A student at Edinburgh Napier University was suspended from her training placement with NHS Scotland after sharing her pro-life views on a private social media forum. The incident speaks to a larger problem of expected conformity in medical education.
In 2016, Sara Spencer moved with her husband from southern California to Scotland, where she enrolled at Edinburgh Napier to become a midwife, while he undertook a PhD at St Andrews. Speaking to the Times, Spencer described midwifery as “the dream job I never knew I wanted”.
The pair are both devout Christians and her husband now works as a Church of Scotland minister in Dundee. Spencer’s religious convictions make her a self-described “pro-lifer”. This is, as she is aware, very much a minority opinion in the field. “Though I am legally entitled to my pro-life beliefs, the majority view is clear:” Spencer told the Times, “no decent midwife should share my views”. According to YouGov polling, only four percent of the Scottish population shares the belief that abortion ought to be illegal.
Aware of this general consensus, Spencer is not usually outspoken about her views in interactions with colleagues. However, when a question about the role of midwives in performing abortions came up in a private Facebook group, she decided to be open.
Secret Community for Midwives in the Making is a “support group for aspiring, student and qualified midwives” on Facebook. A woman claiming to be considering a career in midwifery asked the group “Do midwives have anything to do with abortions and can they refuse to take part in carrying them out because of their beliefs?”
Spencer commented on the post, explaining that while midwives may be called on to help perform abortions, they have the legal right to opt out on conscientious grounds.
Another user referred to religion as “baggage” for the profession, and Spencer responded: “Respectfully, our moral commitment and religious beliefs are not baggage. I would remind you that we have a legal right to conscientious objection”.
Not long after this exchange, Spencer was called to a meeting with her manager at NHS Fife, where she was in training at the time. Apparently, they had received a complaint about her online comments. According to a spokesperson from NHS Fife, “[t]he conduct of students on placement is a matter for their academic institution”.
As such, the matter was turned over to Edinburgh Napier University, which instigated a fitness to practice investigation. NHS Fife decided to suspend her from training for the duration of the investigation.
A spokesperson for the University said that while they could not comment on the circumstances of specific individuals, “midwifery students are expected to abide by the code of practice set out by the Nursing and Midwifery Council.”
While this code makes warns against sharing personal beliefs “in an inappropriate way” and emphasises that social media should be used “responsibly”, it certainly does not prohibit anyone from professing their views in a respectful manner outside of work or from answering questions about the legal obligations of the profession.
Indeed, the investigation eventually cleared Spencer of all wrongdoing, allowing her to resume her training. Yet Spencer claims that her professors continued warning her about sharing her views on social media, referring to her earlier comments as “inappropriate”. Although she has been allowed to continue her training, Spencer told the Times that fears further discrimination over her views in her career. “I worry about coming up against this sort of situation again”, she said, “in fact, I am certain I will”.
Spencer is not worried about her legal right to refrain from carrying out abortions, but rather about how her future colleagues and superiors will react to her personal views. “Although I am confident my right to conscientious objection will be respected clinically,” she explained, “I do worry about how expressing my beliefs will cause me to be perceived and treated.”
Spencer describes an environment within the midwifery profession and in the medical education community where pro-life views are shunned and not respected. “I have repeatedly heard midwives state they cannot understand how someone could possibly hold pro-life values while being a midwife”, she said.
With the help of the Christian conservative advocacy legal group ADF International, Spencer is now seeking official acknowledgements of the rights to conscientious objection and freedom of expression from NHS Fife. She is also asking for guarantees that students and professionals with pro-life views will not be discriminated against in the future.
All academic institutions and public training programmes should be free of viewpoint discrimination and encourage freedom of conscience. That Sara Spencer was investigated for respectfully voicing her opinion in a private Facebook group is a scandal and she deserves an official apology from both NHS Fife and Edinburgh Napier.
However, there is a broader concern about the general treatment of pro-life views as well as other controversial beliefs within the sector. While pro-choice is the overwhelming consensus in the UK, those who disagree have a legal right to conscientious objection and freedom of expression for a reason.
Sara Spencer is steadfast in her beliefs, and therefore willing to face whatever criticism she might receive for expressing them, but this is not true of everyone who harbours doubts about the morality of abortion.
When faced with potential ostracization and condemnation from fellow students, colleagues and even professors, others might be less inclined to voice their true opinions. This would not just be an injustice to those with minority viewpoints, but a disservice to the entire profession.
As the Nursing and Midwifery Council’s code of practice advises, one should “deal with differences of professional opinion with colleagues by discussion and informed debate, respecting their views and opinions”. Perhaps staff at NHS Fife and Edinburgh Napier should take a look at this code of practice themselves.