Should doctors be allowed a conscientious objection?

Should doctors be allowed a conscientious objection?

Session 13D1, held on Sunday

One of pro-con debate sessions at this year’s Euroanaesthesia focussed on whether or not doctors should be allowed to conscientiously object to giving care to patients based on their personal values or beliefs, a scenario that could position them directly against the patient’s wishes.

The against part of the debate was presented by Professor Dominic Wilkinson, Director of Medical Ethics and Professor of Medical Ethics at the Oxford Uehiro Centre for Practical Ethics, University of Oxford, UK.

“Doctors have an ethical obligation to place their patients’ interests above their own interests. Patient requests for medical treatment options that are legally available, professionally endorsed and within the capabilities of the professional, should be respected,” explained Professor Wilkinson. “Conscientious objection demonstrates a lack of respect for the patient and their values, imposes an additional burden on the patient —forcing them to find another provider willing to provide treatment — and, in some cases, leads to significant harm.

He said that doctors who provide medical care within public health systems are providing a public good, adding that it is reasonable for societies to determine what treatments should and should not be available as part of that public good. However, he said: “It is not the role of individual doctors to pick and choose which treatments they will offer on the basis of their personal values.”

He did however allow that doctors are entitled to express their ethical or religious views outside the consulting room, and also engage in debate about the law and about policy. They may choose areas of medicine to work in that fit with their preferences, skills and values. He said: “It is reasonable for employers to be sensitive to the values of individual doctors and, where possible, to provide some level of reasonable accommodation in the delivery of medical care. Societies that are considering health policies in areas that are controversial may choose to permit doctors to opt out of providing that treatment. That may be a valuable form of political compromise.”

However, he concluded: “There is no ‘right’ to medical conscientious objection. Indeed, in many circumstances, conscientious objection is an ethical ‘wrong’.”

The ‘for’ part of the debate was presented by Dr Mary Neal, Senior Lecturer in the Law School, University of Strathclyde, Glasgow, UK. Dr Neal said: “I take issue with the claims that conscientious objection is ‘incompatible with professionalism’ and that professionals should be willing to offer ‘all lawful treatments’.”

She argued that no clear division between ‘personal’ and ‘professional’ values exists, and that in any case, we should accommodate conscientious objection for the same reasons that allowances are made for doctors’ personal commitments.

Dr Neal said: “I argue that not all ‘lawful treatment’ has the same status: the less therapeutically beneficial a treatment is, or is expected to be, the more room there is for members of the professions to adopt different positions on its status as ‘treatment’, and this includes room — under certain conditions — for individual professionals to regard an intervention as not ‘treatment’ and to refuse to provide it. I believe that, in order to be permissible, conscientious objections should be expressed in these terms, and not by reference to a belief that is wholly private and unintelligible to those who are being asked to respect and accommodate the refusal.”

Dr Neal also addressed some of the main concerns raised by opponents of conscientious objection, including: religious privilege; the problem of identifying appropriate limits; and concerns about access to services, among others.