The World Medical Association is revising the International Code of Medical Ethics (ICoME) to limit the scope of conscientious objection.
According to a WMA press release, “Workgroup members and observers representing more than 15 countries have reviewed the document carefully to determine what might be missing from the ICoME, what might be superfluous, what could potentially be organised differently”.
The principal change would be to make referral a duty for a doctor who has a conscientious objection. The current code says:
Physicians have an ethical obligation to minimise disruption to patient care. Conscientious objection must only be considered if the individual patient is not discriminated against or disadvantaged, the patient’s health is not endangered, and undelayed continuity of care is ensured.
The proposal is to add a short but significant clause:
[… is ensured] through effective and timely referral to another qualified physician.
Obviously, this would force doctors who object to legal abortion and legal euthanasia to refer patients to a more compliant doctor.
Professor David Albert Jones, of the UK’s Anscombe Bioethics Centre, at Oxford, has commented that this is “deeply problematic”:
In the first place it utterly fails to establish the duty of doctors to object to practices and procedures that are unconscionable because harmful, discriminatory, unjust or unethical. The right to conscientious objection is based on the duty to be conscientious which is fundamental to medical ethics. In the second place, “conscientious objection” is presented as conflicting with “patient care”. This overlooks the fact that there can be no adequate patient care without conscientious healthcare professionals.
He suggests in a press release that “effective referral” simply will not work as an ethical standard:
if a doctor objects in conscience to participation in torture or capital punishment or to force feeding of a prisoner who is on hunger strike, it would be unprincipled for them to find someone with fewer scruples to do the deed for them. To require a conscientious objector to facilitate delivery of the procedure to which they object is a direct attack on person’s conscience and moral integrity, and thus a serious harm to them. It would be much better to say nothing about conscientious objection than to undermine it by imposing a requirement for “effective and timely referral”.
Michael Cook is editor of BioEdge
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