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MEDICAL REFERRAL FOR ABORTION AND FREEDOM OF CONSCIENCE IN AUSTRALIAN LAW

Published online by Cambridge University Press:  01 July 2019

Joanne Howe
Affiliation:
Associate Professor in Law, University of Adelaide
Suzanne Le Mire
Affiliation:
Professor in Law, University of Adelaide

Abstract

This article examines legislative changes related to abortion regulation in Australia that create obligations of medical referral on practitioners who have a conscientious objection to abortion. Despite a significant Australian history of accepting secularized conscience claims, particularly in the field of military conscription, the limitation of conscience claims about abortion can be traced to a failure to appreciate the significant secular arguments that can be made to support such claims. We draw on arguments of plurality and pragmatism as capable of providing a firm foundation for legislative protections of freedom of conscience in the case of medical referral for abortion. These justifications are not dependent on religious grounds, and therefore they have the potential to be relevant and persuasive in a secular society such as Australia. Acceptance of a pluralistic argument in favor of freedom of conscience is a powerful commitment to the creation of a society that values human autonomy and a diversity of opinion. It sits comfortably with the democratic values that are enshrined in the Australian political system and institutions. It avoids the potential damage to the individual that may be wrought when conscience is overridden by state compulsion.

Type
Research Article
Copyright
Copyright © Center for the Study of Law and Religion at Emory University 2019 

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References

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58 The proposed changes to Australian vaccination regimes fall into this category: Child Vaccination: Government Flags Welfare Crackdown, The Australian (Apr. 7, 2015), http://www.theaustralian.com.au/national-affairs/health/child-vaccination-government-flags-welfare-crackdown/news-story/7f742c6965360e20590c9a6860cfb40c.

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62 See, e.g., Defence Act 1903 (Cth) s 61CC.

63 See, e.g., Amy J. Shaw, Crisis of Conscience: Conscientious Objection in Canada during the First World War 3 (2009) (explaining that the conscientious objectors to military service in Canada had to establish their active membership of an established religion).

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66 This is particularly evident in the context of abortion where arguments in favor of permitting conscientious objection are often based on recognition of the physician's right to freedom of conscience, while those who wish to limit or deny recognition of conscientious objection rely on the woman's rights to life and health: see, e.g., O'Rourke, Anne et al. , Abortion and Conscientious Objection: The New Battleground, 38 Monash Law Review 87119, 104–06 (2012)Google Scholar; Dickens, Bernard M., Legal Protection and Limits of Conscientious Objection: When Conscientious Objection is Unethical, 28 Medicine and Law 337–47, 338–39, 343 (2009)Google ScholarPubMed.

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69 Kassner & Lefkowitz, supra note 29, at 595. See also Matheny Antommaria, Armand H., Conscientious Objection in Clinical Practice: Notice, Informed Consent, Referral, and Emergency Treatment, 9 Ave Maria Law Review 8199, 82 (2010)Google Scholar.

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(i) the position held must be sincere; (ii) it must fit within a coherent system of ethical belief; (iii) it must be consistent with the H[ealth] C[are] P[rovider]’s other beliefs and actions, particularly those in proximate areas of concern; (iv) it must be key or fundamental in the sense that its violation poses a serious risk to the HCP's moral integrity; (v) reasonable alternatives must have been considered so that the exercise of a CBE [conscience-based exemption] is a “last resort”; (vi) the HCP seeking the CBE must be able to “articulate the basis of [her] position”; (vii) the rationale must reflect a valid view of the ends/goals of medicine; (viii) the position must not be intolerant or disrespect the different conscientious conclusions of others; and (ix) the objection must be to the treatment, rather than to the individual patient.

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104 See, e.g., Health Act 1993 (ACT) pt 6.

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107 Health Act 1911 (WA) s 334.

108 Health Act 1993 (ACT) s 84.

109 Criminal Law Consolidation Act 1935 (SA) s 82A(5).

110 Id. s 82A(6).

111 Explanatory Memorandum, Abortion Law Reform Bill 2008 (Vic) 3.

112 Victoria, Parliamentary Debates, Legislative Assembly, 19 August 2008, 2954 (Maxine Morand, Minister for Women's Affairs).

113 Reproductive Health (Access to Terminations) Bill 2013 (Tas) pt 2 s 7(2).

114 Reproductive Health (Access to Terminations) Act 2013 (Tas) pt 2 s 7(2).

115 Good Medical Practice Code § 2.4.6, at 7, Mar. 17, 2014.

116 Reproductive Health (Access to Terminations) Act 2013 (Tas) s 6(3) pt 2.

117 Termination of Pregnancy Law Reform Act 2017 (NT) s 11 pt 2.

118 Health Insurance Act 1973 (Cth) s 132A pt 7.

119 Health Insurance Regulations 1975 (Cth) r 29.

120 Id. at rr 29(2)–(3).

121 Wendy Larcombe, Rights and Responsibilities of Conscientious Objectors under the Abortion Law Reform Act 2008 (Vic), Paper presented at ‘W(h)ither Human Rights’: 25th Law and Society Association Australia and New Zealand Conference (December 2010), at 6.

122 Legislative Council Government Administration Committee “A,” Report on Reproductive Health (Access To Terminations) Bill 2013 (Tas) 54–58 (2013).

123 See, e.g., Sifris, supra note 82.

124 Reproductive Health (Access to Terminations) Act 2013 (Tas) s 7.

125 Under the National Law possible sanctions include cautions, the imposition of conditions, fines, and the suspension or cancellation of registration. See Health Practitioner National Law Act 2009 (Qld) s 196. This was adopted in Victoria by the Health Practitioner Regulation National Law (Victoria) Act 2009 (Vic) s 4.

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131 See, e.g., Larcombe, supra note 121; O'Rourke et al., supra note 3, at 108.

132 Larcombe, supra note 121.

133 Sifris, supra note 82, at 906.

134 See discussion in section titled “What is Conscientious Objection?” above.

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137 Ministry of Health, New South Wales Government, Policy Directive No. PD2005_587, Pregnancy—Framework for Terminations in New South Wales Public Health Organisations § 4.2, at 5 (2005).

138 National Health Service (General Medical Services) Regulation 1992 r 12 (Eng. & Wales).

139 See explanation available at How to Register With a GP Practice, National Health Service, http://www.nhs.uk/NHSEngland/AboutNHSservices/doctors/Pages/NHSGPs.aspx (last visited Jan. 13, 2016).

140 Victorian Law Reform Commission, Law of Abortion: Final Report 113 (2008) (citations omitted).

141 Id. (citing Abortion Services in New Zealand, http://www.abortion.gen.nz/about.html).

142 Hallagan v. Medical Council of New Zealand HC Wellington CIV 2010-485-222, 2 December 2010 at paras. 31–34 (N.Z.).

143 Victorian Law Reform Commission, supra note 140, at 114.

144 Id.

145 Senate Standing Committee, supra note 71, at 18.

146 Id. at 10.

147 Voluntary Euthanasia Bill 2012 (SA) cl 12. This bill failed to garner sufficient parliamentary support. A similar broad exemption can be seen in the short-lived Northern Territory Act, Rights of the Terminally Ill Act 1995 (NT) s 5. See also Voluntary Euthanasia Bill 2010 (WA) (lapsed) cl 5; Voluntary Assisted Dying Bill 2013 (Tas) (failed) cl 31(2)(d); Rights of the Terminally Ill Bill 2013 (NSW) (negatived) cl 5.

148 New South Wales, Parliamentary Debates, Legislative Council, 2 May 2013, 19869 (Cate Faehrmann, Member of Legislative Council).

149 For example, this is the likely effect of the law in Sweden where conscientious objection to abortion is not permitted under the law. See Heino, Anna et al. , Conscientious Objection and Induced Abortion in Europe, 18 European Journal of Contraception and Reproductive Health Care 231–33, 232–33 (2013)CrossRefGoogle Scholar.

150 Fiala & Arthur provide an example of this perspective. They argue that refusing to refer for abortion should be deemed to be “dishonourable disobedience” rather than “conscientious objection”: Fiala & Arthur, supra note 84, at 20.

151 For a current copy of the State/Territory Nominated Occupations List detailing occupations deemed to be in shortage, see ANZSCO Occupations, Acacia Immigration Australia, https://www.acacia-au.com/STNOL.php (last updated Aug. 3, 2017).

152 Goodrich, supra note 54, at 123.

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154 Good Medical Practice Code, § 2.3m at 6, Mar. 17, 2014.

155 Id. § 2.4.4, at 6, § 2.4.6, at 7.

156 See the discussion later in this section on the U.K. case of Doogan v. Greater Glasgow Health Board [2013] CSIH 36 (appeal taken from Scot.); Greater Glasgow Health Board v. Doogan [2014] UKSC 68 (appeal taken from Scot.).

157 Health Insurance Act 1973 (Cth) s 132A.

158 Health Insurance Regulations 1975 (Cth) r 29.

159 Id. at rr 29(2)–(3).

160 See, e.g., the text corresponding to note 140 which particularizes the nature of the referral process in the medical context. It is clear from this that referral requires involvement from the original doctor.

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163 Cited in Whitcomb, Erin, A Most Fundamental Freedom of Choice: An International Review of Conscientious Objection to Elective Abortion, 24 St. John's Journal of Legal Commentary 771809, 794 (2010)Google Scholar (citation omitted).

164 Antommaria, supra note 66, at 85–86. See also Kaczor, Christopher, Conscientious Objection and Health Care: A Reply to Bernard Dickens, 18 Christian Bioethics: Non-Ecumenical Studies in Medical Morality 5971, 65 (2012)CrossRefGoogle Scholar.

165 Greater Glasgow Health Board v. Doogan [2014] UKSC 68 [38] (appeal taken from Scot.).

166 Doogan v. Greater Glasgow Health Board [2013] CSIH 36 [38] (appeal taken from Scot.).

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168 Rowe, Heather J. et al. , Considering Abortion: A 12-Month Audit of Records of Women Contacting a Pregnancy Advisory Service, 190 Medical Journal of Australia 6972, 71 (2009)CrossRefGoogle ScholarPubMed (Access issues reported were “financial or health problems, geographical isolation, lack of transport or child care, being at school, safety fears, alcohol or drug problems, or language or interpreter concerns.”).

169 Evidence to Legislative Council Sessional Committee Government Administration “A,” Parliament of Tasmania, 3 September 2013, 5 (Glynis Flower, Executive Officer of the Hobart Women's Health Centre).

170 Id. at 2.

171 International Planned Parenthood Federation European Network (IPPF EN) v. Italy, App. No. 87/2012 (European Committee of Social Rights) (2012).

172 World Medical Association, Declaration of Oslo on Therapeutic Abortion, adopted by the 24th World Medical Assembly, Oslo, Norway, Aug. 1970 (amended by the 35th World Medical Assembly, Venice, Italy, Oct. 1983; 57th WMA General Assembly, Pilanesberg, South Africa, Oct. 2006).

173 Office of the High Commissioner for Human Rights, General Comment No. 22: The Right to Freedom of Thought, Conscience and Religion (Art. 18) at ¶3, U.N. Doc. CCPR/C/21/Rev.1/Add.4 (July 12, 1993).

174 See, e.g., Getting an Abortion, Children by Choice, https://www.childrenbychoice.org.au/forwomen/abortion/howtogetanabortion (last modified Jan. 11, 2018) (“[n]o referral is needed for either a GP or a private clinic for a medication abortion” and that “[n]o referral is needed for a clinic for a surgical abortion.”).

175 See, e.g., Kibsgaard Nordberg, Eva M. et al. , Conscientious Objection to Referrals for Abortion: Pragmatic Solution or Threat to Women's Rights, 15 BMC Medical Ethics 19, 1 (2014)Google Scholar.

176 Fiala & Arthur, supra note 84, at 15.