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By Dr Michal Pruski (Trainee Clinical Scientist in the National Health Service)

Recently yet another report of conflict between parents and the clinical team over withdrawal of treatment and care for a child was in the press.

In this case, the father was allegedly dragged violently away by police from his dying six-year-old daughter. Though the controversy surrounding this case is substantially different from the nature of the controversies surrounding the now well-known cases of Charlie Gard and Alfie Evans, it never the less prompts further reflection about how withdrawal of care situations in paediatric practice are managed. What was particularly striking to me here is the contrast between how we handle objections of healthcare staff to the continuation of care to children for whom they deem such care to be futile, compared with how we handle objections of healthcare staff to the provision of abortions.

First, it should be clearly stated that the provision of further interventions or the continuation of current therapies is not always appropriate for every case, and that withdrawal of such interventions does not always imply a euthanasia mind-set or intention. Neither, under the law, is it permissible to perform an abortion under all circumstances and moreover some practitioners object to the provision of abortions in general. If we understand conscience in the Thomistic sense (where it includes making judgments about a wide range of practical matters), then objections to both provision of futile care and abortions can be described as conscientious objections. It seems to me clear, especially if medicine has anything to do with health, rather than simply doing what patients want, that practitioners should be allowed to raise conscientious objections in both abortion and futility cases even if it is contrary to the parents’ wishes.

What though is striking in the UK law is how different the burden placed on the practitioner is in cases where the objection is to an abortion from when the objection is to the provision of further interventions in withdrawal of care situations. I am not commenting on whether the legal framework for objections to abortion provision is appropriate in itself, but only to contrasting it with how objections to the provision of further paediatric care are handled in clinical practice and in the Courts.

While in abortion cases, the objecting practitioner, strictly speaking, is not required to write a referral to a provider who will not have such a conscientious objection, there is a general responsibility for ensuring that the patient knows where she might in a timely manner find a practitioner without such an objection; moreover, the scope of the objection to abortion provision is limited to practical participation in an abortion and not to e.g. administrative involvement, as shown in the case of the Glasgow midwives.

With the information on where to find an abortion provider, a woman can seek an abortion from a practitioner who has no conscientious objection to the procedure. In withdrawal of care cases, the objecting practitioners can get a court ruling that such withdrawal of care is in the child’s best interest and the parents have no alternative but to allow this withdrawal to happen. If withdrawal of care cases were treated similarly to abortion cases, the objecting clinician would have to allow the parents to find a provider willing to deliver further medical care (in a reasonable timeframe) and potentially direct them to such a practitioner. When such a willing provider is identified, the objecting practitioner would have to facilitate the necessary formalities of the transfer and not participate clinically in the process. This framework allows both for the parents’ wishes to be respected and the clinicians’ conscientious objection to be honoured in the same way the objection of a practitioner to the provision of abortions is honoured.

There is at least something unsettling about the common factor in these two areas of objections to two different procedures as the law stands at present. In both scenarios, the healthcare system seems to prefer the death of the foetus or child. This situation certainly seems to offer support to those warning about 'a culture of death'. If the assumption that the object of medicine is health is correct, then surely the system’s bias should be the other way around.