Should doctors employed by a government hospital be allowed to make a conscientious objection to abortion? A British doctor, J.W. Gerrard, constructs an original defence of the "yes" position in the latest issue of the Journal of Medical Ethics. He believes that it can be both reasonable and ethical. Two of his arguments are worth exploring.

"My way or the highway" is one common response to conscientious objection. If a doctor accepts the King's shilling, he must play by the rules. But Dr Gerrard points out that this argument is valid only if the doctor's position is idiosyncratic and personal. For instance, a doctor might refuse to do appendicectomies because he believes that the soul resides in appendix. But opposing abortion is not a belief of that kind. In fact, "the view that the fetus is alive and worth saving is rooted within usual professional norms". IVF clinics care for embryos; hospitals try to prevent miscarriages; premature infants are nurse in intensive care.

"Having doctors who are prepared to object when this position is undermined is something that should be at least accepted. Beliefs of this sort, like many aspects of human behaviour, probably lie along a normal distribution curve. Exclude individuals at the conscientious objection end of the spectrum and the graph is likely to shift towards recruitment at the other end. Allowing only those who have no objection to abortion to practise medicine, using this as a discriminator in student selection, is intriguing territory."

Another common argument is that a GP who refuses to refer for an abortion dooms a woman to have a riskier abortion several weeks later. But this is not truly a pro-choice position, Gerrard seems to assert.

"It is one of the unfortunate aspects of abortion that time, so important a commodity for the decision, advances pregnancy; making that decision and any consequences more difficult. That this is so is no reason to dodge the issue. If as a society we are serious about offering real choice for women in abortion we are not there yet. Faster is not the same thing as choice. It may act against it. The presence of conscientious objectors within the system of medicine, including at the level of GP referral, acts as a balance against the scales tipping in favour of too fast abortion provision, a situation detrimental to real choice." ~ Journal of Medical Ethics, October