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Jane Hatfield on Personal Beliefs and Delivering Care in Sexual and Reproductive Health
Date: 30 Jun 2017
Author: Jane Hatfield - CEO of FSRH
Jane Hatfield, CEO of FSRH offers some insight into the development of the Personal Beliefs Guidance launched in June 2017.
I had not been in post long as CEO at the Faculty when we widened access to the FSRH Diploma to nurses. This was the culmination of many years of work by both doctors and nurses here and I was pleased that the Faculty had come to this decision. However, there were some unforeseen consequences as a result of this change one of which was a challenge from an external organisation to the Faculty’s guidelines relating to FSRH Diploma trainees who express Conscientious Objections. While our position on this seemed to me to be entirely defensible – that we expected Diploma trainees to prescribe all forms of contraception – the challenge did provide us with an opportunity to re-look at our position in relation to all our trainees and how ‘personal beliefs’ about any aspect of SRH could or should impact on someone’s eligibility to be awarded a qualification in this field.
The reason for the use of the term ‘personal beliefs’ and not just ‘conscientious objection’ is not coincidental. As soon as we started to talk with our members about this issue it became apparent that there is a wide spectrum of views – from overt ‘conscientious objection’ to delivering abortion care through to a belief in ‘conscientious commitment’ to delivering the care that women need regardless of personal beliefs. Rather than immediately take up a ‘black and white’ position on this issue, we recognised the need to have a conversation with a range of members with different views – whilst also taking advice from experts and other organisations. So, like all good membership bodies we set up a working group! This was chaired by the then President – Chris Wilkinson – with input from members and non-members with a range of views, opinions and experiences and with additional help from Jules Hillier at Brook. This made for lively and thought provoking discussions and is one of the reasons it has taken us two years to come up with a final set of guidelines.
Interestingly it was not abortion care that was the focus of our discussions as conscientious objection to delivery of abortion care is enshrined in our laws. The thornier issue was whether a doctor should have to be willing to prescribe or fit an IUD as a form of emergency contraception if she or he had a personal belief that this ran against his/her views. To begin with we argued back and forth over whether as an independent training organisation working in the field of SRH, we could or should decide whether to insist on this as part of completing the Diploma. However, what we came to understand over time was that we could not legislate for all circumstances in which healthcare professionals are providing care and that the important thing – for us as a professional body awarding and governing these qualifications – is that that patient care is provided to the standards that we espouse.
So, we came to the conclusion that all FSRH trainees – whether undertaking the Diploma or doing other ‘general training’ in SRH at the Faculty – needed to be willing to ‘abide’ by certain principles of care (set out in the guidance) that, if followed, should ensure that a patient is never put at any disadvantage as a result of the views of any healthcare professional they see. So, for example, a doctor wanting to take or re-certify the DFSRH could decide not to prescribe a form of emergency contraception, but they would have to agree to be open about this to their service/employer to enable arrangements to ensure that there was no delay to the patient in being provided with this care. Furthermore, whatever arrangements are made by the clinician, that these would not in any way suggest a judgement about the patient. So, the heart of these new guidelines is that we welcome members by qualification with a range of views and they will be awarded the relevant Faculty qualification if they meet all the requirements of it and if they are willing to show that they will ‘abide by’ principles that put patient care first.
Having started this conversation about the impact of personal beliefs on the delivery of care and awarding of qualifications, I hope that the Faculty will continue it – we have already benefited enormously from the conversation with different members and stakeholders about these issues. I hope that we will get feedback on the new guidelines and I very much look forward to continuing this important conversation.