Conscientious Objection (Medical Activities) Bill [HL]

Baroness Young of Old Scone Excerpts

2nd reading (Hansard): House of Lords
Friday 26th January 2018 Lords Chamber

[Baroness Young of Old Scone (Lab)]

My Lords, I fail to recognise the NHS and the healthcare system in this country that the noble Baroness has just described. I do not believe that there are shoals of professionals in this country who feel that their rights are insufficiently represented by current law. The existing provision for healthcare professionals to object on the grounds of conscience in certain well-defined circumstances is sensible and balanced, and the Bill is unnecessary and potentially dangerous.

I very much respect the concerns of healthcare professionals to decline to participate in a hands-on capacity in specific medical activities, for two reasons. First, they have that right to act in line with their beliefs. Secondly, however, in these often complex and vulnerable situations, where patients themselves have had to make difficult decisions about abortion, IVF or end-of-life care, those patients deserve to be treated by professionals who respect their treatment decisions. It is therefore important that healthcare professionals have a proper right to conscientiously object. That is allowed for in the current legislation and in the guidance issued by the General Medical Council, the Nursing and Midwifery Council, and in current employment law and the Human Rights Act.

But patients have important rights, too, and the Bill would threaten the very principle of respect for the wishes of the patient and their right to exercise choice. This must not happen. If I were being brutal, the Bill could be seen as a tactic to allow campaigning healthcare professionals to undermine legitimate—indeed, vital—patient choices. I will focus on three areas.

First, on employment law, the Bill has provisions for the employer not to “discriminate against or victimise” an employee for invoking conscientious objection, including on their terms of employment; their opportunities for promotion, transfer or training; dismissal; or by subjecting individuals to any other detriment. That looks unobjectionable—motherhood and apple pie—but it is unnecessary because existing employment and human rights law already defends the rights of employees in those circumstances. I believe we hear of only very few cases that come to law where individuals appear to have been discriminated against because there are only comparatively few cases.

The Bill’s changes to the provisions have the potential to undermine the “occupational requirement” exemption under the Equality Act 2010, which, for example, allows an oncology ward not to employ a palliative care nurse who, due to their beliefs, has a conscientious objection to caring for patients whose life-sustaining treatment is, by agreement with the patient and the family, being withdrawn. The provisions in the Bill to extend the right of objection by healthcare professionals to activities required to prepare for or support the activities that are the subject of the Bill would exacerbate this risk even more, in that we could see a situation where a range of healthcare professionals dotted across the healthcare system and the care pathway, in delegating, supervising and planning entire aspects of healthcare and exercising their conscience, could make it impossible for the patient to achieve their rights, and the employer would have no ability to prevent that.

My second point is that the Bill lays no obligation on the objecting professional to refer the patient to someone else for the care they need and are entitled to. Some patients who are less informed about their entitlements and more vulnerable patients could simply fail to secure a service that they should have received. This inequity is unacceptable.

The third issue I want to cover is scope. Extending the scope of conscientious objection puts us on a path towards allowing some healthcare professionals to opt out of providing even basic end-of-life care. It elevates a healthcare professional’s important personal beliefs above their duty to the patient, putting the needs and wishes of the patient last. It is the very opposite of patient-centred care.

We know that 68% of Britons want more control over decisions about their health, as the 2017 Ipsos Global Trends survey showed very clearly. We know that 82% of UK citizens do not want doctors to make decisions about end-of-life treatment on their behalf. The Royal College of Physicians, the National Institute for Health and Care Excellence and the Parliamentary and Health Service Ombudsman have recognised that more needs to be done to support dying people, particularly in exercising their right to make the decisions that are right for them. Therefore, I believe that the Bill is impracticable.

I entirely respect the concern of the noble Baroness, Lady O’Loan, about the ability of healthcare professionals to exercise conscientious objection, but I believe that the balance between the rights of the healthcare professional and the rights of the patient would be fatally skewed by the Bill. Just last week, the US Administration announced plans for a “conscience and religious freedom” division with the Department of Health and Human Services, together with new rules that would dramatically expand the ability of healthcare institutions and workers to refuse to provide medical care on the basis of conscientious objection. We are not Trump-land. Our current laws, rightly, put the needs of patients at the centre. That is what our healthcare system is for. I urge my fellow Peers to reject this Bill.