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.