Written by: Prof Dominic Wilkinson, University of Oxford
This text is republished from The Conversation beneath a Artistic Commons license. Learn the original article.
In response to this, the Royal School of Obstetrics and Gynaecologists (RCOG) has issued guidance that seeks to make clear the authorized obligations of healthcare professionals. The complete guideline has not but been launched, however the RCOG insists that professionals “are beneath no authorized obligation to contact the police following an abortion, being pregnant loss or unattended supply”.
There are totally different moral questions that we’d ask regarding abortion and the regulation within the UK. For instance, we’d ask what the regulation must be. That’s, at what stage of being pregnant and during which circumstances abortion must be legally permitted?
A extra radical query could be whether or not abortion is correctly a query for the regulation.
RCOG and the British Medical Association (the commerce union for UK docs) have lengthy referred to as for reform and decriminalisation of abortion, arguing that – the place it’s supplied by a well being skilled with the lady’s consent – it must be managed and controlled as different types of healthcare.
However a special query pertains to how well being professionals ought to reply in a state of affairs the place abortion is typically illegal and so they change into conscious {that a} lady has sought an abortion outdoors the present authorized framework. Should they report back to the police? Might they report back to the police (for instance, if they’ve a private view that abortion is severely improper)? Or, in the event that they do report back to the police, would possibly the well being skilled be the one who leads to bother?
A query of confidentiality
The central moral difficulty at stake right here just isn’t, in actual fact, the morality of abortion. Moderately, the important thing difficulty is about medical confidentiality and when well being professionals are justified in violating their robust obligations to safeguard the affected person’s medical particulars.
Confidentiality has been considered important to the doctor-patient relationship for centuries. For docs to have the ability to assist sufferers, they want the affected person to supply full particulars of their signs and the way they’ve arisen. That can generally embody very personal particulars – say, of sexual relationships and performance – which the affected person will solely expose if they are often assured the physician will preserve them strictly secret.
In newer many years, confidentiality has additionally been justified when it comes to a extra basic proper of the affected person to privacy and autonomy. That proper appears significantly important relating to reproductive healthcare.
As a result of it’s so necessary, fashionable codes of practice for well being professionals permit confidentiality to be breached solely in actually distinctive circumstances. That would embody notification of a severe infectious illness or prevention of terrorism. Nevertheless it doesn’t, in most circumstances, embody reporting {that a} affected person has dedicated a criminal offense.
For instance, think about a health care provider who discovers that their affected person suffered an damage whereas burgling a home, has suffered an overdose from taking class A medication, or has acquired a sexually transmitted illness whereas participating in road prostitution. Common Medical Council (GMC) steering means that in such circumstances it could not be applicable (until the affected person consents) for the physician to report that info to the police.
The GMC – the physique answerable for medical licensing – signifies that breaching confidentiality would solely be justified for a “severe crime”, and that it could solely be within the public curiosity to reveal if “failure to take action could expose others to a threat of loss of life or severe hurt”.
In fact, one key ambiguity within the GMC steering is what counts as a “severe crime”. The steering notes this and mentions examples of “homicide, manslaughter, rape and little one abuse”. Nevertheless, some members of the group – together with probably some well being professionals – regard abortion as a severe crime, simply as unhealthy as these listed. That will cause them to really feel a accountability to report.
The most recent RCOG guideline seeks to deal with that ambiguity, indicating a view that “it’s by no means within the public curiosity to analyze and prosecute ladies who’ve sought to finish their very own being pregnant”.
Reassuringly robust statements
It signifies that well being professionals should not present info to the police and not using a lady’s consent until “involved for her security or the protection of others”. Such robust statements will hopefully reassure well being professionals of the scope of their authorized obligation to report and cut back the variety of ladies who’re reported to the police.
However we’d surprise what would occur if, regardless of this steering, a health care provider have been to report back to the police. The college guideline refers, elliptically, to “potential penalties of breaching affected person confidentiality”.
That is likely to be supposed to remind professionals of the profound, distressing negative consequences for sufferers in the event that they have been to report back to the police. Nevertheless it must also immediate professionals to think about whether or not they would possibly discover themselves having to reply awkward questions in entrance of their regulatory physique.
Offering info, with out her permission, a couple of lady’s being pregnant and reproductive decisions is a grave risk to affected person belief and dangers severe hurt to weak sufferers. The GMC has suspended docs for much less.
Dominic Wilkinson, Guide Neonatologist and Professor of Ethics, University of Oxford
