Heather Bellamy spoke with Dr Peter Saunders about the implications of new rules issued by the Faculty of Sexual & Reproductive Health earlier this year

Dr Peter Saunders

Doctors and nurses who have a moral objection to prescribing contraceptives that act by killing human embryos are to be barred from receiving diplomas in sexual and reproductive health, even if they undertake the necessary training, according to new guidelines. Under new rules issued by the Faculty of Sexual & Reproductive Health earlier this year, these doctors and nurses are also to be barred from membership of the Faculty and from speciality training. To find out more Heather Bellamy spoke with Dr Peter Saunders, the CEO of Christian Medical Fellowship.

Heather: First of all, I didn't realise that there were some contraceptives that worked by killing human embryos. Please could you explain what they are and how they work?

Peter: Yes, a lot of people don't realise this. In fact most contraceptives act by stopping egg and sperm coming together, either by stopping release of the egg or interfering with sperm transport, but some contraceptives actually act after fertilisation, when an embryo's already been produced and is in the process of implanting in the wall of the womb. These contraceptives act by stopping that implantation process, effectively killing the early embryo.

Heather: Which contraceptives do that?

Peter: That's IUCDs, that's intrauterine contraceptive devices, like the coil: most of them can act in this way; also one of the morning after pills known as ellaOne, which can be taken up to five days after intercourse, is known to act in this way. There are others in a grey area - although the proof is difficult to obtain.

Heather: I know different people have varying opinions on when human life starts, so could you explain why anyone would have an objection to prescribing these contraceptives, in terms of how they would see the start of life with the embryo?

Peter: A lot of people take what we call a gradualist view - in other words they think that human life gradually attains value as development takes place: so a new-born baby is a human being, but not so much a foetus and less so an embryo. There are also a lot of people who believe that human life should be shown the utmost respect from the very first stages, from fertilisation and conception and that we shouldn't be doing things that compromise early human life.

Heather: So what will the effect of these guidelines be?

Peter: The Faculty of Sexual & Reproductive Health is part of the College of Obstetricians and Gynaecologists and they provide postgraduate qualifications for doctors and nurses working in certain fields. Both doctors and nurses who object to prescribing or using contraceptives that act after fertilisation will be barred from getting the Diploma of Sexual & Reproductive Health. Doctors will be barred from undergoing specialist training towards becoming consultants in sexual and reproductive health, so that will effectively mean that they'll be limited in what practice they can do and it'll be very difficult for them to get jobs in this area.

Heather: And how big a part of a job is prescribing these contraceptives?

Peter: It's actually quite a small part of the job. The specialty training in sexual and reproductive health enables you to act in a whole range of different areas and treatments including gynaecological cancer, so cancer of the cervix and womb; psychosexual counselling; infertility; the treatment of sexually transmitted diseases; all forms of contraception; screening for cervical cancer and so on. It's a huge specialty of which contraception is only a very small part and these kind of contraceptives almost make up a minuscule part, so it seems like they're really taking a sledgehammer to a walnut here, because you could easily, I think, make reasonable accommodation for people who have moral objections, to practise in other areas where they have no moral objection.

Heather: There is a conscience clause in the Abortion Act of 1967, please could you explain how a conscience clause works and why that hasn't been adopted with these guidelines?

Peter: Under the Abortion Act of 1967, if you have a moral objection to taking part in abortion then you don't have to participate and no-one can force you to do it and the Royal College can't stop you getting a qualification in obstetrics and gynaecology either. There's a court case currently before the Supreme Court involving two Glasgow midwives who didn't want to oversee abortions, where the scope of that conscience clause is being tested and we're waiting for that, but it seems rather odd that on the one hand the College is allowing people who refuse to do abortions to get its specialist qualifications, but not people who refuse to give these contraceptives, which are effectively abortifacient because they kill very early embryos. It seems that they're doing this because they think they're not legally required to offer conscience protection in this case.

This is going to affect a huge number of doctors. We know that most Catholic doctors already object to being involved in any form of contraception or prescribing it, but there are also many other doctors, other non-Catholic Christians and people of other faiths and people of no faith at all, who would be opposed to using these specific kinds of contraceptives that act after fertilisation. We're talking about big numbers here: there are 14,000 doctors who are already members of the Faculty and 10,000 of those are GPs, so there may well be a large number who've already trained and have these qualifications and it raises the question about how they're going to be managed in the future.

Heather: That's what I was about to ask you. Do you think that under those guidelines they would now be able to sack people or not give people jobs even though they are qualified and have already got that qualification?

Peter: That's not clear - and I think the College urgently needs to make it clear where these doctors stand, because I know there will be some doctors who might even want to return their diplomas and others who'll be very worried about their futures. We know that now, in all fields of medicine, doctors have to undergo continuing professional development and also revalidation and in order to do that they have to show that they have the competence and skills and I would think also still fulfil the requirements of the specialist qualification that they have. I don't see how the College can be consistent in this without also putting pressure on people who already have their qualifications to relinquish them if they're not prepared to go along with this. It's very serious indeed what they've done.

Heather: Are the guidelines legal under equality legislation?

Peter: That's a very interesting question. In response to the Telegraph article that highlighted this issue, the Faculty put out a press statement later in the week and they say that their guidelines do comply with legal and policy frameworks, but I think that's a question that needs to be examined. Under the Equality Act of 2010 you're not able to discriminate against people who have a range of protected characteristics and included amongst those characteristics are religion or belief. It seems to me that what's happening here is that people who have certain religious convictions or beliefs are being directly discriminated against by not being able to participate in training. I would have thought that raises real questions about whether what the College is doing is legal and I would not be surprised at all if a legal challenge is mounted, either a judicial review of the guidelines, or if a group of doctors and nurses who feel aggrieved by these guidelines get together and bring a case against the College. If I was the College I would be consulting my lawyers fairly carefully at this point, because I don't think these guidelines have yet undergone the full scrutiny of the law and that will be a very interesting process.

Heather: Did the Faculty take advice or have a consultation about these guidelines, or even ask their own members at all, or is it just a board that made these decisions with no consultation?

Peter: I don't know the full answer to that about to what degree they consulted. What I do know is that there are doctors who already have these diplomas or specialist qualifications or are seeking to gain them who were really quite shocked to learn about this and the media certainly were not aware. So even though the College may claim to have had these guidelines on their website for a while, I don't think the general public is aware and now that it's come to light there is understandably quite a lot of concern being expressed about it.

Heather: Do you think conscience is becoming less respected generally in the UK?

Peter: I think that in the UK we have a society that is increasingly hostile to Christian faith and values. That has been reflected in the position of institutions like the RCOG on moral matters but also in our laws and some of the new legislation, beginning with the Abortion Act and carrying on over recent decades into equality legislation. I think this has led to some restrictions on the expression of Christian belief and of Christian behaviour and I think that does pose a direct threat to conscience. There's a very real danger here that once you accept that you can discriminate against people on the basis of their moral beliefs, where does it end? This will affect some doctors who have certain beliefs, but we could see the same principle being used to extend that degree of discrimination in the future and that's why it's so important that it gets challenged at this early stage. Even people who don't hold the belief that human life should be shown the utmost respect from the time of fertilisation, I think really do have a moral obligation to stand up against this kind of discrimination as well, because what starts with one group of people will spread to others, inevitably, if it's unchecked. The price of freedom is eternal vigilance.

Heather: Although you have highlighted the Christian faith, this doesn't just apply to that, does it? Because people of other faiths or no faith still may have a moral objection to this.

Peter: Yes - and people from Muslim or Hindu backgrounds, for example, will have very high views on the sanctity of human life and I would not be at all surprised if they felt the same. There will be some doctors of no faith at all who nonetheless believe that human life should be shown the utmost respect from the time of conception and in fact that was once the position of the British Medical Association. Back in 1948 they signed up to the Declaration of Geneva, which says, "I will maintain the utmost respect for human life from the time of conception", so this was all doctors of all faiths and none. It's not we who are changing our view here; we're just holding to the position that the medical profession has traditionally held to. What's happening is that the Royal College of Obstetrics and Gynaecology has changed its view and now it seems to want to discriminate against people who hold traditional views on the sanctity of life.

Heather: Recently David Cameron sparked debate by saying we're a Christian nation and that Christians should be more evangelical in their views. How do you reconcile a Prime Minister that says that, even though there has been much debate about it, with things like this coming through?

Peter: There's been much debate about what David Cameron meant by that. I don't think anyone can deny that the Christian faith and Christian values have had a profound effect historically on our laws, institutions, culture and our language as well, but if one doesn't uphold Christian values about things like the sanctity of all human life and if one doesn't protect the right of Christians to be able to hold Christian belief and act according to those beliefs then I think that there is an erosion of Christian influence in our nation. The critics of David Cameron have made the point - and I think quite accurately - that increasingly in our land we see people who hold beliefs that are hostile to Christianity occupying positions of power in institutions, education, Parliament, the legal profession, media and the entertainment worlds and they are starting to shape the culture in a way that is making it more difficult for Christians to live according to their faith here.

Heather: If anyone reading this is concerned, whether because they're a doctor or that's the profession they were wanting to go into and would need this qualification, or just the general public, is there anything they can do? Can they air their views with this Faculty? Can they make their voices heard at all?

Peter: Yes. I think anybody can write to the chairman of Council of the Faculty of Sexual & Reproductive Health at the RCOG and express their concerns about it. You'll find the statements about this in the media and on their website. I would urge doctors who hold this diploma, whatever their views on the human embryo, that doctors who hold the diploma or specialist qualifications should be contacting the Faculty to express their concern about this discrimination against their colleagues. People in the general public and of course this affects patients too, because, imagine if you're a Christian patient or a Muslim patient and you'd like to be treated for, let's say, your cancer of the cervix by a doctor who shared your religious views, surely you should have a right to that? But if this goes through it will bar doctors with certain beliefs even from qualifying as specialists, so I think arguably there's also a form of indirect discrimination acting here. This is something that doesn't just affect doctors: it affects patients, which means all of us and it affects our whole society: it is a very serious undermining of personal and professional freedom and it must not be allowed to go without protest.