Ethics

CMF Breakfast

Choosing his subject and title months before the ARM agenda was published, Professor John Wyatt, consultant neonatologist at University College London Hospital and Chairman of CMF's Medical Study Group, spoke to 45 at the CMF Breakfast on Wednesday on: 'The doctor's conscience: a luxury we can no longer afford?' The synopsis of his talk, distributed to press, is:

• The right of conscientious objection is at the heart of all ethical medical practice; it is not confined to issues related to abortion, nor is it limited to those who hold strong religious beliefs.
• The practice of medicine has always rested on a number of core ethical values. These foundational values are part of physicians' understanding of who they are and have provided the basis for historical codes of ethics such as the Hippocratic Oath and the Declaration of Geneva.
• In the last century coercive state power has often led to unethical medical practice. Examples include medical research in Nazi Germany, the abuse of psychiatry in Communist Russia and the procurement of transplant organs from executed prisoners. In these circumstances doctors have claimed the right of adherence to a higher moral code than that enforced by the state.
• The right of conscientious objection preserves the reputation of doctors as independent moral agents who act according to core ethical principles. It is important for the practice of medicine within society that doctors are seen to act with personal moral integrity.
• The threat to exclude doctors with minority ethical beliefs from certain fields of clinical practice within the UK or to compel them to act against their profoundly held core values is profoundly discriminatory and a violation of both their personal moral integrity and of international human rights legislation.
• Conclusion – The right of conscientious objection is an important safeguard of personal moral integrity, a safeguard against coercive state power, and a reflection of the special characteristics of the medical profession within society.

ARM Motion 528

The 'threat' mentioned was debated for 35 minutes during the ARM's medical ethics section the next day. Evan Harris MP, representing Oxford division, commenting on GMC guidelines, sought to limit a doctor's right to conscientious objection solely to those procedures currently protected in law – abortion (in the 1967 Act) and IVF (in the 1990 HFE Act). In a late amendment, the withholding and withdrawing of treatments from the mentally incapacitated was included. (See http://www.cmf.org.uk/ethics/abortion_law_liberalisation.htm Peter Saunders' earlier analysis of Dr Harris's overall strategy about conscience and abortion.)

First to oppose the motion was newly qualified CMF member David Randall, who asked why the ARM was considering this proposal when the excellent GMC guidance which the BMA's Medical Ethics Committee had contributed to, and approved, had only been out a few months. It 'covered all the scare stories' and 'as a Christian myself, I found it very helpful'.

The debate continued, very fairly chaired by Peter Bennie, with 'for' and 'against' speakers selected alternately. However, Andrew Dearden of BMA Council, who had planned to speak 'for' the motion, announced that after hearing the speeches by David Randall and Philip Howard, he had changed his mind. With the Chairman's encouragement, he spoke 'against'. Fred Wright of Oxford division, called next to speak 'for', announced to applause that he was only there in case Evan Harris could not attend to propose the motion, and that he could not have done that with a clear conscience as he too was against it!

Wendy Savage was prevented on procedural grounds from turning a 'point of information' into a speech, and after comment by Tony Calland, Chair of the MEC, and Hamish Meldrum, Chair of Council, electronic voting took place.

The final agenda motions, and the percentage votes (rounded up or down) are appended below, but preventing consultation when '(b) the doctor recognises that s/he is not in a position to give balanced advice to patients considering that procedure and does not claim to do so' was lost by 25-75%, and '(c) the medical practice makes every effort to inform patients in advance, for example through practice leaflets, which doctors are able to provide such advice and make appropriate referrals' was narrowly lost by 49.4-50.6%. Doctors felt 'insulted' by the suggestion that they could not give fair counselling and advice whatever their own personal views, and feared that some doctors might be 'targeted' as a consequence of statements in practice leaflets.

CMF might have preferred that the entire (unnecessary) motion had been lost but these important victories and the spirit of the meeting demonstrate that we are far more in tune with the conscience of the profession, and with the practice of medicine, than is Dr Evan Harris.

More counselling and support for women before and after abortion

There was more good news when Motion 545, recommended for approval, was passed on a show of hands as the medical ethics section over-ran its time. It acknowledged that abortion can be a psychologically traumatic process for women, and urged the BMA to campaign for increased counselling and support for women before and after this procedure.

Motion on animal-human hybrids lost

Two more CMF members had earlier proposed (Bernadette Birtwhistle) and seconded (Avril Stirzaker) Motion 527 that using animal-human hybrids was unethical and unnecessary because effective alternatives exist. Although the vote was lost on a show of hands, unsurprisingly in that the BMA had supported hybrid use and Parliament has (so far) approved it, the ethical concerns would not have been heard otherwise, and our members were encouraged by the support they received.

Appendix.

Voting (show of hands or percentages) on the Motions discussed here

527 Motion by SHEFFIELD DIVISION: That this Meeting opposes the use of animal-human hybrids in stem cell research, and believes that work should be focussed on ethically acceptable alternatives such as reprogrammed adult cells or umbilical cord blood stem cells. LOST by hands vote

* 528 Motion by OXFORD DIVISION: That this Meeting:

(i) supports the rights of doctors and other health care professionals to conscientiously object to carrying out certain non-emergency lawful procedures, where:

(a) such conscientious objection is recognised in statute, as in abortion and IVF and the withdrawal and withholding of life-supporting medical treatment in patients without capacity; PASSED 58/42

(b) the doctor recognises that s/he is not in a position to give balanced advice to patients considering that procedure and does not claim to do so; LOST 25/75

(c) the medical practice makes every effort to inform patients in advance, for example through practice leaflets, which doctors are able to provide such advice and make appropriate referrals; LOST 49.4/50.6

(d) in the event of seeing a patient seeking advice on such a procedure, the doctor should tell them immediately of the existence of a conscientious objection and of their right to see another doctor, although the consultation may continue if the patient and doctor both agree; PASSED 71/29

(ii) calls on the GMC to ensure its guidance on personal beliefs and medical practice reflects this view; PASSED 67/33

(iii) calls on parliament to retain the statutory right of doctors and other health care professionals to conscientiously object within the above limits; PASSED 61/39

A 545 Motion by CARDIFF AND VALE OF GLAMORGAN DIVISION: That this Meeting:

(i) acknowledges that abortion can be a psychologically traumatic process for women, and

(ii) urges the BMA to campaign for increased counselling and support for women before and after this procedure; PASSED by hands vote