Ethics

The General Medical Council published its definitive guidance on Personal Beliefs and Medical Practice on 17 March 2008. CMF had earlier made a submission to the consultation that led to this.

Generally we welcome the broad thrust of the guidance and find much of it consistent with our long stated view of how, from a Christian perspective, we should approach all patients (see 'In relation to patients' in our historic Affirmation on Christian Ethics in Medical Practice).

The myth of secular neutrality

We were particularly pleased that the final guidance incorporated as we had requested the important recognition that 'All doctors have personal beliefs which affect their day-to-day practice' (paragraph 6 of GMC guidance), and that it is not just those with religious faith who bring presuppositions, values and worldviews to every consultation.

Discussing beliefs

We welcome the recognition (9) that patients' beliefs should be acknowledged, and that they 'may be an important aspect of a holistic approach to their care'. There is a growing evidence base reviewed in the British Medical Journal that faith helps health, and two book reviews on our website consider the relationship between faith and health:

• Realized Religion - Research on the Relationship between Religion and Health - Theodore J. Chamberlain & Christopher A. Hall
• Handbook of Religion and Health - Koenig, McCullough and Larson

We accept the principles of the guidance about doctors' personal beliefs in 17-20, agree we must not impose beliefs on patients, and note that if there can be 'inappropriate or insensitive expression' then there must conversely be expression of views which is both appropriate and sensitive.

Conscientious objection and abortion requests – GMC clarification

Of particular concern to CMF members in general practice, obstetrics and gynaecology, and related areas is the issue of duty when responding to patients requesting abortion. We wrote to the GMC requesting clarification and find their formal response helpful and reassuring. It is posted with their permission. This extract deals with the central queries:

'You ask three specific questions about whether our guidance obliges doctors to provide particular services:

1. Will doctors be obliged to sign abortion authorisation forms?
2. Will doctors be obliged to clerk patients for abortion (ie carry out pre op examination and assessment)?
3. Will doctors be obliged to refer patients seeking abortion to other doctors who will authorise it?

The answer to all three questions is 'no' – see Good Medical Practice and paragraph 21. Reading paragraph 26 in the context of Good Medical Practice and the preceding paragraphs of the supplementary guidance (particularly paragraph 21), should ensure that readers understand our intention in this guidance. This is to distinguish between doctors refusing to participate directly in, or facilitate the execution of, procedures to which they have a conscientious objection on the one hand, and on the other, refusing to provide any other care on the grounds that the patients concerned were about to undergo, or had undergone such a procedure. It is the procedure to which the doctor objects, not the patient.'

We feel the GMC's last sentence here – 'It is the procedure to which the doctor objects, not the patient' – summarises the situation perfectly.

Other areas of conscientious objection

Doctors have a legal right under Section 4(1) of the Abortion Act 1967 to declare conscientious objection to participating in abortion. Other contentious areas – post-coital contraception for example – are not formally covered by law and the GMC's letter to us advises:

'While we hope that doctors will read the guidance as a whole, we accept that, in isolation, paragraph 26 could be cited to suggest that the GMC offered no scope for doctors to object to procedures on grounds of conscience save those protected in law (although that would make nonsense of the section on conscientious objection, as a whole). In view of this, we will consider adding a short clarification, perhaps in a footnote, to ensure that this paragraph cannot be read and misinterpreted out of context.'

The debate continues

Although reassured by this GMC clarification, CMF will continue to maintain a watching brief on the implementation of this guidance in specific cases. We are wary about misuse in malicious complaints and have already described such a case. We are also taking legal advice.

There has been media interest in these questions and on 9 April General Secretary Dr Peter Saunders was on BBC Radio 4 - You and Yours, participating in a 17-minute discussion with Jane O'Brien from the GMC Standards and Ethics secretariat and with Dr Evan Harris MP.

Conclusion

The GMC guidance is just guidance, and the question for all practising doctors is how that guidance might come to be interpreted in the event of complaints against practitioners.

CMF encourages all members to study the GMC guidance carefully in association with its overview guidance, Good Medical Practice and to review their own policies and practice, not least (23) regarding 'printed materials such as practice leaflets'.

CMF will seek to keep members informed of developments.