Just over three years ago, two devout Catholic midwives lost an important claim in the courts. Disciplined for declining to make arrangements for abortions in a Glasgow maternity ward, they sued, saying that the Abortion Act’s conscience clause allowed them to refuse to participate in the procedure. The Supreme Court, combining an impressive capacity for casuistry with a matching unconcern for moral consistency, chose to define “participation” as meaning carrying out the abortion, and nothing more. Organising, managing and aiding other people to do it was quite different; there was no right to refuse to do it. The point matters a great deal. Many NHS hospitals now put abortion and other controversial procedures out to tender (a matter itself a cause for concern, though not here), and so organisation rather than participation is increasingly what will be demanded from often unwilling staff. A House of Lords initiative, Baroness O’Loan’s Conscientious Objection (Medical Activities) Bill, aims to reverse this. Covering doctors, nurses, midwives, pharmacists and other healthcare professionals, it allows conscientious objection to any activity involving three procedures of crucial importance: abortion, IVF and deliberate withdrawal of life-sustaining treatment. It explicitly eschews the Supreme Court’s curious distinction between doing evil and merely arranging for it, by extending the right of refusal to “supervision, delegation, planning or supporting of staff”. It also supplements the previous law by expressly preventing employers penalising those invoking the conscience clause.