more_vert
CONSCIENTIOUS objection by doctors is often raised in relation to issues such as contraception and abortion, but it can apply in many different circumstances.
The AMA recognises that this can be a fraught area for doctors, so has released a position statement that outlines when a conscientious objection may be invoked and provides guidance to minimise the risk that a doctor’s conscientious objection will impede a patient’s access to care.
The statement applies to any circumstance in which a doctor conscientiously objects to providing or participating in a particular treatment or procedure, for example, in-vitro fertilisation (IVF), circumcision, or withholding and withdrawing life-sustaining treatment.
A conscientious objection is based on sincerely held beliefs and moral concerns, not self-interest or discrimination.
While we may not always share the same beliefs and moral concerns as a colleague, every doctor’s personal views and values should be respected. A doctor who has a conscientious objection should not be treated unfairly or discriminated against.
However, finding an acceptable balance between a doctor’s right to conscientious objection and a patient’s right to access timely health care has not been easy.
The tension between doctors’ and patients’ rights was highlighted in debates last year over the Tasmanian Reproductive Health (Access to Terminations) Bill 2013. The bill, which was passed by the Tasmanian Parliament in November, allows a doctor to conscientiously object to performing or providing advice about an abortion. However, it also mandates that an objecting doctor must provide the patient with the name and contact details of another (non-objecting) doctor.
There are many doctors who believe that referring patients to (or informing patients of) non-objecting doctors constitutes participating in the treatment they object to and thus compromises their own moral integrity.
Anecdotally, we have heard that both those who believe conscientiously objecting doctors should be mandated to refer a patient to a non-objecting doctor and those opposed to this mandate believe that their positions are consistent with the Medical Board’s statement on conscientious objection in its code of conduct for doctors in Australia. The Board stipulates doctors have a right not to provide or directly participate in treatments to which they conscientiously object. However, it also says doctors should inform their patients of the objection and not use an objection to impede access to treatments that are legal.
From the AMA’s perspective, specific guidance was needed for our members on how to fulfil their ethical obligations to patients.
Our position statement is built around the fundamental principle that a doctor’s conscientious objection should not impede a patient’s access to care. Where a doctor has a conscientious objection to providing or participating in certain treatments or procedures, he or she should make every effort in a timely manner to minimise the disruption in the delivery of health care.
Medically appropriate treatment, however, should always be provided in an emergency even if that treatment conflicts with the doctor’s personal beliefs and values.
The position statement also provides guidance to doctors on how they can fulfil this obligation to patients. They can, for example, inform the patient of their objection, preferably in advance, inform the patient that they have the right to see another doctor, and, most importantly, ensure the patient has sufficient information to enable them to exercise that right.
We believe our position statement strikes an appropriate balance between the rights of doctors and the rights of patients.
Dr Steve Hambleton is the president of the AMA and a practising GP.
Jane McCredie is on leave.
Loading ...
I wish there were more men like Andrew Watkins in this world. Practical but concerned. I very much doubt that any woman undergoes an abortion without a lot of soul searching – it isn’t like having a wart removed. Until we walk in their shoes we should not judge. I also remind those who have opinions about why a woman should or shouldn’t do, until the foetus can support itself it is not viable. Women have to think about what the situation is in which this potential life may be subjected to. It is all very well for men to have opinions on what women can or cannot do with their bodies but they aren’t the ones who have their world changed forever.
Don’t put your trust in Princes- even if in the sheep’s clothing of APRHA, government etc. Ethical objections to government or even AMA should be respected too. There is no perfect solution, we must accept different opinions and not degenerate into a totalitarian state like we know from Hitler, Stalin, North Korea and Peoples Republic of China where use of prisoners’ organs is mandated practice.
Why are so many of the medical profession so determined that they have the inviolable right to decide ones life span. My 70 year old sister had a 2 year sentence of death pronounced on her with a cancer of the gut. She was in pain and discomfort for all that 2 plus years, but with a little drug relief, and repeatedly told she was ‘incurable’, all they could do was extend her life span. She lost so much weight she dropped her panties in the street. She was fed sludge through a ‘fitting’ in her belly wall. In the later year she had immense trouble controlling her body functions and I, her brother had to clean her up. Not a normal sibling relationship. She appealed to me to ‘get a gun’ on several occasions, if I could have I would have. The medical profession gifted her over 2 years of fear, indignity, pain, discomfort etc. on her to say nothing of the suffering of the rest of her family, and for what reason? We did not need a referring doctor to make a decision for a rational adult.
It still should be compulsory to refer to a non-objecting doctor. Or would the 44% who do not think this referral should be compulsory prefer to go back to a time of backyard abortions?
I cannot conceive of a medical professional having a conscientious objection to providing health care procedures, prescriptions or counselling.
I can conceive of medical professionals who might have moral objections to undertaking procedures that are not immediately recognisable as essential health care.
The principal moral obligation is to the physical and mental health/welfare of the patient – no personal beliefs can be excused for failure to facilitate an appropriate treatment.
Where a procedure is requested for non-life-threatening conditions, then I could accept that the personal beliefs of the medical professional should be honoured.
Thus, an abortion to save the mother’s life is non-negotiable; an abortion for the sake of an abortion is negotiable.
If any doctor objects to termination of a viable foetus, should the doctor be required to refer the pregnancy to China?
Likewise if the doctor ojects to harvesting organs from living patients-China? Trade in organ transplants-lots of holiday destinations to choose to buy your new kidney, just ask your objecting doctor.
Amputating healthy foreskins? Don’t send any intact foreskins to heaven-they will bounce back.
Harvesting healthy wisdom teeth to stem cell banks? I wonder what happened to mine.
Left -over embryos? Left over bone-the bone bank?
Botox?
Obviously, objecting doctors will need comprehensive CME to advise patients, foetuses, foreskins, wisdom teeth , embyros , bone and wrinkled patients on where to find non-objecting doctors to “treat’ them.
Andrew Watkins states that “the interests of patients should take absolute priority”. I would not disagree. What he fails to realise is that when a pregnant woman walks into the clinic there are two patients. To be forced to consider the rights of one patient and ignore the rights of the other does seem to treat me as if I am not a professional and am unable to think. If section 8 was talking about having to send every patient with an AMI to CCU regardless of age there would be many doctors up in arms. Once a law starts to take away professional judgement and conscience, then the next law may take away more and more of our ability for clinical judgement.
Currently the standard-bearers for ethical conscientious objection are the drug companies, refusing to sell their products for lethal injection of prisoners in the USA, as described in the Sydney Morning Herald 21 Jan. The International Federation of Societies for Surgery of the Hand has issued a statement of support for our members who are being ordered to amputate criminals’ hands. The doctor is being coerced to perform a safe, painless procedure under anaesthesia, or else a ‘backyard amputation’ will be carried out with a sword, leaving the surgeon to tidy up the open stump.
Even though these medical procedures are perfectly legal, and indeed, government-mandated, in their countries, international medical associations support the rights of doctors to refuse to participate in a procedure to which they conscientiously object. Referring a patient to an abortionist is ethically no different than putting in a cannula, so someone else can give the lethal injection – the doctor’s participation facilitates the activity to which the doctor has a conscientious objection.
We must differentiate between a doctor’s informed conscientious objection to killing a foetus (or even a criminal), and the so-called ‘conscientious’ objection of parents who have never seen diphtheria, nor stood in a tetanus ward in a third-world country, who have irrational qualms about immunization. I would conscientiously refuse to sign any ‘conscientious’ objection certificate to immunization.
The AMA should support doctors’ individual rights. If the government wants more abortionists, it can train/employ them.
It is bad enough that doctors are breaking Victorian and Tasmanian laws in doing what their conscience dictates, but it’s even worse for nurses who share that moral view and are forced by law to assist at elective abortions if the abortion is deemed by others to be an emergency, eg, the psychological health of mother. It seems that patients have all the rights but their carers have only limited rights. How does that equate in a secular so called egalitarian society? Where are the libertarians when you want them?
Adrew Watkins has a valid point. I take his example of not giving blood will result in a patient dying. It is irreversible. I would find that difficult to say in that circumstance that the doctor should follow his conscience. I would say that in the circumstance of abortion there are 2 patients and one is destined to die by the hand of someone else. In this circumstance, it could be the referring doctor who is forcing their beliefs on the patient with irreversible results.
Who gets to define what’s good medical practice? Too many people forget Germany in the 1930’s or Stalinist Russia. There, the party decided what was “good” and the profession had to do what it was told. What happens if euthanasia becomes stardard practice: Should doctors be compelled partake in it? The shameful complicity of our profession in these terrrible regiemes is proof that privlidge, education and social standing do not ensure “ethical” behaviour.
I agree that doctors should not impose their views on anyone but neither does the public have the right to impose their view on medical practitioners either through individual or collective coertion. If some people thought more about this they’d realise that “good medicine” becomes an issue of popular sentiment and political power. The conscience clause is more about having a “safety mechanism” in society and to permit diversity of opinion. Even scientific progress is protected by this mechanism. Remember Simmelweiss? He was piloried by the medical profession and ostracised by it for his ideas on puerperal sepsis. You’ve got to give room in society for people with different opinions.
Ethical question. Let’s say the fundy Christians came into power and demanded that doctors ‘treat’ gay individuals: Should doctors be compelled to treat or refer to someone who will?
We are professionals. It is fundamental that the interests of patients should take absolute priority. As professionals we have a privileged position in society and we get to deal with life’s tragedies and ambiguities. In this endeavour our absolute duty is to ensure that the patient can make the best of things in their own terms, guided by our expertise and neutral advice.
As doctors, when we are patients we expect a colleague to provide neutral advice.. This is what our patients generally expect of us as well. Inherent in the provision of any such process is that the patient will from time to time make a decision with which we may not agree. If we then invoke the right to pull the pin should a patient not agree with us , the whole process has been a charade, predetermined by the doctor’s beliefs. Society has quite rightly moved beyond this.
Were I to be a Jehovah’s Witness and refuse to transfuse a dangerously ill patient because of my concern for their immortal soul society would be down on me like a ton of bricks. I would be seen as dangerous for placing my own religious beliefs over those of a patient who presumably did not share those beliefs. Why the difference with abortion and contraception?
The principles behind laws such as the Victorian Clause 8 are fundamental to good medical practice across the spectrum of medical practice, not just around abortion and contraception – think again of how we, as doctors, would want our wishes around other areas such as ART, end-of-life care etc. respected.