case qualifies under the terms of the Abortion Law and we will be legally covered provided we have clearly registered our reason for not referring or facilitating the abortion. We cannot impose our views upon others and so, under the law, we should not obstruct her access to another doctor. If we deliberately facilitate the carrying out of a wrong action, we have responsibility for it. Referral is a material form of cooperation. Letting patients know that they have a right to seek another opinion may be cooperating in only a very distant way. The decision on exactly what to do must be guided by a well informed conscience.
Many could not write a letter recommending or even entertaining the idea of an abortion. This would normally involve signing the green form which requires two doctors to recommend this course of action. Some doctors agree to write a letter expressing the woman's wish, while clearly dissociating themselves from the decision. They do not sign the form, as this implies legal agreement to the proposed action. It is clearly wrong to provide the name, address or telephone number of an abortion clinic.
Some doctors write a letter of referral to a pro-life consultant, (few and far between), who would then necessarily cause further delay and time for thought, before a hospital colleague could provide a second opinion. Some consultants only agree to do abortions in selected cases and 'counsel' the patients. In fact, if a woman has decided to have an abortion she can always make her case sound extreme and she will persuade someone sooner or later. This sort of selection can cause a lot of bad feeling between colleagues who do not like the uncertainty of outcome and judgemental attitude.
GENERAL PRACTICE PARTNERSHIPS
A GP can avoid the situation from arising by being in a partnership. If it is made it clear to the partners from the start that no abortion referrals will even be contemplated, the others may agree to see and counsel patients for the second opinion. There is usually a time delay as the pregnancy often needs confirmation by an early morning urine sample and so the patient can make the return appointment with another doctor if she wishes. Some patients do change their minds and do come back to seek more support.
It is obviously more difficult for a single handed doctor, although it is surprising how quickly a GP can gain a pro-life reputation. He will need to inform the patient that she has a right to a second opinion. Members of the Guild of Catholic Doctors differ on whether the patient should be given precise information on where to seek that second opinion.
THE LEGAL STATUS OF CONSCIENCE
Evangelium Vitae should be read and studied by all health care workers as it helps to clarify the situation;
'Doctors and nurses are also responsible, when they place at the service of death skills which were acquired for promoting life.' (Evangelium Vitae, n.59)
'Indeed from the moral standpoint, it is never licit to cooperate formally in evil. Such cooperation occurs when an action, either by its very nature or by the form it takes in a concrete situation, can be defined as a direct participation in an act against innocent human life or a sharing in the moral intention of the person committing it. This cooperation can never be justified either by invoking respect for the freedom of others or by appealing to the fact that civil law permits it or requires it. ... To refuse to take part in committing an injustice is not only a moral duty; it is also a basic human right.'(Evangelium Vitae, n.74)
The Pope goes further:
'What is at stake therefore is an essential right which, precisely as such, should be acknowledged and protected by civil law. In this sense , the opportunity to refuse to take part in the phases of consultation, preparation and execution of these acts against life should be guaranteed to physicians, health-care personnel, and directors of hospitals, clinics, and convalescent facilities. Those who have recourse to conscientious objection must be protected not only from legal penalties but also from any negative effects on the legal, disciplinary, financial and professional plane.'(Evangelium Vitae, n.74)
This perhaps gives us an agenda for action. 'As a society we have a duty, by our laws, to protect doctors and other counsellors, as well as women and unborn children, from the pressure to cooperate in abortion..'(Joseph McCarroll, Pro-Life, Ireland)
'The Gospel of life is for the whole of human society. To be actively pro-life is to contribute to the renewal of society through the promotion of the common good. (Evangelium Vitae, n.101).