A conscientious objection to participating in termination of pregnancy (ToP) services among a “cohort” of anaesthesiologists was raised in HSE reports throughout 2024.
The Department of Health was advised of “reported concerns re conscientious objection” among anaesthesiologists in one hospital. The quarterly reports from the HSE National Women and Infants Health Programme (NWIHP) noted “ongoing engagement” with the unidentified hospital and separately with the College of Anaesthesiologists of Ireland (CAI). The hospital had commenced ToP services. The records were released to the Medical Independent under Freedom of Information law.
In early 2024, the NWIHP met with representatives from the CAI. According to the HSE, the meeting related to “issues of mutual interest, particularly conscientious objection and implications for service provision. A key focus was unanimous or significant conscientious objection among anaesthesiologists.” The HSE added conscientious objection was not confined to any one specialty and is provided for under law.
Mr Martin McCormack, CEO of the CAI, said the College was aware that the NWIHP had engaged with “a number of stakeholders” on access to ToP services.
His understanding was the issue regarding anaesthesiologists related to elective rather than emergency interventions. Mr McCormack said it was “important to note” that the legal and ethical provisions for conscientious objection do not extend to emergency care. “Anaesthesiologists are expected to provide appropriate care in such circumstances, irrespective of personal beliefs.”
Mr McCormack said the CAI acknowledged the “significant service challenges” that can arise in units where provision is limited. However, he said resolving these issues “must take place within a framework that upholds the legal rights and professional autonomy of individual doctors”.
“The College would strongly oppose any move to impose participation in termination services as a condition of employment for anaesthesiologists.”
In recent years some consultant posts – predominantly in obstetrics and gynaecology – have included a requirement to participate in ToP services.
According to the HSE: “Where a post/appointment has been approved and funded to lead on the coordination and management of ToP services locally, approval is contingent on explicit participation in the service as a funding condition. For non-ToP-specific roles, NWIHP recommends that candidates be informed of the scope of services provided at the site, including ToP. This does not override their right to conscientious objection.” On last review, seven maternity hospitals/units provided elective surgical ToP. In addition, four units were providing manual vacuum aspiration. The HSE said the key barriers to the provision of surgical ToP included logistical and infrastructural challenges; and workforce constraints, including availability of theatre staff and conscientious objection. All 19 maternity hospitals/units now provide medical ToP.
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