Thursday, 20 September 2012

The role of conscience in medicine

The presentations delivered at the International Symposium on Maternal Health (Dublin, 8th September 2012) have just been made available on the internet. Of the many excellent presentations given at the event one of the most powerful came from Dr John Monaghan, consultant obstetrician and gynaecologist at Portiuncula Hospital in Ballinasloe, Co Galway.

Dr Monaghan began by outlining Ireland’s outstanding record on maternal health. This may be due in part to the pioneering work of Bartholemew Mosse who, in 1757, established the world’s first purpose built maternity hospital, The Rotunda, in Dublin. Since then Ireland has continued to be a leading light in obstetrics and maternal health. United Nations agencies have consistently ranked Ireland as one of the safest places in the world for expectant mothers. It is significantly safer than the US or the UK. 

And the differences between the records of Ireland and the UK was something Dr Monaghan wanted to look at specifically. One possible factor he identified could be the problem of recruitment. In 2007 a report from the Royal College of Obstetricians and Gynaecologists in Britain claimed that, over recent decades, the number of medical graduates choosing to specialise in this branch of medicine had fallen to dangerously low levels. 

“If you look at career choices of medical graduates in the UK” said Dr Monaghan “...the medical school with the most graduates coming into obstetrics and gynaecology is Queens University, Belfast. We take a look at maternal mortality. The figures for 2003-2007 in the different countries in the UK ...Northern Ireland has the lowest maternal mortality, for this five year period. So they seem to get more graduates and more live mothers.”  

He continued, “With its high recruitment and its low maternal mortality, I ask myself what else is different between the North of Ireland and the rest of the UK. There is only one difference that I’m aware of, the Abortion Act doesn’t apply there. And maybe this is why [more] graduates are attracted to work in obstetrics.”

“There have been several stories, especially in the UK, about more young doctors opposing abortion on ethical grounds. ...I’m suggesting that it’s nothing to do with religion or ethics it’s just that the prospect of abortion is sufficient to put many good graduates off practising obstetrics.

“...So we have evidence of increasing conscientious refusal among young doctors for abortion, so what do we think we can do about that? Well,” said Dr Monaghan, “one suggestion is that we should get rid of conscientious objection.” 

He went on to outline the growing threat to freedom of conscience within the medical profession. Anyone unsure of just how serious this threat is needs only to look at the Technical Guidance Document for the Reduction of Maternal Mortality just issued by the United Nations Human Rights Council. But as Dr Monaghan demonstrated, when doctors are no longer guided by the their code of conscience but by political decrees, then the consequences are grave. 

The legislation which prohibits abortion in Northern Ireland and the Republic is the Offences Against the Person Act. It was passed in 1861 but the origins of our law date back to the fifth century before the birth of Christ when the western tradition of medical ethics was founded on the Hippocratic Oath. This oath prohibited doctors from killing their patients through abortion and euthanasia.

These principles were reaffirmed in 1948 by the World Medical Association in the Declaration of Geneva which bound doctors to “maintain the utmost respect for human life from the time of conception, even under threat,” and not to use their medical knowledge contrary to the laws of humanity. 

The publication on the internet of Dr Monaghan’s presentation could not be more timely. Hopefully, the success of the International Symposium on Maternal Health will remind the medical profession, in Ireland and farther afield, that as the judges at Nuremberg warned, doctors cannot deviate from their ethical obligations even if legislation demands it. 

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