Thursday, 15 February 2007

Conscientious objection in medicine, or paternalism

I came across a paper in the New England Journal of Medicine entitled Religion, Conscience, and Controversial Clinical Practices. The essence of it was that a survey was carried out on a random selection of doctors in the USA and it was found that many don’t feel an obligation to let their patients know about treatments which are legal but which they find morally wrong, nor do they feel they need refer them on to another doctor who may not have such views. The article asks whether it is right that doctors should refuse any information to their patients, to discuss it, or to refer them on, and where should the balance lie between the patients rights and the rights of healthcare providers not to have to carry out practices against their principles.

I remember when I was a student it was generally known not to go to such and such doctor at the university because she was Catholic and absolutely refused to prescribe contraceptives. I also remember being sent away from a family planning clinic of all places and being told not to come back until I had had a baby! Why did she think I had gone there in the first place? Because I didn’t know how to do it? She thought it was time, after 4 years of marriage, that I should have a child. I managed to hang on there for another three years, having found a different clinic in the meantime.

As a result of those relatively trivial experiences (though they didn’t feel like it at the time), on reading the paper I immediately thought that it was totally unjustifiable for a doctor to withhold treatment and/or information for any reason.

Reading further I found this article in the BMJ where the conclusions are

"Values are important parts of our lives. But values and conscience have different roles in public and private life. They should influence discussion on what kind of health system to deliver. But they should not influence the care an individual doctor offers to his or her patient. The door to "value-driven medicine" is a door to a Pandora's box of idiosyncratic, bigoted, discriminatory medicine. Public servants must act in the public interest, not their own."

It seems a reasonable view until you read one of the responses wondering whether he would have been able to have been a conscientious objector in Nazi Germany or Stalinist Russia. Then today I read NHS Blog Doctor: The extended role of the Health Care Professional which did make me think yet again. It really isn’t easy.

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