Always Let Your Conscience Be Your Guide? Part 3

Should students be accepted for medical school if they have no intention of treating certain people or conditions?

A survey shows that a significant number of medical students think doctors should be able to refuse any procedure that contradicts their beliefs. The procedure that causes the most contention is, as always, abortion.

Not all of the respondents were religious; non-religious students thought opt-outs should be a right too - 35% thought there was a place for conscientious objection. The survey also found a prevelance among the religious to object to certain procedures and patients.

In general, support for a doctor's right to refuse any procedure that troubles their beliefs was highest among Muslim medical students at 76.2% while 54.5% of Jewish students thought the same, as did 51.2% of Protestants and 46.3% of Catholics.

More than double the number of Muslim students than non-believers would refuse an abortion when contraception failed. A higher percentage of Muslim students than others would object to prescribing contraception. Nearly eight percent of them also stated they would object to ‘intimately examining a person of the opposite sex’. The survey didn't ask how students would feel about examining LGBT people which, along with not exploring the reasons for objections in the non-religious, is a limitation.

Doctors opting out of treating certain patients is only part of the problem. Some students are refusing even to learn certain areas of medicine in the first place.

It was reported in the Sunday Times four years ago that some Muslim medical students were refusing to attend lectures or answer exam questions on alcohol-related or sexually transmitted diseases because they claimed it offended their religious beliefs. This was corroborated by both the BMA and the GMC. Professor Peter Rubin, chairman of the GMC’s education committee, said: “prejudicing treatment on the grounds of patients’ gender or their responsibility for their condition would run counter to the most basic principles of ethical medical practice”.

GMC guidelines recognise the right of freedom of expression for medical students but state that this 'cannot compromise the fundamental purpose of the medical course: to train doctors who have the core knowledge, skills, attitudes and behaviour that are necessary at graduation'.

The GMC also specifically states that a foundation level doctor cannot practise while refusing to examine patients on grounds of gender or those patients whose illness can be attributed to their lifestyle. Guidance drawn up by the GMC advises doctors to refer a patient to a colleague if they object to a certain procedure or treatment. They must also give patients enough information so they can seek treatment elsewhere within the NHS. In some situations, doctors' consciences can (and should) be accommodated but the foundation level doctor is often the first one to see acute patients and any delay in treatment could have serious implications.

The research paper on the survey concluded that ‘Once qualified as doctors, if all these respondents acted on their conscience and refused to perform certain procedures, it may become impossible for conscientious objectors to be accommodated in medicine’. It also states that ‘The views of large numbers of Muslim students are contrary to GMC guidelines, and thus the medical profession needs to think about how it will deal with the conflict’.

Although Muslim students are clearly a growing problem, Muslims are not the only ones to object to certain procedures. The Christian Medical Fellowship, which has 4000 members, is also strongly anti-abortion, for example. Almost a third of the students surveyed wouldn’t perform an abortion for a congenitally malformed foetus after 24 weeks, a quarter wouldn’t for failed contraception before 24 weeks and a fifth wouldn’t even perform an abortion on a minor who had been raped.

Some of the reporting of this survey has gone straight to worse-case scenario and ignored the finding that a lower percentage of students would refuse to carry out a procedure than actually objected to it. However, the percentages are still significant and the situation needs to be addressed while respondents are still students. If the number of medical students prepared to carry out a termination when they qualify is shrinking, then women will find it hard to access abortion safely and quickly in the future.The UK may be drifting towards the situation in Italy where nearly 70% of gynaecologists refuse to perform abortions and 50% of anaesthetists refuse to assist on moral grounds even though abortion is legal.

While the GMC is holding out against students' right to pick and choose what they learn, the question remains - why do people want to become doctors if they are only going to treat certain patients or conditions, and where do they think they will practice this limited form of medicine? It's not just women's needs that are taking second place to beliefs; the provision of universal healthcare is being challenged too. Perhaps medical students need to be triaged when they apply to colleges and clearer limits set on the conscience to make sure that patients' needs always come first.

I wrote a response to the GMC consultation on conscience opt-outs for the National Secular Society some time ago.

In Part 1 I looked at the affect on women of pharmacists being able to opt out of selling emergency contraception if it's against their beliefs. I also wrote a consultation response for the NSS on this subject. It's not just in the UK where conscience is becoming a problem. In Part 2 I looked at the debate in the Parliamentary Assembly of the Council of Europe on doctors' opt-outs.

Update 3 August 2011
In related news, a Christian midwife is refusing to wear trousers because Deuteronomy 22:5 says that it's wrong to wear the clothes of the opposite sex. Trousers are part of the uniform for hygiene purposes and the hospital is so far sticking to its guns saying that wearing them is 'proportionate'. Let's hope she never wears clothes of mixed fibres and doesn't have pierced ears.

Religion, sex and death - election style

It must be election time. The main parties are parading their religious beliefs in order to court what they imagine to be the faith vote.

Both Cameron and Brown's Easter messages are likely to alienate more people than they attract though - both non-believers and people of other faiths. Gordon Brown said that 'the Christian Church is the conscience of our country' and that the visit of the Pope in the autumn would 'make this a special year for the UK'. I'm not sure what meaning of 'special' he was using.

Cameron's Thought For The Day style homily included: 'No matter what faiths we follow, we can all draw strength from Christ's message of hope, of a new beginning and a promise of a new dawn'. It is to be assumed that he will be drawing strength from other religions, too. Or not.

The Tories have gone further than Labour (so far) in parading their religious credentials. In an interview with the Catholic Herald, Cameron pledged to lower the abortion limit, block assisted dying and allow schools to teach PSHE (sex education) any way they like.

On abortion, he said the limit should be reduced to 20 or 22 weeks, His reason for this is 'the way medical science and technology have developed in the past few decades'. He doesn't go into details and blatantly ignores scientific evidence.

Foetal viability was rigorously examined by the House of Commons Select Committee on Science and Technology in 2007. The Committee concluded that:

'While survival rates at 24 weeks and over have improved they have not done so below that gestational point. Put another way, we have seen no good evidence to suggest that foetal viability has improved significantly since the abortion time limit was last set, and seen some good evidence to suggest that it has not.'

This conclusion is shared by the British Medical Association and the Royal College of Obstetricians and Gynaecologists. Foetal viability means survival of foetuses who are alive at variable times during the pregnancy or the capability of surviving the neonatal period and growing up into an adult.

To put this into context, in 2007, 89% of terminations happened before 13 weeks. In 2005, only 1.3% happened between 20 and 24 weeks.

Are Catholics in this country so different from those in America and Australia? 64% of US Catholics disapprove of the statement that abortion is morally wrong in every case and 72% of Catholics in Australia say decisions about abortion should be left to individual women and their doctors. Cameron may well be scuppering himself with all but the most hard-line Catholic voters, let alone with the rest of us.

His argument against assisted dying is that there is a 'line to be drawn between allowing nature to take its course under some incredibly painful circumstances and on the other hand allowing doctors or others (however well-intentioned) to accelerate death. I think it would be wrong to tread over this line, because there are very serious implications for our families, and for our society as a whole'. The biggest danger he sees is 'that terminally ill people may feel pressurized into ending their lives if they feel they've become a burden on loved ones'.

He presents no scientific research, no statistics, no information from countries where assisted dying has long been successfully carried out. He just goes for the scare tactic. He also commits the hoary old mistake of of assuming that nature is good and right. Perhaps he'll remember that when someone close to him needs an organ transplant or cancer treatment. And he seems to have forgotten (or ignored) a poll showing that over 80% of people in the UK are in favour of assisted dying. Never let the facts get in the way of rhetoric.

When it comes to sex education, he thinks that 'schools should be allowed to teach it in a way that's consistent with their beliefs, and parents should be free to decide whether or not their children should take part in these lessons... I'm a big supporter of faith schools'.

He may think this is a vote-catcher but he is putting the health and well-being of the next generation at risk by allowing religious schools to keep them in ignorance or mix facts with faith.

As I wrote about PSHE before, it's hard to see how a school with a strong religious ethos will be able to teach the facts and get its religious message across without these two aims coming into conflict. Children in faith schools are often the most in need of accurate, impartial information as devoutly religious parents are unlikely to be willing or able to give it to them.

Proposed Conservative amendments would strike the requirement from the current PSHE proposals that teaching should 'endeavour to promote equality', 'encourage the acceptance of diversity' and 'emphasise the importance of both rights and responsibilities'. They would mean that schools would not be required to teach PSHE and also allow parents to withdraw pupils of any age.

The danger is that young people have no way of judging the quality of any sex and relationship teaching they do get until it is too late and they fall pregnant or get an STI. And how will young gay people cope in a school whose religion actively disapproves of homosexuality? The irony is that good PSHE would help reduce abortion rates overall and help women face the decision on whether to have a termination in a more informed way, which could reduce the (already small) number who need late ones.

The Tory party's stance on equality wasn't helped when Chris Grayling, the Shadow Home Secretary, said that Christian B&B owners should be allowed to turn away gay couples. Hotels should take anyone but Christians should be allowed to say who comes into their homes - even though these homes are businesses for tax and legal purposes like hygiene and health and safety - laws which Christian B&B owners would of course observe because they don't happen to clash with their bigoted beliefs. The law says that services must be provided to everyone without prejudice. Grayling's message appears to say that belief puts you above the law.

It's not just the Tories who are pushing the religious agenda. Religious groups are trying to give the impression that they can deliver masses of voters. In previous elections when parties running on the Christian ticket stood, they failed in no uncertain terms. In the last European election, the Christian Party averaged only 1.6% of the vote, despite having a candidate in every constituency.

A group called Westminster 2010 has made a declaration which includes pledges to

'protect the life of every human being from conception to its natural end and we refuse to comply with any directive that compels us to participate in or facilitate abortion, embryo-destructive research, assisted suicide, euthanasia or any other activity that involves intentionally taking innocent human life'.

and

'support marriage - the lifelong covenantal union of one man and one woman as husband and wife. We believe it is divinely ordained, the only context for sexual intercourse (...) and we refuse to submit to any edict forcing us to equate any other form of sexual partnership with marriage'.

So - no abortion, assisted suicide, embryo-based research, civil union, sex outside marriage or divorce. By refusing 'to submit to any edict' they are partly referring to equality law. That's law passed by Government and approved by the Queen (they're very keen on saying this is a Christian country based on Christian values because the Queen is Head of State and Head of the Church).

This manifesto is signed by five senior clerics, a peer, the chair of the Mission and Public Affairs Committee of the Church of England, the principals of three theological colleges and senior staff of around a dozen Christian associations and campaigning groups. That's a lot of heavy pressure put on MPs, threatening them with lost votes if they don't promote the same values. Blackmail is now apparently part of the democratic process. It should be noted that less than 3% of the population go to Church of England services at Easter, the festival on which the whole religion rests.

No wonder Brown and Cameron are bending over backwards to appease the religious voters. Except that the days of people receiving political guidance from the pulpit are long gone. Very few people now vote on single issues. Voting for a party purely on its stance on abortion, for example, is likely to land you with an MP or party you disagree with on many other issues, like tax, health care or foreign policy.

Not one of these religious messages puts women's and gay rights or health and well-being or personal choice before faith. Not one of them is evidence-based. Not one is even humane. Vote for the Dark Ages.