Neil Chanchlani: Conscientious objection

Neil Chanchlani“See one, do one, teach one?”

Gone are the days when medical students did what they were told, learnt what was on the syllabus, and spoke when spoken to.

“See one, do one, teach one?” Not a chance.

Instead, they conscientiously object.

A study in the Journal of Medical Ethics analysing the results of 733 medical students across the UK showed that these days, you can be a medical student, and not want to learn. Over 5% (n=39) of students in the study said they would refuse to intimately examine a person of the opposite sex; 10 students would refuse to learn about the moral arguments surrounding abortion at medical school; and 4 students claimed they would refuse to learn about the clinical impact of alcohol at medical school.

When did learning what’s on the medical curriculum become optional? Understanding common symptoms is absolutely vital to good medical practice, whether that may be weight loss in someone who has gastrointestinal cancer or hepatic pain in an alcoholic. Both are symptoms of diseases that a physician must know how to spot, diagnose, and manage.

Aside from the obvious career restrictions, if one does not want to intimately examine a member of the opposite sex, how can he or she ever wish to provide adequate healthcare to a patient?
The study also revealed that a staggering 8.5% (n=62) of students surveyed in the study claimed they wouldn’t examine or treat a patient intoxicated with alcohol. As approximately 35% of accident and emergency attendances and ambulance costs are related to alcohol, it’s interesting to see how this will pan out in practice.

Perhaps if you live in a cosmopolitan city, where there are a lot of hospitals, you can see another doctor quickly if the doctor who first sees you doesn’t like the state you’re in. But what if it’s one am, there’s only one hospital nearby, and the only on-call doctor refuses to treat your injury because you’ve had a few too many beers. What if your injury isn’t even alcohol related – say you have a diabetic emergency, but you’ve had quite a few beers, can you expect treatment then? Where are we allowing the line to be drawn?

Often, those advocating conscientious objection justify their view as a matter of moral, cultural, and religious belief. But at risk of sounding like a broken record, how can doctors of tomorrow attempt to provide adequate healthcare to those that they refuse to treat and examine.

“Oh, its fine, we’ll just refer them on to someone who doesn’t mind…”

As shown above, that may not always be a possible solution. In these days of overworked seniors, inexperienced juniors, and strict European Working Time Directive regulations, finding someone to take a patient off your hands isn’t as easy as making a call.

Furthermore, it’s a matter of retaining responsibility for your role as a healthcare provider and providing your patient with the best possible treatment.

This isn’t just a theoretical problem. Some medical students have actively refused to attend lectures or answer exam questions on alcohol-related injuries and sexually transmitted diseases. “One male student was prepared to fail his final exams rather than carry out a basic examination of a female patient.”

The new generation of students has been encouraged to think independently, question evidence, and make decisions accordingly. But maybe we have come too far. To question and actively disengage in learning the fundamentals of medicine helps no one.

Neil Chanchlani is student editor, Student BMJ.

  • dcohen

    Good article, but the concept of refusing to examine or treat a drunk or female patient is utterly ridiculous. I'd like to avoid seeing violent drug addicts, people who haven't washed for weeks and those with swastikas tattooed on their arms, but that is not the way of the world. You take medicine as a whole, not cherry picking the bits you like. Otherwise, get a new career. You're in this for the patient, not for yourself.

  • dc

    Those results are fascinating. 

    While I support the notion of conscientious objection I feel it should have a limited place in medical training and medical practice. There are too many instances where continuity of care can not be maintained if a doctor refuses to see particular patients – or worse, choose to see them and then treat them according to the doctor's own moral viewpoint.

    But perhaps, just as those conscientious objectors who refused to go to war were conscripted to civil service or jailed, we should be ensuring that these students have mandatory 'social service' where they have to spend time with people addicted to alcohol and drugs, people experiencing family violence, survivors of rape and torture, and people with mental health problems. This exposure could provide a broader understanding of the world, which may allow them to be more patient focussed rather than 'self' focussed.

  • Steph

    What?? Where do these highly conscientious people live, in Fairyland? I too have had my moments of discomfort, but I got over them. When the consultant told me to examine a penis, I did it, though I'm a female and the patient was my age. As for alcohol and STDs, I seriously doubt any religion/morality practices sin-by-association. These people have a twisted view of what ethics are truly about…..or else simply don't want to get their pristine white coat dirty, and are using 'morals' as an excuse. Let them fail, they do not want to be doctors, they just want a nice MD with their name on it. I apologise if I seem harsh, but this is just silly.