{"id":4322,"date":"2022-08-22T16:03:44","date_gmt":"2022-08-22T15:03:44","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=4322"},"modified":"2022-08-22T16:03:44","modified_gmt":"2022-08-22T15:03:44","slug":"doctors-should-not-be-forced-to-refer-patients-for-controversial-procedures","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2022\/08\/22\/doctors-should-not-be-forced-to-refer-patients-for-controversial-procedures\/","title":{"rendered":"Doctors should not be forced to refer patients for controversial procedures"},"content":{"rendered":"

By David Albert Jones.<\/p>\n

Should doctors have a right not to provide legal but morally controversial procedures such as assisted suicide or abortion?\u00a0 And, if a doctor declines to provide some procedure, should the doctor be required to refer the patient to another doctor who will provide it?<\/p>\n

Where abortion or assisted suicide are legal, the law often provides a right not to participate.\u00a0 However, some countries have no conscience protections and others give only limited protection.\u00a0 In the United Kingdom, the Doogan case<\/a> showed that the Abortion Act 1967 does not protect healthcare professionals from having to organise for abortions to take place.\u00a0 In Australia, in relation to \u201cvoluntary assisted dying\u201d there are strong protections in law, but research shows<\/a> that it is hard for junior doctors to exercise their legal rights when senior colleagues hold a different view.<\/p>\n

Respect for conscience is a matter not only of law but also of professional ethics.\u00a0 The World Medical Association is currently revising its International Code of Medical Ethics.\u00a0 The version that was shared publicly in 2021 included conscientious objection but required doctors with an objection to ensure \u201ceffective and timely referral to another qualified physician<\/a>.\u201d<\/p>\n

In response, an open letter signed by over 300 academics and doctors<\/a> argues that doctors should not be required to refer patients for procedures that the doctor sincerely and reasonably believes to be unethical.\u00a0 Patients and the medical profession need doctors who are committed to acting ethically and who will not be bullied into doing what they judge to be seriously unethical.<\/p>\n

There was a meeting about revision of the Code in Washington earlier this month.\u00a0 It is reported<\/a> that the WMA has pulled back from the uncompromising language in the consultation.\u00a0 However, the Code still needs to be considered by the WMA Council and, if approved, be adopted at the WMA General Assemble in Berlin in October.\u00a0 The outcome is not yet certain.<\/p>\n

Some bioethicists have argued that doctors \u201chave no moral claim in liberal democratic societies to the accommodation of their individual conscientious objections<\/a>.\u201d\u00a0 \u00a0The idea here seems to be that it is for democratic processes to decide what is legal and doctors should then be compelled to provide whatever is legal.\u00a0 However, what is legal is not always ethical and there is diversity of view both in society and in the medical profession about what is ethical.\u00a0 The majority is not always right and each person must take responsibility for his or her own actions.<\/p>\n

Consider the example of assisted suicide in Australia.\u00a0 It was illegal but is now legal.\u00a0 Was it also unethical before?\u00a0 Is it also ethical now?\u00a0 It is permitted in Australia but is prohibited in most countries.\u00a0 Many doctors in Australia consider assisted suicide to be ethical and are happy to provide it.\u00a0 Others continue to think it unethical.\u00a0 The dissenting doctors are not only expressing private opinions.\u00a0 They are expressing the shared understanding of many healthcare professionals in Australia<\/a> based on reasonable ethical concerns and in agreement with the current position of the World Medical Association<\/a>.<\/p>\n

People draw the line in different places but everyone draws a line somewhere.\u00a0 In Belgium it is legal to provide euthanasia or assisted suicide on the basis of \u201cconstant and unbearable physical or mental suffering that can not be alleviated, resulting from a serious and incurable disorder.<\/a>\u201d This includes psychiatric conditions<\/a> such as gender dysphoria<\/a>.\u00a0 Should a doctor in Belgium be required to refer someone who is trans and is suicidal to a doctor who is known to be willing to assist suicide for this reason?\u00a0 Or, if a doctor objects to making a referral in this case should their objection be respected?<\/p>\n

Doctors are increasingly under pressure from many directions.\u00a0 There are allocation constraints, whether mediated by insurance companies or by government, there are targets whether set by healthcare managers, trusts or politicians.\u00a0 Patients also come with confused ideas or unrealistic expectations shaped by the internet and social media.\u00a0 Many have noted how healthcare workers have suffered both psychologically and morally during the pandemic.\u00a0 A failure to respect conscience will result in further \u201cmoral injury”<\/a>\u00a0to conscientious clinicians.<\/p>\n

Some say that doctors who object to medical practices that are legal could leave medicine and get another job<\/a>. \u00a0However, forcing conscientious doctors out of medicine, and excluding people from some moral communities from taking up medicine, will have profound consequences for the profession and for society. \u00a0Failure to respect conscience could impact not only the make up of the profession but also undermine the morale of doctors and exacerbate problems of recruitment to some specialisms.<\/p>\n

Furthermore, it is regarded as a truism that there is a positive duty to recruit a diversity of people into medicine.\u00a0 Effectively excluding people from the profession on the basis of reasonable and widely shared moral, political or religious beliefs is flagrant discrimination.\u00a0 It stands in direct contradiction to the aim of increasing inclusion and diversity within the medical profession.<\/p>\n

 <\/p>\n

Author<\/strong>: David Albert Jones<\/p>\n

Affiliations<\/strong>: Director, Anscombe Bioethics Centre, Professor of Bioethics; St Mary\u2019s University, Twickenham; Fellow, Blackfriars Hall, University of Oxford<\/p>\n

Competing<\/strong> interests<\/strong>: The author drafted the open letter referred to in this post.<\/p>\n

Social<\/strong> media<\/strong> accounts<\/strong> (of the centre of which the author is director):<\/p>\n

https:\/\/twitter.com\/AnscombeCentre<\/a><\/p>\n

https:\/\/www.facebook.com\/AnscombeBioethicsCentre<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

By David Albert Jones. Should doctors have a right not to provide legal but morally controversial procedures such as assisted suicide or abortion?\u00a0 And, if a doctor declines to provide some procedure, should the doctor be required to refer the patient to another doctor who will provide it? Where abortion or assisted suicide are legal, […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":354,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8054],"tags":[],"class_list":["post-4322","post","type-post","status-publish","format-standard","hentry","category-conscientious-objection"],"yoast_head":"\nDoctors should not be forced to refer patients for controversial procedures - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2022\/08\/22\/doctors-should-not-be-forced-to-refer-patients-for-controversial-procedures\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Doctors should not be forced to refer patients for controversial procedures - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"By David Albert Jones. Should doctors have a right not to provide legal but morally controversial procedures such as assisted suicide or abortion?\u00a0 And, if a doctor declines to provide some procedure, should the doctor be required to refer the patient to another doctor who will provide it? 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