Last week the High Court upheld a new law affecting health care providers with ‘conscientious objections’ to abortion. Terry Bellamak, president of ALRANZ, breaks down the decision and explains what it means for people seeking abortion care in 2021.

You may or may not have heard about a High Court case from last week – New Zealand Health Professionals’ Alliance v Attorney-General. It’s about the right of health practitioners to refuse to provide legal, proper healthcare because they object to it on moral grounds. This is so-called “conscientious objection”. 

But really, this case is about abortion care and people’s right to receive that care without unnecessary delays. It’s also a good case to know more about, because it could affect you or someone you love. Allow me to explain.

First of all, what is ‘conscientious objection’?

In the context of this case, conscientious objection is obstructing a patient’s access to medical treatment that the health practitioner disapproves of by refusing to provide treatment, and sometimes by refusing to provide further information. Objectors usually refuse to provide abortion care, and sometimes contraception or emergency contraception.

Those who obstruct other people’s access to abortion care like to call themselves “conscientious objectors”, allowing them to borrow the mantle of those courageous conscripted soldiers who refused to fight in the world wars. 

There is very little resemblance, however. Those soldiers suffered at the hands of military authorities who punished them harshly for their refusal to fight. The health practitioners do not suffer at the hands of authority figures. In fact, in the context of the doctor-patient relationship, they are the authority figures. It is patients who suffer delay in receiving safe, legal, time-sensitive care, and sometimes get an offensive lecture on their morals to boot.

What was this case about, specifically?

The New Zealand Health Professionals’ Alliance (NZHPA), a society that, in its own words, “advocates for freedom of conscience in healthcare” challenged new sections of the Contraception, Sterilisation, and Abortion Act 1977, later amended by the Abortion Legislation Act 2020.

The newly added section 14 says that when health practitioners object to informing patients about abortion care, they must tell the patient of their objection and how to access the contact details of the nearest provider who can help them. Section 15 says employers of objecting health practitioners must accommodate their objection, unless doing so would cause unreasonable disruption.

As plaintiffs, the NZHPA claimed that sections 14 and 15 limit their rights under the NZ Bill of Rights Act. They asked the court for a declaration that those sections are inconsistent with the Bill of Rights. The court considered whether the law limited their freedom of conscience, freedom to manifest religion, and freedom of expression.

Why does this sound so familiar?

That’s because this has happened before. The NZHPA went to the High Court in 2010, complaining that the New Zealand Medical Council (NZMC) had ruled that objectors had to refer their abortion patients to doctors who would help them. They argued that making a referral came too close to providing abortion care, and was too great a burden on their consciences. The court agreed. 

When the dust settled, patients’ rights had been gutted. The NZMC’s rule was tossed aside. This left New Zealand with some of the weakest medical objection rules in the world. In bringing this case to the High Court in 2021, the plaintiffs were trying to restore those old, weak rules.

What did the High Court decide?

The court upheld the new sections, finding that objectors must provide assistance to their patients as required by law. It said the law does not limit any of the plaintiffs’ rights, and even if it did, those limitations would be demonstrably justified in a free and democratic society.

How did this case turn out so differently from the one in 2010?

There are two answers to that question, the little answer and the big answer. The little answer is that things are now different – the defendant, the type of proceeding, the questions the court had to answer, and the things the court had to take into account.

The big answer is that everything is different – it is a different world. In 2010 abortion was a criminal justice matter. Today, abortion is a health matter. Back then abortion was literally against the law, with two certifying consultants having to approve the abortion to make an exception. 

Now we have a right to safe, legal abortions up to the twentieth week of gestation. Abortion had public support in 2010. Now that support is far more widespread.

OK, but how did the decision play out?

This case was supposedly about objectors’ consciences. But the court pointed out that pregnant people who want abortions have consciences too. It is simply not the case that their consciences are somehow worth less that the consciences of objecting health practitioners.

The judgment says:

“It is far from clear to me why— particularly in the case of the minimal and remote act required by s 14—a proper interpretation of s 15 of the NZ Bill of Rights Act would permit the conscience of one individual either to restrict the exercise of conscience by another, or to limit access by women to a process that is not only lawful, but is grounded in their fundamental rights.”

Parliament has recognised abortion as a fundamental human right by legalising it. Now the courts can decide cases taking that into account. This is a victory for patients’ rights. By treating patients’ and health practitioners’ consciences as equally deserving of consideration and protection, it has made society a bit more equal.

So what should I do if a health practitioner refuses me service?

It depends on the service. If it’s contraception or abortion, the health practitioner has to tell you about their objection, and tell you how to find the contact details of the nearest provider of that service. If they don’t, they are not following the law. Get their name. If any health practitioner treats you disrespectfully or gives you a lecture on your morals, write down what was said as accurately as you can, then definitely make a complaint to the Health and Disability Commission (HDC).

If it’s a pharmacy, contact the headquarters and make a complaint. If it’s a doctor or nurse practitioner, contact the head of the practice and make a complaint. If they don’t seem to take it seriously, make a complaint to the HDC. If it’s emergency contraception, that’s slightly different. The minister of health is responsible for seeing that everyone can access emergency contraception within 48 hours of requesting it. Note the time, and if it takes you longer than that, contact the HDC and the Ministry of Health.

And if you have any questions, you can always contact ALRANZ to explore your options in confidence.

There’s no such thing as a person who dislikes a handwritten letter in the mail.

The last time my hand hurt from writing was in 2014, during my final university exam. I had three hours to write four essays and my hand couldn’t keep up with the sentences forming in my head. My handwriting was, in the words of an angry mum, disgustang. As I walked out of the exam room I stretched my hands, tried to rub out the dent my pen had made along my middle finger, and vowed never to write another essay by hand again.

I’ve kept that promise to myself as far as never returning to any form of academic institution, but since 2014 I’ve maintained a love for the one good reason (in my opinion) to write by hand: letters.

When’s the last time you wrote someone a letter? Or even just a card that said more than “Happy Birthday” or “Sorry you’re leaving”? When’s the last time you received a letter or card? If you’re someone who skim reads cards and then throws them away, this is probably not the article for you. But if the thought of receiving a handwritten letter in the mail from someone you love is even just a little bit exciting, why not give that feeling to someone else?

We’re in week seven of lockdown here in Auckland and so far I have received 11 envelopes in the mail. Five were from the bank (boring), two from the IRD (terrifying and then boring), one telling me I can now get the vaccine (great), one was my ACC levy invoice (ruined my week), one was a handwritten letter (made my day) and one was a handwritten card (made my week).

I have also had a frankly embarrassing number of online purchases delivered and none have brought me as much joy as receiving a lovely card.

There’s a personal touch to handwriting that allows for a connection otherwise missing when everyone’s confined to their homes. When I read something handwritten I know it’s an original: no one else is reading what I’m reading and likely no one else will. It’s a snapshot of the writer’s life that the internet can’t touch. Like someone sending you a page of their diary.

Yes, even in isolation we can FaceTime and Zoom and “hang out” virtually, but nothing feels as close to intimacy as a letter, no matter how clumsily written. It requires time, thought, and commitment that clicking a link doesn’t. We love to romanticise letters sent from soldiers in battle to partners back home. They serve as a narrative history. World events told through the yearnings of young men existing daily in the presence of death. This pandemic is our war, and the perfect time to record some of the many feelings we’re all having that we at times don’t understand. Sure, you can just journal but why not make it collaborative?

I have a close friend who loves writing a good card as much as I do and were we to lay out our birthday and Christmas cards over the years, any stranger could read them and see a friendship evolving and strengthening.

It of course helps that my love language is words of affirmation paired with a voice and (lack of) expressiveness that doesn’t lend itself to verbal proclamations. Instead, I write them down. And in writing down my feelings, I confirm them to myself. Telling someone you care for and appreciate them is lovely. Spending time writing it down and knowing it’ll be received in isolation and possibly kept forever is a real commitment to that sentiment.

So while we’re all feeling just a little bit vulnerable and a little bit insecure, try writing down your feelings and sending them to someone you love (or someone you don’t!). Don’t put stock in a response – that’s never the point – but use it as an exercise in being open, with the bonus that few people dislike receiving personal letters in the mail. If you have a friend in the neighbourhood, write them a nice little note and drop it in their mailbox on your silly little walk. Or buy some cheap postcards and send out telegrams like you’re travelling the world except you maybe haven’t left your house in days.

We’re living in a world that is simultaneously over-connected and isolating. A handwritten note is a way to remind yourself and another that you exist in the real world.

Last Saturday I was working at my desk when I heard music playing outside. I assumed it was one of my flatmates enjoying their breakfast in the garden but quickly realised it couldn’t be because it sounded like…my music. The music I only listen to in my room because no one else likes it. I ran outside and learned that the music was coming from one of our neighbours’ backyards. I couldn’t see them and we’ve never spoken to those neighbours in the four years we’ve lived in this house. I considered yelling out asking them to please turn it up but that felt weird.

So I wrote them a card instead, thanking them for the nice music and admitting that it had been a bright spot for me in an otherwise tough week. I don’t think they’ll ever respond but it doesn’t matter. I hope they enjoyed receiving it.