What is the point of being a doctor when conscience overrules professional duties?

A new study recently published on the Journal of Medical Ethics and  reported by the newspapers explored the attitude towards conscientious objection of 733 medical students from four different UK medical schools (Cardiff University, King’s college London, Leeds University and St George’s University of London).The results of this survey are interesting and deserve to be introduced in details.When the students were asked if doctors should be entitled to object to any procedure for which they have a moral, cultural or religious disagreement, the 45.2% agreed doctors should be entitled to make conscientious objection, the 40.6% disagreed and the 14.2% was unsure.

Students were also asked if they would object to eleven practices presented to them (practices like abortion for congenital abnormalities, abortion for a raped minor, prescription of birth control, examining a patient intoxicated with alcohol or a patient of the opposite sex etc.) and why they would object. The 19.7% of the objections considered in this study were due to religious reasons, the 44.1% were related to non religious reasons and the 36.2% to both religious and non religious reasons. Muslim Students were more likely to report religious objections ( 28.4%), followed by protestant students (27%) and then Roman Catholic students (23.1%). But there are other interesting data that we need to take into account, as for instance the highest percentage of students in favour of conscientious objections are Muslims (76.2%), followed by Jewish students (54.5%), Protestants (51.2%) and Roman Catholics (46.3%). The 53.0% of students following other religions resulted to be in favour of conscientious objection, but “just” the 35.5% of atheists or non religious students declared to be in favour of conscientious objection.

A special attention was paid to Muslim students, among who the percentage of people in favour of conscientious objection is considerably high. For instance, the study shows that the 72.6% among Muslim students have some kind of objection to perform an abortion for congenital abnormalities after 24 weeks and the 45.2% declared they would not indeed perform this kind of intervention under the above mentioned circumstances. Moreover, the 73% among Muslim students reported an objection to the practice of abortion for failed contraception before 24 weeks and the 60.3% would not perform this procedure if required to do so .

The researcher, Sophie LM Strickland, probably paid more attention to Muslim students in the light of some episodes she mentions later in the article like students refusing to attend lectures on alcohol related diseases or refusing to carry out examination of an opposite sex patient.So, although this study claims that not all objections are based on religious reasons, the percentage of medical students in favour of conscientious objection is the highest among Muslim student and the lowest among non religious or atheist students. Still, the percentage of conscientious objectors among non religious/atheist students is impressively high.Conscientious objection in the medical context is not bad per se, but it can bring bad consequences for the patients, as it imposes them the burden to wait for longer in order to get the required treatment. If we take into account the case of emergency contraceptive we can clearly see how time is sometimes of essence. Women who want to use a morning after pill need to find a willing doctor within 12 hours from the intercourse, otherwise the pill becomes less effective, up to the point that it is completely useless (after 72 hours).

The number of controversial practices, far from being limited to the eleven cases taken into account in this survey, is potentially infinite. Different doctors (or medical practitioners in general) can object to many different practices, putting at risk the wellbeing of the patients they are supposed to take care of.

But even if we just think of conscientious objection to abortion, leaving aside blood transfusions or other emergency treatments, it is pretty evident that a high percentage of conscientious objectors will not bring any benefit to patients and will undermine the efficiency of a public health system. Abortions in European countries are now safe, but just because they are practiced in hospitals with high hygienic standards and by expert practitioners. When the percentage of conscientious objectors is too high, though, women are more keen on looking at back street abortion, exposing themselves to the danger of septicaemia and other infections which can bring to death.

Studies like this one show it is urgent to think of some counter-measures to solve the issue of conscientious objectors in medicine. We need to know, for instance, if the Muslim future doctors who refuse to visit patients of opposite sex would leave aside their religious concerns when the life of the patient is at risk, or when it would take too much time and/or trouble to find a willing colleague. And would conscientious objectors agree to find a willing doctor performing what they refuse to perform, or they would leave the burden of the research to their patients?

But we especially need to understand if it is really worth it to train in medicine people who will never perform all the beneficial, legal and safe treatments our hospital offer to the patients. What is the point of investing public money and resources to provide a degree in medicine for people who put their moral or religious concerns before the wellbeing of the people they are supposed to cure? Are we sure we want to put at risk our right to be cured just because we want to safeguard doctors’ right to conscientious objection? Maybe we should stop hiring doctors who make conscientious objections in favour of the ones who are able to leave aside their moral concerns. And maybe we should discourage students to pursuit a career in medicine if they cannot put their patients before their own moral or religious beliefs.

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2 Responses to What is the point of being a doctor when conscience overrules professional duties?

  • Theo says:

    Thank you for the article Francesca. I confess I had a completely different idea of conscientious objection, and I think the examples you mentioned aren't even allowed in my country.

    For us, denying to serve the army or carrying out certain lab procedures during one's med study is allowed, although only under consistent justification and sometimes with a minucious analysis of the objectors life – it's not an easy thing. Now, what you say is that a hired doctor can deny do to his work if it goes against his beliefs – in other words, that a doctor can deny to heal patients if this goes against his beliefs.

    Besides the problems you raised, there is one more I'd like to add: once you become a doctor, you swear the Hyppocractic oath; as a soldier, you swear an oath of obeying orders from your superiors. By having willingly done so, you allow your duty to override your beliefs when they are in conflict.

    Therefore the problem is: are conscientious objections still valid in these cases? Returning to the second paragraph, I mean: the doctor declared and sworn he would heal patients whenever possible. How can he consistently and legally object to do so?

    Naturally, the whole notion of conscientious objection could be transferred to other disciplines, which would make apparent how ridiculous the idea can be. It'd be possible to see historians refusing to talk about the cruzades, physics professors refusing to lecture on the origins of the universe, biologists about evolution, musicians about "lesser-music", mcdonald's workers refusing to sell unhealthy food, and so on.

    But, as usual, I believe that a clear separation of one's duties from one's beliefs (in other words: State and religion) would solve a lot of problems.

    • Khalid Jan says:

      What does the Hyppocractic oath mean in our age and time? If followed to the letter, the doctors who take the oath should be practicing medicine for free. Hitler's general Erwin Rommel, burned Hitler’s written order "that all allied soldiers found behind German lines be killed" (Paul Christopher, The Ethics of War and Peace, p. 90). Rommel was a soldier; he was supposed to follow the orders of his superior. But he refused because it was the wrong thing to do. Say, for example, sometime in future, the WHO and numerous medical associations proposes that anyone diagnosed with cancer should commit suicide by way of a lethal injection instead of opting for treatment. How would a religious and an atheist medical doctor deal with such circumstances? No one can say it cannot happen: one need to look at the current economic meltdown in various European countries. Rules are good as long as there is prosperity. The moment prosperity vanishes, the survival instinct kicks-in. The able will save themselves, and the disabled will get the lethal shot.

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