To expect a midwife to carry out termination duties?

[foglike]

To think a midwife has to carry out these duties and not claim religious discrimination because she's catholic?

bbc link

This thread has evolved into many different avenues of discussion but the thin thread of truth is that (This is just my opinion) a tool designed by men (Religion) and run mainly by men is being used by women controlled by these men to undermine the right of women to have a termination.

In any other area of life this would be termed bigotry but women are fighting other women over this issue and intelligent women at that.

Thank god i'm not religious.

bumbley. 'Handling an emergency' - one example: a woman undergoing termination starts haemorrhaging, and then has a heart attack. ALL staff available - including those with a conscientious objection - are expected to do whatever they can to save her life.

Reasonable, don't you think?

'Also, re delegation, they must feel that delegation is involvement'. Maybe the cleaners feel that by swabbing the ward floor they are 'involved' (the termination couldn't go ahead in a filthy room). Maybe the staff who serve cups of tea, refill the water jugs, change the light bulbs, book patients in feel 'involved'. It's like those NHS recruitment ads showing the hundreds of staff involved in saving one life: clinical care is a huge team operation, and literally scores of people are indirectly involved with every termination. If you accept that staff have the right to withdraw co-operation, however indirect their involvement, then you are basically saying that NHS services can at any time be voted out by the staff. Which will lead to pro-life groups lobbying staff to sign up to refuse their involvement, and the whole termination service will become untenable very, very quickly.

Look, I understand you are pro-life and that's fair enough. I'm not arguing that HCP should not have the right of conscientious objection (in principle, I'm ambivalent about this; but in practice, I think it is an applecart that shouldn't be nudged). But you should take responsibility for your views and accept the implications: this is NOT 'women have the right to choose abortion and midwives have the right to choose not to undertake abortion'; this is you saying, in effect, 'women have no right to actually have an abortion because HCP have a priority right to make it impossible for abortions to be provided'.

Woolly, I am not pretending that is what the case is about - if you read the thread you will see that some people eg rational believe that people should not become HCPs at all if they will not help perform abortions so there are a few different things being discussed. You have made a good point about what the definition of 'supervise' and 'support' is - maybe that what they are also seeking to clarify. If 'supervise' or 'support' means stand and watch and step in to finish if there are problems then surely you could see why there would be an issue.

Religious bigots? is anyone who is a catholic automatically a religious bigot in your opinion? Are you ignoring the fact that ANY doctor/midwife can opt out?

Your animal rights analogy is just silly. There are plenty of other areas someone could work in if they are an animal rights activist without going to a mink farm! It's not like these women have taken a job in an abortion clinic and then object to carrying out their duties for goodness sake! Abortions are a tiny part of what goes on in an NHS maternity unit.

RV, you are giving one example where yes, 'supervision' may not have anything to do with carrying out the abortion. What about an example where the 'supervision' involves sitting in while a junior midwife performs the abortion and having to step in if something goes wrong. When you don't know what comes under 'supervision' and support' you could end up forcing a woman to assist because she has no alternative even though technically she has 'opted out'.

Also, you're really jumping to ridiculous conclusions about abortions not going ahead based on this objection. It's a bit sensationalist really. In any case, even if your worst case scenario happened and the NHS were no longer providing them then there are plenty of clinics that do where no one has any objections to the procedure. It's a complete hypothetical anyway!

I do know what supervision and support means. You clearly don't. And no, I am not jumping to conclusions. I have worked in both abortion and maternity services and my points are neither sensationalist nor hypothetical. One of the very major reasons why NHS abortion care is contracted out is because NHS staff don't want to get involved in abortions - conscientious objection already HAS disrupted service provision. In the case of late medical abortions - the ones attended by midwives - they mostly have not been contracted out because non-NHS clinics are not licensed to perform them. Why are they not licensed to perform them? Because they require specialist resources (midwifery care and immediate access to paediatric intensive care) that are not available in a stand-alone non-NHS unit.

I'm trying not to sound all know-all and patronising here, but getting slightly exasperated because I have been trying to explain how it works in practice (as have other NHS staff on this thread) and you are choosing to wilfully ignore the important knowledge offered. By all means choose to continue sitting in a bubble of ignorance, firmly in your pro-life comfort zone, but don't tell me I'm being ridiculous because I have been there and worked the systems and DO know what I'm talking about.

Bumbleymummy
Please don't misattribute comments to me. You've addressed a post to me, but I have called no-one a religious bigot and have said nothing about animal rights.

Ah, yes, let's dismantle the NHS and send people off to clinics when they need a treatment that some HCPs don't like.

Woolly, No, that part was intended for fog, it was a separate point. Apologies if it misled anyone.

RV, I am not choosing to wilfully ignore anything. No one has yet offered a comprehensive overview of the duties that would fall under 'supervision' and 'support' and I don't claim to know them - I'm not a midwife. There have been a few examples given but there does not seem to be any guarantees. Eg, I take it the baby being born alive (presumably thats why paediatric intensive care is required) would be considered an emergency. If something like that happened, would the 'supervising' midwife be expected to attend?

As i said, I don'tbknow exactly what is expected of them but if there is something that they object to then I respect their right to do so. It is not for me to judge whether their reasons are right or wrong - someone else has that job - but I think theynhave the right to object if they feel that they are expected to do something that they disagree with. I don't expect people to be forced to do anything they disagree with, something which others on this thread feel should happen which, IMO, is hypocritical. Apparently, in their opinion, the right to choose should only extend to women who are choosing abortion - everyone else's rights go out the window!

Jux, why are you twisting posts? Can you not find something I actually said to argue against? Where did I say 'dismantle the NHS' and did you miss the part where I said it was completely hypothetical anyway? I'm just pointing out that even if abortions weren't available in nHs hospitals for whatever reason that does not mean no abortions could be carried out in the UK which is the conclusion that some people seem to be jumping to.

So if an animal rights activist wanted to work as A hcp it is OK if they then refuse to give out drugs tested on animals because they should be able to be HCPs and still follow their own beliefs.

Allowing people to refuse treatment, that cna be life saving, based on their own beliefs is a slippery slope. If you belive somethign is wrogn and a sin then thats it, buddists can refuse to prescribe drugs tested on animals, JWs can refuse to give blood transfusions, muslims can refuse to treat women with their hair uncovered, christians can refuse to treat homosexuals for sex related issues, etc. Then lets think about stem cell treatment, IVF etc and the fact that now they have got their way with refusing treatment for women needing terminations we are seeing court cases about medical staff refusing to delegate these tasks to other or to have any indirect part in it - would you really want your doctor refusing to delegate the giving out of drugs tested on animals (or indeed on humans in trials she disapproves of).

I don't see why dismantling the NHS is at all likely to be a factor, considering the provision has been in place for well over 50 years.

Especially as the majority of NHS funded terminations are contracted out to the private sector already.

bum,
You said it did not matter if the NHS was refusing treatment becuase people could go to clinics (whihc are private and only get paid for on the NHS with a referral from a NHS doctor) if they wanted. That is supporting dismantling of the NHS.

And no-one forced them to become HCP. Termination is an important part of medical care, it can save lives, so if people disagree with terminations they should not become HCPs any more than those who do not want to give blood transfusions, or drugs tested on animals.

Kelly2000: animals rights example. No it wouldn't. There is no provision for an opt out on anything other than contraception/termination.

edith,
that is exactly why it will be a factor. people wanting to dismantle the NHS will point out that this has been happening for fifty years, and has worked well so why should it be different for other procedures.

edith,
at the moment there is not. But why not? Last year it was ruled that personal beliefs were on a par with religious beliefs in an employment tribunal. If people can use their religious belief to opt out of one procedure, then it could be successfully argued that it is religious discrimination not to allow those of other religions to work as their faith dictates i.e not harm animals. That is why it is a slippery slope. Arguing thta the ability to refuse treatment should be limited to things that women mainly require is not going to cut much ice as that would leave room to argue sexual discrimination as well.

There are differences in the examples you are giving though. None of them involve the taking of a human life and while you may disagree that it is a life - others believe that it is and can not reconcile themselves with being involved in the termination of that life. You are not going to be able to tell someone what a 'life' is anyway. Even the law itself changes on that! I actually don't understand people who base their opinion on what 'life' is based on the definition in law. It changes! When the age of viability decreases, they just adjust their opinion along with it...it's a bit strange.

Most of these comparisons with anortions are just inappropriate at best and ridiculous at worst. The closest example you are going to get is euthanasia. For some reason people seem to think it is more acceptable for a doctor to opt out of involvement in that.

In any case, to address your example, if a HCP could offer me an alternative drug that had not been tested on animals or could refer me to someone else who would prescribe them then I wouldn't have a problem with it at all. TBH I would prefer drugs that did not involve cruelty in their production (wouldn't most people?) so I don't really see it as comparable.

I don't think it is a factor. Remember this conscience clause has been in existence for 50 years under every shade of government, has never been extended and is definitively restricted to one area with no "creep" whatsoever.

The rise in contracting out NHS funded operations to the private sector is rooted in costs and management aims, and for terminations it shot up under New Labour. the conscience clause is simply unrelated to this.

Actually Kelly what I said was,

"Also, you're really jumping to ridiculous conclusions about abortions not going ahead based on this objection. It's a bit sensationalist really. In any case, even if your worst case scenario happened and the NHS were no longer providing them then there are plenty of clinics that do where no one has any objections to the procedure. It's a complete hypothetical anyway!"

That does not say that it 'doesnt matter if they stop providing them' and it in no way supports the dismantling of the NHS - stop making silly straw man arguments.

EW, people just seem to like jumping to sensationalist conclusions!

OK, let me try to provide some clarification as best I can (I'm sure one of the MN midwives could and will do better!):

AFAIK there has been only one Industrial Tribunal ruling to date (Janaway v Salford AHA, 1988) which defined midwifery participation in termination as "actually taking part in hospital treatment designed to terminate a pregnancy". The Royal College of Midwives policy, leading from this, is that the interpretation of the conscientious objection clause should only include direct involvement in the procedure of terminating pregnancy. So a midwife who has declared a conscientious objection cannot be made to do anything herself that will directly help terminate a pregnancy - sitting up an infusion line, for example, or assisting in theatre.

Indirect involvement covers all those activities that are one step away from the termination, that involve running the service that is providing the termination. So: booking a woman in for termination, giving her a cup of tea, drawing up the ward rota. Also: choosing which staff WILL assist the termination, helping them with any concerns they might have. So if a midwife had trouble setting up a drip for a woman undergoing termination, and went to ask advice from the ward sister, the first midwife would be directly involved, the second indirectly involved. If the second midwife (the supervisor) then came in and set up the drip herself, she would be directly involved. At the moment, the situation is that the supervisor would not be expected to enter the room and set up the drip herself, but she would be expected to provide advice and support to the first midwife to help her get her job done (so she might, for example, page the doctor, or ask another experienced midwife to go in and help). If she refused to provide even this indirect support, then you have a problem because the first midwife isn't allowed to practise without recourse to management advice and support.

If a baby is born alive (hugely unlikely) then that would count as a life-or-death emergency and all staff would be expected to do everything they can to save the baby's life. Presumably you have no objection to that?

bumbley, Edith, I'll say it again: there are very few private clinics licensed to do late abortions. I think I am right in saying there are none licensed to do very late abortions. Very often, late abortions are due to the mother's medical situation, meaning she has to be in hospital.

Non-NHS clinics are stand-alone units. They have transfer arrangements to NHS intensive care (paediatric and maternal) and excellent safety records. But they cannot safely provide care in complex medical cases where the mother might need to be rushed into theatre, or have the involvement of other NHS staff e.g. a cardiac intensivist or an oncologist.

It is a complete fantasy that these abortions can be shifted out of the NHS. They cannot.

You can ignore this point all you want: I keep reposting it for the benefit of others coming to the thread.

that is exactly what you implied. And refusing treatment for terminations could kill a woman, or lead to health problems so refusing to help with a termination is putting a person's life at risk. So those that refuse to help with terminatiosn are happily putting lives in danger.

But as you are happy to be refused drugs on the basis of other people's beliefs lets see what you think when you are rushed into A and E after an accident and are refused drugs, and then refused an blood transfusion because the staff on duty are against it. I cannot help think that those who support the ability to refuse treatment on the grounds of belief, but then claim that this should only apply to abortion only do so because they have no intention of ever having an abortion, but have no idea if someone might hit them in their car so want to ensure that they cannot be disadvantaged by religious beliefs.
You claim that some people think a termination is taking a life and so their beliefs should be pandered too, but ignore the right of others to have their beliefs pandered to because they think it is wrong. I also fail to see with why refusing condoms is allowed as these do not take a life and in fact save lives? Should doctors be allowed to refuse chemotherapy on pregnant women because it could cause miscarriage? Should it be right to refuse to sell a pregnant woman alcohol, or let her do anything that could potentially harm the baby?

Kelly, thR situation would never arise because there will always be someone who WILL help. In fact even the Catholic church concedes that in some cases abortion is permissible so it's hardly clear cut.

Dilly,
If the courts rule in favour of these two midwives there might not be anyone able to help, because if the perosn in charge is against the procedure they will be able to refuse to direct anyone else to help. At the moment the government is not required to make sure there is pharmacist open all the time that supplies the mornignafter pill, so it is possible people can be refused it and have no where else to go.

Sorry Renee - I was referring to the figures for all terminations.

Kelly: your A&E scenario is another straw man. There is no opt out on any of those issues.