Recent research published in the Journal of Medical Ethics suggests that many medical students would consider exercising conscientious objections to a broad range of interventions, extending, in some cases, to a refusal to treat patients of the opposite sex or those whose ill health derives from personal 'lifestyle' choices. This research is strengthened by the GMC's recent review of its guidance on personal beliefs which noted an increase in the number of enquiries it had received from doctors seeking to exercise a conscientious objection. This also confirms the BMA's experience.
Medical professionalism refers to that set of values and behaviours that underlie successful therapeutic relationships.
As the GMC states, 'good doctors make the care of their patients their first concern.' Care for their patients will not always be a treating doctor's sole concern but it is their primary one.
Medical professionalism refers to that set of values, behaviours and dispositions that underlie successful therapeutic relationships. Although professionalism is a complex concept, it is clear that effective doctors cultivate the ability to reflect on their practice. An important aspect of this is developing an awareness of those areas where the expression of personal values might have a negative impact on patients or the therapeutic relationship. Of course doctors will bring their own private values to their work, but it is vital that doctors exercise restraint where the expression of these values or beliefs might be detrimental to the interests of patients.
In addition to its inter-personal aspect, medicine and health in the UK are important public goods. The NHS is committed to the provision of health on the basis of need. Although we recognise that the concept of health 'need' is complex, the BMA fully supports this position. Pragmatically, were significant numbers of doctors to opt-out of providing certain treatments or treating certain types of patients, the NHS would struggle to function. Were doctors to opt out of treating classes of patient - those for example whose illnesses were thought to arise from their personal choices - the fundamental obligation to provide appropriate treatment in a supportive and non-judgmental manner could not be met. Doctors and their institutions could also be vulnerable to legal challenge for discrimination.
The Equality Act 2010 provides protection for individuals against unfair discrimination on the basis of the following 'protected' characteristics:
- gender reassignment
- pregnancy and maternity (which includes breastfeeding)
- religion and belief
- sexual orientation
'Unfair discrimination' is defined in two ways: as 'direct' and as 'indirect' discrimination. Direct discrimination is where an individual is disadvantaged as a result of a policy that specifically provides inferior treatment to someone on the basis of one or more of the protected characteristics. Indirect discrimination arises as the result of a policy that may not have been intended to disadvantage individuals with any of the protected characteristics, but may nonetheless have that effect. A ban on hats for example might indirectly discriminate against those whose religion requires them to wear them, such as Sikhs.
A refusal to treat patients because of their gender or sexual orientation would render both doctors and their institutions vulnerable to charges of direct discrimination.
'Disability' is defined as 'a physical or mental impairment which has a substantial and long-term adverse effect on that person's ability to carry out normal day-to-day activities.' Failure to treat individuals because their ill health might be the result of lifestyle factors could be construed as both direct and indirect discrimination against people with disabilities.
Discussion with patients
As mentioned earlier, patients in the NHS are entitled to expect high quality, clinically-indicated care delivered in a supportive and non-judgmental manner. At times, doctors or other health professionals seeking to exercise a conscientious objection may need to discuss the matter with their patient, explaining, for example, their reasons for referral to another practitioner.
In these circumstances they should ensure that they discuss the matter as sensitively as possible, bearing in mind that the patient may be in a particularly vulnerable position. Sensitive handling should be designed to minimise any distress to the patient arising from a perceived judgment of the patient or the patient's values by the doctor or health professional.
Read our guide about dealing with discrimination