IT'S a question we have all have pondered from time to time.

How involved in an act do you have to be to feel actually culpable? For some conscientious objectors during two world wars, it was enough not to actually go into combat yourself but, for others any involvement, however slight, in the machinery of war was something their moral compass would not permit.

Last week, two Glasgow Catholic midwives, Mary Doogan and Concepta Wood, lost a legal battle against a health board's refusal to recognise their right to the conscientious objection of their involvement in abortions. Court of Session judge, Lady Smith, deemed that, since they were merely supervising staff looking after women having terminations, they were "sufficiently removed from direct involvement to afford appropriate respect for and accommodation of their beliefs".

She upheld what has long been established and is made clear by the Royal College of Nursing and other bodies: as a midwife, doctor or nurse working for the health service, your right to object is limited only to the frontline. Once you're at one level of remove, you must quash your qualms and get on with the job.

In a complex system such as the NHS, this conscience cushion is probably all that can be afforded. Far from being an attack on religion, Smith's decision is a pragmatic one, designed to balance a person's right to freedom of conscience with a woman's right to have access to a termination. Conscientious objection to abortion would not be a problem but for the fact that even a small cluster of objectors can have a huge impact on the working of a system. In the UK, where we don't yet have "abortion on demand" and women seeking termination require the signatures of two doctors, it's easy to see how conscientious objection by a GP to give this authorisation might be a barrier to access. Because of this, objecting doctors are also expected to refer to another doctor quickly and not in any way impede the process.

Nevertheless, whatever our views on abortion, it's not difficult to relate to Doogan and Wood's desire to follow their consciences.

In an era in which we are constantly reminded that the products we buy or the companies we work for link us to others who may suffer, it is not enough to simply feel that one never directly does bad things. One must not enable bad things to be done. For Doogan and Wood, who felt abortion was "wrongful and an offence against God and the teachings of the Roman Catholic church", their conscience boundary was crossed when the hospital moved the provision of terminations on to the labour ward on which they worked. Before that, knowing that abortions were performed in the hospital was something their consciences could assimilate, but being in contact with and supervising a team carrying them out was not.

This debate is not just about individual rights to conscientious objection. It is also about the structuring of hospital services, and whether any consideration for the sensitivities of staff or patients should be made. If Wood and Doogan had won, there would have been pressure on hospitals to restructure to ensure this kind of issue didn't arise.

That might not have been a bad thing. After all, the current approach to abortion generally ignores the complicated feelings around the procedure. One recent survey found that most Americans described themselves as both "pro-choice" and "pro-life". Americans, of course, live in a different political and religious landscape, but even here difficult feelings about abortion aren't confined to Catholics, or the staff who carry out the procedures. The little death that is an abortion is rarely taken on as lightly as some in the pro-life movement make out, and I know many who have grieved over their abortions even as they continued to believe they were the right thing.

Even as a non-religious person, I can imagine being in hospital for a termination and feeling uncomfortable about being on a labour ward with those giving birth to healthy babies – or finding it chilling if a child I had just given birth to was struggling for life and the smaller, less developed life of a foetus was being terminated nearby. It seems a little insensitive, if medically practical, to sit the two processes side by side. I am sure, if we ever embrace the idea of euthanasia, we will not be happy putting the assisted suicide patients alongside those who are struggling to stay alive – although that is a rough equivalent to what's happening on a labour ward that carries out terminations.

However, it also seems that the logistics of really ensuring that no-one who objects ever has any contact with a termination would remain too complicated to ever entirely prevent clashes with consciences.

Some will see Lady Smith's decision as an attack on Catholic values, and on freedom to follow a faith. Some may even see this as further evidence of the creep of what Tory party chairman Lady Warsi has described as "militant secularisation".

But how much conscience can be accommodated? By allowing conscientious objection at the frontline, we already have a system that gives space to the beliefs of people who are, after all, in a minority. While there are no figures for the abortion views of midwives, one survey, more than 10 years ago, revealed that 82% of GPs are pro-choice. Meanwhile, only 20% of women are against the right to abortion. The lines have long been drawn.

It would have been surprising if Lady Smith had made any other decision. Midwifery, after all, is not military conscription. There is no draft to dodge, and no punishment if one does so. Rather, there is only the impetus now, sad as it might be, for those who object deeply to consider another career.