GESTIÓN EN SALUD PÚBLICA: BioEdge: The unsettled status of conscientious objection in the UK

sábado, 19 de marzo de 2016

BioEdge: The unsettled status of conscientious objection in the UK

The unsettled status of conscientious objection in the UK

by Michael Cook | 19 Mar 2016 |

What are the rights of doctors who have a conscientious objection to certain procedures in the United Kingdom? The slightly confusing status quo is the subject of an article in the Journal of Medical Ethics by a Cambridge University academic, John Adenitire.

Dr Adenitire sketches a gradation of hostility towards conscientious objection.

1. At the very top there are Julian Savulescu and others who have argued that conscientious objection is “a door to a Pandora's box of idiosyncratic, bigoted, discriminatory medicine” and has little place in modern medical practice. This is not a widely shared view.

2. Then there is the British Medical Association (BMA), the profession’s “trade union”, which defends conscientious objection only in three specific scenarios. It “should ordinarily be limited to those procedures where statute recognises their right (abortion and fertility treatment) and to withdrawing life-prolonging treatment from patients who lack capacity, where other doctors are in a position to take over the care.”

3. And then there is the General Medical Council (GMC), the profession's regulator in the UK, which allows conscientious objection, albeit with a number of caveats. According to its 2013 policy statement, Personal beliefs and medical practice: “You may choose to opt out of providing a particular procedure because of your personal beliefs and values, as long as this does not result in direct or indirect discrimination against, or harassment of, individual patients or groups of patients. This means you must not refuse to treat a particular patient or group of patients because of your personal beliefs or views about them.‡ And you must not refuse to treat the health consequences of lifestyle choices to which you object because of your beliefs.”

4. Most accommodating of all is a ruling of the European Court of Human Rights (ECtHR) in the British case of Eweida in 2013. It applied Article 9 of the European Convention on Human Rights to several cases of discrimination in the UK. Article 9 guarantees “the right to freedom of thought, conscience and religion”, “subject only to such limitations as are prescribed by law and are necessary in a democratic society in the interests of public safety, for the protection of public order, health or morals, or for the protection of the rights and freedoms of others”.

It is Dr Adenitire’s contention that the Eweida ruling “effectively provides that medical professionals have the right to conscientiously object to providing certain healthcare services well beyond the scope endorsed by the BMA”.

This implies that “Given the unsettled nature of the law on the topic, [National Health Service] employers will have to proceed very cautiously as it will not always be clear whether denying a request will be considered lawful by a court. This entails that NHS bodies may be at risk of expensive legal challenges by medical professionals whose requests have been denied.”

Dr Adenitire therefore believes that the BMA’s policy should be changed to align more closely to the Eweida ruling.

However, the law is still unsettled and Dr Adenitire is not necessarily hostile to proposals for legalised assisted dying which are currently being debated in the UK. In an unpublished paper he goes on to argue that in certain circumstances doctors already have a “conscience-based right to provide assistance in dying”

- See more at: http://www.bioedge.org/bioethics/the-unsettled-status-of-conscientious-objection-in-the-uk/11802#sthash.u35SjMua.dpuf

Hi there,

Next week the staff of BioEdge will be celebrating Easter, so there will be no newsletter. We shall resume early in April.

This week's issue contains a familiar but still sobering story about experiments by Nazi doctors during World War II, this time with an Australian twist. In dusty archives historians have uncovered the experiences of five Australian POWs captured in May 1941 in Crete. They were infected with hepatitis by an SS physician, Dr Friedrich Meythaler, to see how the disease was transmitted. Luckily none died of the disease.

This is just a single thread in the tapestry of World War II horrors, although of special interest to Australians. What interested me was a coda by the German historian who is writing up the story, Konrad Kwiet, of the Sydney Jewish Museum. His mother and sister were both doctors and they actually were friendly with Dr Meythaler, who eventually became an eminence in German medicine in the post-War years. His sister was utterly astonished when he told her a few months ago about Meythaler's dark past.

There is a well-worn moral to this anecdote, but one which cannot be repeated too often. Doctors need to be firmly and unconditionally commited to the dignity of all human beings. Otherwise they can easily succumb to the temptation to exploit vulnerable men and women in the course of following orders, or even more disgracefully, to advance their careers.