A matter of conscience

A matter of conscience
Muslim religious objections may pose an unforeseen difficulty for Government abortion plans, writes Greg Daly

 

“The one thing that doesn’t abide by majority rule is a person’s conscience,” Alabama lawyer Atticus Finch tells his daughter in Harper Lee’s 1960 novel To Kill a Mockingbird. It’s a powerful statement, and one worth bearing in mind by those who’d seek to make an idol of the ballot box.

It also homes in on one of the key issues facing doctors, religious or otherwise, who believe that they have duties towards all human beings, born or unborn, regardless of how the 36th Amendment to the Constitution permits the State to regulate abortion by law.

It already appears as if there are large numbers of such doctors – the tiny number of general practitioners so far willing to sign up to provide abortions may be artificially low, but there is no evidence so far available that there are hordes of family doctors desperate to provide or even facilitate terminations.

Stumbling block

According to Kilkenny-based consultant obstetrician Trevor Hayes, however, one stumbling block that the Government does not seem to have considered is the religious convictions of hospital doctors around the country, and in particular the convictions of Muslim doctors.

Many of the country’s non-consultant hospital doctors (NCHDs) are Muslim, Dr Hayes says, and would have serious religious qualms about performing abortions.

“A lot of the NCHDs, a lot of the registrars and senior registrars and SHOs (senior house officers) – so the front line – would be from Egypt, Sudan, and generally Muslim countries,” he tells The Irish Catholic. “These would be in the country hospitals, and because of that they have frontline exposure, and they would have religious objections to being involved in the abortion service.”

He’s not claiming this based on hearsay, he adds, pointing out that he has been told this “directly” by Muslim doctors.

“It’s one of the reasons why Cavan was one of the first hospitals to say that they wouldn’t be providing the service, because the consultants – all the consultants there are Muslim,” he continues. “I’m not professing that I have huge knowledge about Islam, but they have religious objections to being involved in it.”

*****

Dr Hayes may not be an expert on Islam, but Dr Ali Selim, spokesman for the Islamic Culture Centre in the south Dublin suburb of Clonskeagh undoubtedly is, and is adamant that provision of abortion save in cases on dire need would be anathema for Muslims. “In Islam abortion is the lesser harm, conducted only to save the mother’s life if all other options prove to be useless,” he says, adding: “Life is God’s gift.”

Cavan’s maternity unit is by no means unusual in depending heavily on Muslim doctors who would have conscientious objections in this area, Dr Hayes adds.

“A lot of the county hospitals are like that,” he says, citing the example of St Luke’s Hospital in Kilkenny where he is based. “We’ve got eight registrars, seven SHOs, and of that 15, 13 would be Muslim. That’s quite high, and it would be quite similar in Wexford, Waterford, Kerry and Clonmel.

“So, a lot of the NCHDs would be on call overnight and at the weekend service – you’re going to have great barriers to providing this service. All four consultants in Kilkenny have agreed not to provide the service. Cavan, Wexford, Clonmel…I think 12 out of 19 units are not getting involved.”

The dependence of Irish hospitals on Muslim doctors may seem incredible, but statistics from the OECD and the Medical Council do suggest that this is a reality. Ireland depends more on foreign-trained doctors than the vast majority of OECD countries, with roughly two out of five doctors in the country being trained abroad.

Graduates

According to the Medical Council’s Medical Workforce Intelligence Report, this number is far higher when hospital doctors below consultant rank are considered in isolation – the report notes that in 2015 “76.8% of doctors who worked as non-consultant hospital doctors (not in training) were international medical graduates”.

Further, Obstetrics and Gynaecology, the report makes clear, is the field most likely to be staffed from doctors with overseas qualifications, with 58% of all doctors in that area having graduated abroad.

Pakistan and Sudan are the two leading countries for qualification of doctors who qualified outside Ireland, and it seems likely that the majority of these doctors are Muslim; indeed, Pakistani-, Sudanese- and Egyptian-qualified doctors together make up 36% of Ireland’s overseas-qualified doctors. When these figures are viewed together, Dr Hayes’ thesis looks extremely plausible.

“Now, the conscientious objection is still up for debate, and it still will be involving the Medical Council about whether or not they will make the doctor refer, which is very difficult, I think, for a doctor who has conscientious objection,” he says.

“Because you’re part of the chain, because they actually make a distinction, not only that you will refer but that you should know the person you’re referring to will provide the service, so therefore you have knowledge of the patient’s journey, which in my mind means that morally – ethically – you are part of the process.”

In practical terms, he says, referral in such a situation is facilitating the death of a human being.

“It’s absolutely facilitating the death because as a conscious decision you know – the Government does say that it’s a determined decision to end the life of the baby. This was not collateral damage – it defined abortion correctly in the heads of the bill.”

Overall, he thinks, the Government could have serious difficulty in realising its vision.

“There’s 19 units, and I suspect 12 units won’t be providing the service because, I suppose, of the lack of cohesion, where there might be one out of four consultants who’d be happy to do it,” he says, adding that the relative lack of willing GPs only makes the situation more difficult for the Government.

“You’ve got up to 80% of GPs who are not happy. They weren’t consulted,” he says, dismissing consultations with GP committees as essentially irrelevant in a situation where, to find out the real feelings of Ireland’s GP, “they should have balloted the whole GP service”.

Crux
 of
 the
 issue

Speaking for himself, and expressing astonishment that Mass-going voters would have voted to allow the Oireachtas to legislate for abortion, he points out the absolute crux of the issue from a conscience point of view.

“We’ve turned our back on God – I never thought Ireland would be like that. Surely as an Irish citizen, and as an Irish doctor, I have every right to save my soul, and what law or referendum should dictate a change to that? I’m not going to damn my soul for any country or for any law.”

At the same time, he says, there’d be a huge irony if it turned out that the conscientious objections of Muslims would be a key factor in preventing Ireland’s healthcare services in becoming vehicles for abortion.

“They’re the main service providers in the peripheral hospitals,” he says. “Wouldn’t it be strange if religious objections from Muslims would be the ones to turn the tide, and not the Catholics?”

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