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ss nucleus - spring 2008,  Personal beliefs in medical practice

Personal beliefs in medical practice

Alex Ho reviews a topical debate in London

Christians strive to live out their convictions about Jesus Christ, under the authority of the Bible. This extends to every part of our lives, including medicine. Due to be published this year, the GMC (General Medical Council) guidance on Personal Beliefs and Medical Practice should be of particular relevance.

The controversial nature of the topic is evident. The British Medical Association criticised the draft document for potentially excusing doctors from involvement in any procedure to which they conscientiously object.[1] This set the scene for a debate between Dr Evan Harris (Oxford MP and member of the former House of Commons Science and Technology Select Committee),[2] and Dr Andrew Fergusson (CMF Head of Communications), at Guy's Hospital, London on 6 December 2007.

'each speaker has 15 minutes…'

Professor Robert Lechler, debate chair and vice-principal of King's College, introduced the proceedings. Harris kicked off by recognising that people may go into medicine due to personal beliefs. However, there were three reasons to support the motion: Personal beliefs should never impact patient care in medical practice. Harris chose to use examples relating to abortion.

Prioritising the best interests of the patient is a fundamental ethical principle. A doctor who refuses to refer a pregnant woman for an abortion fails his duty to the patient, as the patient's viewpoint has been 'dismissed'. Harris presumably equates a patient's best interests with patient autonomy.

Harris believes that it is unethical for a doctor to give advice regarding abortion if he is not prepared to provide one or to refer to a specialist who will. The patient would have to start the consultation process again, making for an inefficient service, not to mention the embarrassment of being 'lectured'. General practices can make it clear if some of their doctors are unhappy to offer abortion referrals and such GPs should not start the consultation in the first place.

To close, he argued that there is a significant chance of doctors with personal beliefs being 'tempted into unethical deeds', such as giving anti-abortion advice on the basis of their beliefs. Doctors should recognise the autonomy of patients, who must not be persuaded by the religious views of a doctor, even though doctors have the right to put across their views.

Next, Fergusson took the lectern, arguing that all doctors have personal beliefs, which inevitably impact patient care. In Harris' framework, personal beliefs are subjective views about an issue for which there is a 'rational' and therefore correct opinion. Opinions are looked at with suspicion if they are in accordance with one's faith, as faith is considered subjective. In comparison, the secular views of society are deemed objective even though they may be merely based on another belief system, such as secular humanism. [3]

Fergusson then tackled the GMC guidance. He explained CMF's proposal for a change in the wording from 'Doctors' personal beliefs may inform their day-to-day practice' to 'All doctors have personal beliefs which inevitably inform...' [4] After this, he started to discuss Harris' recent activities in the area of personal beliefs.

a sensitive subject?

In October 2007, the Commons abortion inquiry considered scientific issues relating to the 1967 Abortion Act, in particular the 24-week upper limit for most abortions. During the consultation, the Guardian [5] reported 'an apparent attempt by faith-based organisations to skew the balance of evidence presented to the committee of MPs.' It quoted Harris: 'The CMF risks undermining the inquiry by getting people called as expert scientific witnesses when they are not.' It alleged that six people presenting evidence to the Select Committee failed to disclose links to CMF.

Fergusson responded by pointing out that a faith position did not negate the evidence that was being presented. However, Harris interrupted him in mid-sentence by standing up and walking out, exclaiming, 'I'm not here to debate this... I was here to debate the topic... I didn't come here to be decried on this subject!'

the show must go on

The chair kept his composure, deciding that Fergusson should be granted the courtesy of finishing his speech. He moved on to explain the potential positive impacts of personal beliefs in medicine, such as the founding of the modern hospice movement by Cicely Saunders. He concluded that Christians, even as they hold personal beliefs, must offer an effective service to people seeking care.

The debate was opened up to the floor, the chair standing in to defend Harris' case. Discussion centred on abortion and the audience grappled to ascertain an evidence-based approach. A student asked whether doctors should simply obey the law; the legality of an action depends on what is currently ethically and morally acceptable in society. Indeed, laws differ between countries. What about doctors practising in a country with lower ethical standards than the UK? One example is the use of transplant organs from executed prisoners.

A vote was not taken and closing speeches were called off - unsurprisingly, given the absence of one speaker. I left with a number of unanswered questions but no complaints; it was rather more exciting than my average night out in London!

References
  1. News Review. Nucleus 2007; Autumn:10,11
  2. Now renamed the Innovation, Universities and Skills Select Committee
  3. Paul J. The God Delusion and the Human Illusion. Nucleus 2007: Autumn:22-29
  4. www.cmf.org.uk/ethics/submissions/?id=47
  5. Randerson J. Guardian 2007; 15 October
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