Nad’s not Mad – she just has reactionary Tourettes

Every time Nadine Dorries MP gets on TV and in the press my heart sinks a little. I’m a Conservative supporter, even though that seems to be perpetually unfashionable – hardly anyone seems to admit being one in polite company – but the sorts of views she expounds every time make it a little harder to explain “yes, but that doesn’t mean I agree with her”. That said, the backlash against her views also seems to be often quite disproportionate. For example, even if you believe that recommending abstinence from sex is not a very productive form of sex education I don’t think you have to vilify someone for disagreeing and wanting it nevertheless to be available as an option that is discussed alongside contraception and methods of having sex safely.

The latest Dorries policy to raise hackles has been her proposal, (thankfully rejected by the Government), that independent counselling be made available to women who are seeking an abortion. Fortunately I have never, to my knowledge at least, been in the position of being responsible for an unwanted pregnancy or to have had to go through the process of obtaining a termination. I can see both sides to the argument that a termination involves the ending of another’s life and is therefore wrong and that it can also be wrong to require a woman to carry to term and bear a child that they either don’t want or are incapable of supporting. This piece is not about whether abortion is right or wrong or whether it should be allowed or not.

The thing which is most curious about the proposal on counselling is its difference to the proposal on abstinence as sex education. That is, that it excludes the possibility of other forms of advice being given. Although the independent counselling Dorries and Frank Field MP propose is not to be compulsory, it will be the only form of counselling that could be given. Specifically, they ask that counselling on abortion should not be provided by organisations which have “an interest” in carrying out termination procedures. This means that charities like Marie Stopes which both counsel and get paid to carry out terminations would not be considered independent and would therefore have to choose which of the two activities they were to carry out. On the other hand, organisations which had a particular moral or religious stance to the advice and counselling they were providing (eg Care Confidential who were exposed on Newsnight as training their counsellors to tell women that abortion was a mortal sin) would be considered independent.

The parallel that has been drawn by Frank Field is with misselling of financial services by advisers who were not independent of the providers of the products. However, there is a crucial distinction. In the financial services context the problem is the lack of impartiality of non-independent advisers. A Marie Stopes counsellor could be described as lacking impartiality on the basis of the supposed financial benefit to their organisation of being paid to carry out abortions. However, a counsellor with a specific religious stance on abortion would be equally lacking in impartiality. Impartiality rather than independence is the important feature. In financial services advice there is little or no moral element to the choice being made by the customer so it is not unreasonable to conflate independence and impartiality. In the morally charged issue of abortion, the financial element is likely to be rather less significant and so seeing impartiality and financial independence as equivalents rather dangerous.

I would be very surprised if Marie Stopes counsellors were ever disappointed by a woman deciding after counselling that they did not want a termination or that they would seek to talk them round. On the other hand, a counsellor who believed that abortion was up there with the very worst sins that a woman could commit would never be likely to think that anything other than a decision not to have an abortion (other than perhaps in very limited and defined areas such as where they had been raped) was a disaster. I’d expect, and indeed want, such a counsellor to keep on pushing towards “no” if that was their belief.

That would be the opposite of what one would normally want from an independent and impartial adviser. That is not to say that anyone who has a particular religious or moral view on abortion should be disqualified from advising or counselling on it. Relatively few religious people conform to the media stereotype of hellfire preachers, most or many think deeply about their beliefs and are aware of the difficulties of the struggle in reconciling abstract beliefs with practical human action. Many will believe that it is not their role to judge people and will be conscientious in both standing up for their moral beliefs and accepting that individuals need to make a free choice. The reality is that impartiality and independence are not easy to get in a counsellor on something as morally complex as abortion and that an unsophisticated disqualification of either religious links or links to providers of abortions is foolish.

Ultimately, the decision is really none of anyone’s business other than the woman seeking the abortion. She should be provided with the opportunity for counselling to help her to make what must be an astonishingly difficult choice, if she wants or needs it. The form of the counselling and any underlying approach, whether religious or otherwise should be made clear from the start so that an informed choice can be made as to which service to use, but I don’t see any need for the State to prescribe artificially what form or set of beliefs on the issue should be promoted or rejected in what ultimately is an issue of personal choice.

The other peculiarity of Dorries’ approach is that it is also inconsistent with her support for the Health and Social Care Bill more generally. One of the major elements of the Bill is to make most health services susceptible to being provided by private healthcare businesses. That is not necessarily a bad thing. However, what it does mean in this context is that the Bill overall will have the effect of making more advice and counselling on healthcare in the hands of people who are not, in Dorries’ sense, independent of the provision of that care. Abortion might be argued to be something of a special case because it involves a potentially mortal sin in the taking of the life of another.

I believe this is a mistake and a matter of degree. There are many healthcare decisions made on the advice of doctors and other professionals which are similarly weighty. The logic of Dorries’ position would be to say that doctors seeking to provide a life-saving blood transfusion to the child of Jehovah’s Witnesses would be insufficiently independent of the commerciality of the process to provide that transfusion to be allowed to advise on it. The organ donor services would similarly be too closely linked to the commercial aspects of carrying out transplants to be allowed to advise and counsel relatives of potential donors. Instead in that example, it would be better for those families to be provided with independent counsellors who, for example, may have religious views on the importance of being buried intact.

More broadly, much of Conservative economic policy relating to public services is inconsistent with Dorries’ ideas of independence from the financial benefits of providing the service. The Localism Bill and its aim of making all public services contestable will have the effect of giving more organizations, whether local not for profits, charities or large corporations a financial interest in the provision of public services. Many of these may be sensitive and involve advising people about the use of the services being provided. Must there be a presumption also of independence of advice in say referring someone to an outsourced addiction treatment service?

For that matter, couldn’t the NHS as it is be considered to lack independence? After all it gets its funding to carry out the same procedures that it is funded to advise and counsel on! This is one of the reasons why Louise Mensch MP’s suggested compromise amendment with its reliance on the independence of the NHS fails conceptually (as does the idea that neutral counselling could be an option – being pro-choice is as much a moral stance as being pro-life).

To be consistent, the proposal should therefore either be coupled with a rejection of the broader marketisation policies in the Bill or be broadened out to require similarly “independent” advice for a much wider range of procedures. The former would have Ms Dorries rapidly sidelined by the Government. The latter would be so obviously unworkable and wrong as to keep her reactionary Tourettes well off the front pages.