Steve Hambleton: Objection rights

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.