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Freedom of Conscience in Caring for Both Lives

Healthcare for Both Lives seeks to support professionals who practice in line with the values in our declaration. As healthcare professionals it is important for us to understand the role of freedom of conscience, and how to considerately apply this freedom when facing issues around caring for both lives. 


Personal beliefs, experience and values shape how all of us see the world. This includes our vision of what healthcare should look like, and our personal role in it. Protecting freedom of conscience in healthcare is crucial as patients need to trust that those caring for them have integrity as independent caring professionals. Furthermore, it gives healthcare professionals integrity, dignity, and respects their moral values. History has shown that when healthcare systems suppress or discourage moral dissent, professionals can become complicit in unethical practices. Some particularly horrific examples include: eugenics and forced sterilisations in the 20th century[1], human experimentation in Nazi Germany[2], the USA Tuskegee syphilis experiments (ending only in 1972)[3] and very recently, organ transplants from prisoners in China[4]. Upholding freedom of conscience protects healthcare professionals, strengthens the ethical resilience of the system, and ultimately benefits patients by ensuring care is delivered with integrity.


As of March 2026, there is a statutory right across the UK to conscientious objection to participation in abortion (except where necessary to save the life or prevent grave permanent injury to the physical or mental health of a pregnant woman).[5][6] The Doogan case (Greater Glasgow Health Board v Doogan [2014]) clarified the term ‘participation’ to be performing tasks involved in the course of treatment rather than administrative, managerial or ancillary tasks.[7]


Conscientious objection is not limited to those whose decision relates to their religious beliefs, and different professionals may find their ethical concerns mean they choose to exercise their right to conscientious objection in overlapping but slightly different situations.

With a clear understanding of regulatory expectations, careful reflection, and sensitive conversations, it is possible to prepare for situations in which you may want to exercise your freedom of conscience. Each professional’s circumstances and workplace environment will differ, but in general it is important to explore with your supervisors, colleagues and/or employer how you can practise in accordance with your conscience without placing undue burden on colleagues or compromising patients’ access to timely care.  Practising these conversations with trusted peers beforehand can help ensure they are constructive when they arise in the workplace.


With this in mind, what are the expectations of different professional regulators?


Doctors

In the UK, the General Medical Council (GMC) regulates doctors, physician associates (PAs) and anaesthesia associates (AAs). The GMC recognises that doctors have personal beliefs and values which may affect their practice, and states: ‘Doctors in training and medical students may choose to conscientiously object to providing particular treatments, as long as they do so in line with our guidance.’[8] The GMC provides detailed guidance which we strongly recommend reading in full.[9] Some doctors are concerned about being asked to refer for an abortion, for example in General Practice. While many patients now self-refer for abortion without consulting a primary care professional, this situation may occur infrequently. The GMC expects doctors to do our best to ensure patients who may consult us about abortion are aware of our objection in advance. However, if you are consulted about this, patients have a right to information and the options available to them, and this must not be obstructed. Current GMC guidance advises:


§  Tell the patient that you do not provide the particular treatment or procedure, being careful not to cause distress. You may wish to mention the reason for your objection, but you must be careful not to imply any judgement of the patient.


§  Tell the patient that they have a right to discuss their condition and the options for treatment (including the option that you object to) with another practitioner who does not hold the same objection as you and can advise them about the treatment or procedure you object to.


§  Make sure that the patient has enough information to arrange to see another doctor who does not hold the same objection as you.[10]

 

One resident doctor in England shared their story:


“In advance of my training rotation, I arranged to meet with my educational supervisor, the training programme director and also the clinical lead to discuss with them how I could practise in accordance with my conscience, in view of my concern for the life of the preborn child as well as the pregnant patient. I had practiced how this discussion might go with two wise senior colleagues, and this helped me prepare for the meetings with my colleagues. During the meetings, we discussed working together so I could act according to my conscience and avoid taking part in a woman’s pathway to an abortion. The seniors were all supportive and helped me find a way to meet my training objectives and support the service, whilst maintaining my conscience. I volunteered to take on other roles for the department to lighten the load of my colleagues in other areas. With advanced planning, I was able to avoid being part of the pathway leading to an abortion, and also had some really encouraging discussions with others from my team. I still received very positive feedback from my supervisors for the rotation, and have now successfully interviewed for a consultant post with the same department.”


Medical students

It is important for medical students to be aware of the GMC guidance above. Additionally:

As a medical student, you also have the right to hold a conscientious objection to some types of treatment and you should discuss this with your medical school. However, you must achieve the capabilities described in Outcomes for graduates.[11]

One medical student shared their story:


“Unfortunately, our 'beginning of life ethics' lecture was given with one clear perspective, and ridiculed doctors who didn't share the lecturers' pro-abortion views.  Following the lecture a small group of students spoke to a local GP involved in the University's ethics teaching about our experience. They then arranged a meeting with the organiser of our medical school's ethics teaching, and asked if we would be willing to discuss our teaching at the meeting. We were very nervous as first-year medical students meeting with a head of department, but we used this opportunity to explain the unbalanced way abortion had been taught to us, and how those who take up conscience rights had been spoken about. The University listened to our concerns and as a result, subsequent teaching has included a lecturer from both sides of the argument, changing the way abortion is taught at our medical school to be more balanced, and preventing students with conscientious objections from being marginalised.”


Nurses, midwives and nursing associates

Nurses, midwives and nursing associates are required to adhere to the professional standards contained in The Nursing & Midwifery Council (NMC) Code[12]. Again, it is key to be familiar with the Code.


“…tell colleagues, your manager and the person receiving care if you have a conscientious objection to a particular procedure and arrange for a suitably qualified colleague to take over responsibility for that person’s care” (Paragraph 4.4)


“make sure you do not express your personal beliefs (including political, religious or moral beliefs) to people in an inappropriate way”[13](Paragraph 20.7)

One nurse shared their story:


"During my training as an adult nurse, I hadn't heard about conscience rights until my final placement of year three. Following a conversation with my mentor about my Christian faith, I was asked whether my religious beliefs would have implications on my willingness to be involved in some specific patient cases, primarily relating to terminations of pregnancy due to the prevalence within my area of work. I was worried my preferences wouldn't be recognised properly or taken seriously, until I was told about my right to conscientious objection. After researching this further, I realised the lawful protection I have to conscientious objection, and approached the senior nursing members to discuss my objection in being involved in abortions. The team supports my choice, and arranges for a swap in staff members whilst the case is ongoing to facilitate this. I feel encouraged and empowered by the law stemming from conscientious objection and I'm incredibly thankful for it."


Conclusion

It is important for healthcare professionals to be familiar with their legal protections and regulators’ guidance around freedom of conscience. Freedom of conscience enables healthcare professionals to maintain their integrity, dignity, and respects their moral values. Occasionally, it may be appropriate to share the reasoning behind our conscientious objection with patients, but this must be carefully considered and approached with sensitivity if done. With thoughtful preparation, open communication and mutual respect, we can uphold our personal convictions while supporting our colleagues and without obstructing patient’s access to information and their full range of options.


[5] Section 4 Conscientious objection to participation in treatment. The Abortion Act, 1967. legislation.gov.uk/ukpga/1967/87 https://bit.ly/3kib3DP

[6] Part 7 Conscientious objection. The Abortion (Northern Ireland) Regulations 2020. https://www.legislation.gov.uk/uksi/2020/345/contents/made

 
 
 

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