The Brandsma Review

Pro Vita, pro Ecclesia Dei et pro Hibernia – A journal of conservative Catholic opinion from Ireland

Isssue 124, January-February 2013


IT WAS C S Lewis who said that when a man loses his faith, he doesn’t start in to raping and pillaging the next morning. The pattern of virtues he learnt in his youth persists, on its own, at least for a time. Ithink he said 30 to 40 years, a generation perhaps. It is 30 years this year since Irish people voted in a constitutional amendment to protect the unborn child. I wasn’t involved in that debate. In 1983, as a trainee obstetrician in Dublin, I took the line that another obstetrician expressed to me recently: “It’s a societal issue, not for obstetricians to decide”.

I don’t take that view now, for two reasons. The first is that the opinion of obstetricians is perceived by the people as significant. If the obstetricians say they want it, people and politicians take that seriously, as we saw in the recent hearings of the Health Committee in the Dáil. The most commented on contribution was from Dr Rhona Mahoney, Master of the National Maternity Hospital, who advocated legal clarity, as she did not wish to go to jail, and neither did she want her patient to. The view of the obstetrical community appeared to be that they favoured legislation for abortion. It was “liberty at the barricades” leading women on to the repeal of the 1861 Offences Against the Person Act, which makes performing an abortion a felony. This Act however is still on the statute books in the UK and is there, not to deal with doctors, but with anyone who attempts an abortion. There are good health reasons, apart from the present debate, why abortion should remain a crime.

Alarming proposal

My second reason is that under the proposed legislation, the obstetricians are the ones who are expected to perform the abortions. The report of the so called “Expert Group” deals with this question in a way which I find very alarming, and which has not received any significant public attention. The report has a section (§ 6.9) on conscientious objection. It is not clear why this came into the Report at all. It wasn’t specified in the terms of reference, but it needs to be looked at carefully.

What it says is that conscientious objection is “limited” and that these limits could be set by “regulatory bodies or employers”. This statement is full of dangers.
The origins of this view on limiting conscience can be traced to publications in the last five years or so (three or four papers) in the medical literature in the United States.
The best known is a paper published in the New England Journal of Medicine, March 2009, by Julie Cantor, a California lawyer. These papers can be directly connected to the increasing reluctance of obstetricians in the US to get involved in performing abortions (currently 14 % of US obstetricians, down from 22 % in 2001). The response to increasing refusal has been to attack the notion of conscientious objection itself and, they hope, to compel doctors to perform abortions.
The Cantor paper puts it this way:

Qualms about contraception, sterilisation or abortion? Don’t practice women’s health. Believe the body should be buried intact? Don’t become a transplant surgeon. Believe in pain at the end of life? Don’t become an intensive care specialist

I don’t know, or have never heard of the last two categories (doctors who demand the body remain intact, or believe in pain as a good) and I think they are put there to make the idea of anyone objecting to abortion look ridiculous; but more worryingly, that doctors who do object should be excluded from practising women’s health (obstetricians, but also GPs).
This view, which is recent and specifically aimed at abortion refusers, is what prevailed at the Expert Group on Abortion in Ireland. As I was told myself when I remonstrated about this at another forum: “Doctors should leave their conscience outside the room”. I cannot accept this and one can only hopethat other doctors will not accept it either.

‘Enhanced interrogation’

I shall try to show why this is a dangerous precedent.  In April 2009 the British Medical Journal (BMJ) published a leading article on torture. The article dealt specifically with the situation in Guantánamo Bay, where the American Government wished to perform what is called “enhanced interrogation” (snarling dogs, enforced nudity and long periods of standing are specified). Two organisations became involved: the American Medical Association (AMA) and the American Psychological Association (APA). What was interesting was that the two organisations took opposite ethical positions on the question. The AMA refused to participate. The APA however in 2002 adopted a new enforceable standard which allowed members to “set aside any ethical responsibilities that are in irreconcilable conflict with governmental authority”.

The main question raised by the BMJ writers was why the two organisations came to different decisions on this question. They suggested that the APA decision was made because they had a shorter history of professional organisation than the doctors. This was
not to suggest that they were naïve, but that the historical experience of medicine had an extremely dark past which contributed to the AMA’s deciding against. This insight of the physicians they traced back to the Second World War. The first prosecution for war crimes after WW2 was what became known as the “Doctors Trial” in 1946. Seven of 20 doctors were hanged, nine imprisoned and seven were acquitted. Of course many escaped capture. The revelations about doctors’ behaviour caused worldwide shock, along with the fact that during the war over 50 % of doctors were members of the Nazi party (7 % for teachers). Nazi ideology appeared attractive to doctors at the time, principally for its ideas of racial “hygiene” and eugenics.

Nuremberg principles

What came out of all this were the Nuremberg principles (April 1947). The authors of the BMJ article above suggested that these principles should apply to all professions, not just medicine. The Nuremberg principles were enlarged by later declarations of Geneva (1948) Helsinki (1964) and Tokyo (1975). These declarations deal with, among other things: torture, experimentation on human beings and conscience.Geneva states: “I will practice my profession with conscience and dignity” or: “a physician’s knowledge and conscience are dedicated to fulfilment of his duty” (Helsinki). Specifically it is no defence for a physician to justify his behaviour based on following a State law which is unethical or cruel. This tragic historical experience was what led the AMA to reach a conclusion that was at odds with the decision of the psychologists, and the intentions of the American government.

In Ireland the ethics guide of the Medical Council used to refer to these Declarations and even quote them in full. Not any more. Previous guides stated “Medical care must not be used as a tool of the State, to be granted or withheld or altered in character under political pressure”. Not any more. It is replaced by references to “professionalism”, something which is value free and changeable. The Nazi doctors were “professionals” in the context of their own ideology. If one were to accept the Expert Group’s view that conscience is limited, and that those limits be set by employers (in practice the State) then I think we could say that the demands of conscience as described in the Declarations are abrogated, or at least forgotten.

Conscience remains vital. In the above examples, the evidence that it is becoming obscured bears out the observation of C S Lewis that things persist for a time, but when the foundational beliefs are eroded, the edifice does finally fall after an interval of some years. Public opinion, not least among obstetricians, has changed on the ethics of abortion. This arises from a relentless and sophisticated media campaign for change, a weakened—could one say a divided? — Church, and the production of hard cases to create
doubt about the fundamental, and rational question of the right to life. The weakening of conscience surely is a symptom of that spiritual malaise which has been affecting European thought for centuries, and Ireland for the last three decades or so.
If the State becomes the final moral arbiter in medical decisions, then the consequences can to some extent be foreseen. History conclusively shows the outcome when this direction is taken.

One little sign for hope on the question of conscience was the silent comment of Justice Antonin Scalia of the American Supreme Court. He wore a hat, of a particular and antique design, to the inauguration of President Obama which was widely noticed. A silent statement much more powerful than anything you have read here!

The Editor adds: This This hat was a gift from the St Thomas More Society of Richmond, Virginia. It was a replica of the hat worn by St Thomas More in a portrait by Hans Holbein the Younger.

Dr John Monaghan is a consultant obstetrician at Portiuncula Hospital, Ballinasloe, Co. Galway

Also in this issue:


The Last Stampede of Benedict XVI

Why We Must Not Lose the Initiative

In Defence of Jérôme Lejeune, Servant of Life


Dr John Monaghan

David Manly

Professor James R. Lothian

David Manly

Mel Cormican

Nick Lowry

Peadar Laighléis

From the Editor’s Desk includes ‘The Pelican and Blood Donation’ and ‘Chaplain’s Apology’; Letters from Mervyn Samuel and Seán Kelly; Another list from Francis Book Sales; Hurling Shots from the Ditch include ‘Labour loses Chairman’, and ‘Thin-Skinned King Herod’; Straws for the Camel’s Back include ‘Dialoguing with Dummies’, ‘Elephant in the Room’, ‘Saints De-Haloed’, and ‘Roll on the Schism’.



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This entry was posted on January 1, 2013 by in Issues 2013, Uncategorized and tagged , , .
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