Conscientious objection and expressing personal beliefs

Guidance on conscientious objection and expressing your religious and cultural views when practising as a doctor.

Location: UK
Audience: All doctors
Last reviewed: 24 June 2022
Justice scales article illustration

What is conscientious objection?

Doctors are entitled to have their own personal beliefs and values in the same way as any other member of society. A conscientious objection is when a doctor does not wish to provide, or participate in a legal, and clinically appropriate treatment or procedure because it conflicts with their personal beliefs or values. A conscientious objection is based on sincerely held beliefs and moral concerns, not self -interest or discrimination.

Doctors can therefore only claim a conscientious objection provided it is lawful, non- discriminatory, and does not cause patients harm, or deny them access to appropriate medical treatment or services.

The BMA does not want to unnecessarily restrict doctors from seeking to exercise a conscientious objection, or other expressions of their belief. We seek to balance doctors' freedom with the rights of patients to receive appropriate treatment in a non-judgmental fashion.

 

Is there a legal right to conscientious objection?

There are only two areas in the UK where there is a statutory right to claim a conscientious objection; these are abortion, and fertility treatment.

Abortion

Section 4(1) of the Abortion Act 1967 (Scotland, England, and Wales) and section 12 of the Abortion (Northern Ireland) (No. 2) Regulations 2020 provide that a health professional cannot be compelled to participate in the administration of a procedure which results in the termination of a pregnancy if they have a conscientious objection, except where it is necessary to save the life or prevent grave permanent injury to the physical or mental health of a pregnant woman. There is no statutory right to conscientious objection in the case of emergency hormonal contraception as this is not an abortifacient.

Fertility Treatment

Section 38 of the Human Fertilisation and Embryology Act 1990 provides that a health professional cannot be compelled to participate in any activity covered in that legislation (assisted reproduction and embryo research) if they have a conscientious objection.

 

Are there any limits to the statutory rights of conscientious objection?

The limits of conscientious objection in abortion were confirmed in the UK case of Janaway v Salford Area Health Authority (1988) UKHL 17 which held that the right is limited to a refusal to participate in the procedure(s) itself and not to pre- or post- treatment care, advice, or management.

The position was further clarified in the case of Greater Glasgow v Doogan and Another (2014) UKSC 68 in which the Supreme Court held that conscientious objection does not extend to health professionals supporting, supervising, and delegating to staff participating in abortion.

A summary of these cases is available at PubMed and Greater Glasgow Health Board (Appellant) v Doogan and another (Respondents) (supremecourt.uk).

Furthermore, in an emergency, health professionals must provide appropriate care and treatment despite any conscientious objection.

 

Should doctors be able to exercise a right of conscientious objection outside the limited statutory rights of abortion and fertility treatment?

Yes, subject to the provisos below, the BMA believes doctors should have a right to conscientiously object to participation in other legal and clinically appropriate treatments, for example, contraception, non-therapeutic male infant circumcision (NTMC), and the withdrawal of life-sustaining treatment.

However, this right does not extend to refusing to treat a patient where this would give rise to direct or indirect discrimination, or harassment under the Equality Act 2010 in England Wales and Scotland or parallel legislation in Northern Ireland i.e., on the grounds of patient’s age, disability, marital status, pregnancy, race, religion or belief, sex, and sexual orientation. This means for example, that a doctor must not refuse to provide a patient with clinically appropriate medical services because the patient is proposing to undergo, is undergoing, or has undergone gender reassignment, or a refusal to treat patients of the opposite sex. It is the procedure itself that the conscientious objection refers to, not specific characteristics of the patient.

It should also be noted that doctors may be required to fulfil contractual requirements that may restrict their freedom to work in accordance with their personal beliefs. For example, where the treatment is a core service, such as contraception, and all the GPs in a practice have a conscientious objection to its provision, they must make alternative arrangements for their patients by sub-contracting this part of the service.

 

What are the responsibilities of doctors who have a conscientious objection to a treatment or procedure that may be clinically appropriate for the patient?

Where a doctor will not provide or participate in a treatment or procedure based on a conscientious objection this can affect patient care. The BMA believes that they have an ethical obligation to minimise disruption to patient care and must not use a conscientious objection to intentionally impede patient access to care. Furthermore, in an emergency, doctors must provide appropriate care and treatment despite any conscientious objection.

The GMC advises that where a doctor has a conscientious objection to a legal, and clinically appropriate procedure or treatment, patients should be made aware of this in advance of a consultation. In its guidance Personal beliefs and medical practice, the GMC states at paragraph 10 ‘If, having taken account of your legal and ethical obligations, you wish to exercise a conscientious objection to services or procedures, you must do your best to make sure that patients who may consult you about it are aware of your objection in advance. You can do this by making sure that any printed material about your practice and the services you provide explains if there are any services you will not normally provide because of a conscientious objection.’

In addition, the GMC in its guidance Personal beliefs and medical practice at paragraph 12 states ‘Patients have a right to information about their condition and the options open to them. If you have a conscientious objection to a treatment or procedure that may be clinically appropriate for the patient, you must do the following.

  • a) Tell the patient that you do not provide the treatment or procedure, being careful not to cause distress. You may wish to mention the reason for your objection, but you must be careful not to imply any judgement of the patient.
  • b) Tell the patient that they have a right to discuss their condition and the options for treatment (including the option that you object to) with another practitioner who does not hold the same objection as you and can advise them about the treatment or procedure you object to.
  • c) Make sure that the patient has enough information to arrange to see another doctor who does not hold the same objection as you.’

If a patient wishes to be seen by another health professional, the doctor must ensure they have sufficient information to enable them to do so. If it is not practical for the patient to make the arrangements themselves, the doctor must arrange for another health professional to take over their care without delay. It is important to ensure that any inconvenience or distress to the patient is kept to a minimum.

Doctors should also inform their employer and colleagues about their conscientious objection in order that they can practise in accordance with their beliefs without compromising patient care or over-burdening colleagues.

 

Can doctors exercise a right of conscientious objection to patient ‘life-style’ choices?

No. It is not appropriate for doctors to refuse to treat patients whose illnesses are thought to arise from their personal choices, for example, smoking, alcohol, and drugs.

The GMC in its guidance Good medical practice states at paragraph 48 ‘You must treat patients fairly and with respect whatever their life choices and beliefs’ and at paragraph 58 ‘You must not refuse or delay treatment because you believe that a patient’s actions or lifestyle have contributed to their condition.’

Patients should be offered information about how to safeguard their health but the fact that their actions may have contributed to their condition should not give rise to moralising or delaying treatment.

 

Can doctors express or discuss their personal beliefs with patients?

The GMC in its guidance Personal beliefs and medical practice states at paragraph 31 ‘You may talk about your own personal beliefs only if a patient asks you directly about them or indicates they would welcome such a discussion. You must not impose your beliefs and values on patients, or cause distress by the inappropriate or insensitive expression of them.’

In the case of Kuteh v Dartford and Gravesham NHS Trust [2019] EWCA Civ 818 the Court of Appeal upheld the dismissal of a nurse after she initiated conversations with patients about religion, assured her employer that she would stop, yet continued to do so, told patients they had a better chance of survival if they prayed, gave patients bibles, and asked a patient to sing a psalm with her. Read a summary of the case (Crossland Solicitors).

Some doctors may seek to manifest religious or cultural beliefs or views through the wearing of religious symbols. Like the GMC, the BMA does not seek to tell doctors what to wear. However, the BMA anticipates that doctors will be sensitive to the impact that such symbols may have on their patients.

 

Does the BMA have any further guidance on conscientious objection?

Yes, the BMA has information on conscientious objection in its guidance on abortion, non – therapeutic male circumcision (NTMC), the licensing of firearms, and clinically-assisted nutrition and hydration (CANH) - see key resources below.