Group opposes any moves that erode rights in dealing with patients seeking terminations, writes Claire Trevett.
A group of doctors opposed to abortion say they will fight any moves in looming reforms to erode their rights to refuse to deal with patients wanting abortions. The issue of referring patients seeking abortions to another doctor has drawn opposition from the group.
Justice Minister Andrew Little says he agrees with a Law Commission proposal for doctors who are "conscientious objectors" to abortion to be made to directly refer a patient on to another doctor who they know will provide the service.
Currently, such doctors only have to advise the patient they can get the service elsewhere without specifying where.
The Law Commission report said such a step could help ensure women accessed the services without unnecessary delays.
Little said it seemed to be a reasonable suggestion and it could a breach of medical ethics not to refer on.
"There have been some cases where a medical practitioner declining to give advice on conscientious objection grounds has said 'and I'm not going to give you any advice on where else you can go'. That seems to me to be wrong."
However the suggestion has drawn fire from Dr Catherine Hallagan, a Wellington-based GP who is in the Health Professionals Alliance, a grouping of doctors who object to practices such as abortion on moral and religious grounds.
Dr Hallagan rejected Little's claim it was a breach of medical ethics, saying it was long established and the High Court had ruled in 2010 that a doctor need only inform a woman she could get a service from another doctor or a family planning clinic.
She did not believe the provisions needed to change. "For the same reason that patients have a right not to be coerced into receiving treatment, doctors and nurses have a right not to be coerced into providing it."
Hallagan's stance on the scope of conscientious objection has backing from the NZ Medical Association, which supports the provisions as they stand.
Its chairwoman, Kate Baddock, said the provisions were reasonable and they worked.
There was also concern that eroding that right would have ramifications if legislation to allow euthanasia was passed – something she expected more doctors would declare a moral objection to than abortion.
"When you consider more than 70 per cent of all doctors are not in support of euthanasia, then one could argue they would object to being involved in it. We very much would like to hold the status quo on that objection."
She said in one practice she had worked in doctors had been up front about it when signing up new patients, but that was not a requirement.
However, Abortion Law Reform Association head Terry Bellamak said doctors should not enter a field where abortion cases might arise if they were not prepared to deal with them.
"Ultimately, philosophically I think people should only become doctors if they are willing to perform the whole job. So they should only become obstetricians and gynaecologists if they are willing to perform abortions at need."
Bellamak said at the least, doctors should not charge for consultations and should have to refer on to another provider who they know will provide the service. Allowing women to refer themselves to abortion services rather than rely on a GP to do so would help reduce that problem.
In New Zealand, "life" does not legally begin until birth but Hallagan said her objection was based on her belief that as a doctor she had a duty of care toward both the mother and the unborn child. "In every abortion a patient dies at the request of another patient."
She said abortion should remain a crime in the Crimes Act. "When abortions happen, human lives are extinguished on request."
Reproductive matters such as abortion and contraception are currently the only areas where doctors and other health workers can refuse to provide a service on moral or religious grounds. There are no figures on how many doctors use its provisions.
That right is enshrined in the Contraception, Sterilisation and Abortion Act and also covers nurses and other health workers asked to help perform an abortion or provide contraception.
The Herald spoke to several women about their abortions. The women were aged from their 20s to their 50s. They all had different reasons, and the experience had different impacts on them. They have different views on the reforms.
For Jennifer* the overriding feeling of her abortion was one of relief.
An artist, she was in her first year at university three years ago when she got pregnant. She was 20.
Family Planning organised it all and she was told to state explicitly that she would be in mental or physical danger if the pregnancy went ahead.
"She said if I did not say that I would not be allowed an abortion.
"For me, it wasn't going to be physically detrimental so I had to say I would be mentally compromised, which was a lie.
"Really, I was just in my first year of university and I didn't want to have a baby."
Most abortions take place within three weeks of that first request, but for Jennifer it took 10 weeks.
She had terrible morning sickness which had meant she had to quit her job and could not go to university. "I was basically vomiting the whole time."
It also meant she had to have a surgical abortion rather than the medical abortion she had wanted.
She said the physical healing afterwards was harder than she expected. "But mentally and emotionally I was really good. I know I'm not alone in that. A lot of people feel relief."
She now helps out on the campaign for law reform and wanted reforms that would give women the ability to get an abortion without having to pass some test. "I strongly believe it's nobody's business except the person who is pregnant."
She had no regrets.
* Not her real name.
She had an abortion in the late 1970s, soon after it became available legally. She was 28, and not in a relationship with the father.
"I panicked, I thought it was a good idea. It was expedient and it got me out of a tight spot."
Hill was one of eight mothers who have had abortions and took out a newspaper advertisement to argue for care in the reforms alongside Family First.
She said she was "a bit of Germaine Greer's right hand woman at the time". Abortion was a big issue among the feminist movement, and that was the backdrop to her thinking around it.
"I just went on with my life, but looking back I changed markedly at that time. I'd always been a bit of a party animal and that increased. But underneath there was this part of me I was protecting."
When she had children later, she struggled to bond with her firstborn. She was angry and distant.
It took a long time and a lot of counselling before she put the grief aside. "It doesn't define me anymore, it's not who I am. It's just a piece of my life where I made a bad choice."
She is now a churchgoer and knows people will assume religion is behind her decision to oppose reform. But she does not think it is realistic to ban abortion.
"Please be cautious about amending a law which is already able to give us virtually abortion on demand. I just wonder if you open it any wider what we open ourselves up for.
"This is not without effect. I'm not saying every woman feels like this. I'm just saying we need to consider this carefully."
She would like women to be able to see a scan of their child before deciding and consider options such as abortion and keeping the child.
1. Retain the current law
2. Decision on abortion is for a woman alone, in consultation with health practitioner
3. Doctor decides if abortion is appropriate, considering women's mental and physical wellbeing. That "test" would be set out in law. (closest to current).
4. Woman decides alone unless pregnancy is more than 22 weeks pregnant. After that, doctor decides if abortion appropriate, considering mental and physical health.
*These are the Law Commission options, which could be changed by the Government.
1. Cabinet decides on a process – before Christmas
2. Justice Minister Andrew Little puts up legislation – early 2019
3. MPs get a conscience vote on it soon after. If it passes first reading, goes to select committee for public submissions and any changes. That will likely be a dedicated select committee.
4. If sufficient support, passes by end of 2019.