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17 Aug 2018

BY DR CHRIS MOY, CHAIR, AMA ETHICS COMMITTEE

The AMA’s Ethics and Medico-Legal Committee is undertaking a routine, five-year review of the AMA’s Position Statement on Conscientious Objection 2013. While the definition of a conscientious objection is itself being reviewed, the current Position Statement states that it occurs when a doctor refuses to provide, or participate in, a legal, legitimate treatment or procedure because it conflicts with his or her own personal beliefs and values. A conscientious objection is based on sincerely held beliefs and moral concerns, not self-interest or discrimination.

The issue of conscientious objection is increasingly relevant for the medical profession, particularly in terms of legislation related to abortion, as well as the emerging area of voluntary assisted dying. Relevant legislation generally recognises that doctors have a right not to provide a treatment or procedure to which they conscientiously object; however, the area of contention largely lies in whether or not a doctor invoking a conscientious objection must refer the patient to another practitioner.

In relation to abortion, some States mandate such a referral (such as Victoria), while others do not. Interestingly, while the state of Victoria mandates referral in terms of abortion, it does not do so in terms of the new voluntary assisted dying legislation.

The Federal AMA’s current policy does not specifically address the issue of referral. Instead, it says that:

A doctor who makes a conscientious objection to providing, or participating, in certain treatments or procedures should make every effort in a timely manner to minimise the disruption in the delivery of health care and ensuing burden on colleagues. If you hold a conscientious objection, you should inform your patient of your objection, preferably in advance or as soon as practicable and inform your patient that they have the right to see another doctor. You must be satisfied the patient has sufficient information to enable them to exercise that right. You need to take whatever steps are necessary to ensure your patient’s access to care is not impeded.

But does this go far enough to ensure that those patients seeking a legal treatment are not impeded in accessing the care they seek by a doctor with a conscientious objection?

This is a discussion that our Federal Council will have at their meeting in August. Council will consider whether the AMA should support the concept of ‘effective referral’. While the definition of “effective referral” is itself under review, it is sometimes defined as the requirement of a doctor with a conscientious objection to refer a patient in a timely manner to another doctor who the practitioner reasonably believes does not have a conscientious objection to the treatment being sought. Council will also consider issues such as:

  • in what situations is mandating effective referral appropriate, if any? (eg, abortion, contraception, IVF, voluntary assisted dying); and
  • how can doctors working in facilities with institutional conscientious objections assist patients in receiving the care they seek?

Following this initial discussion by Federal Council, the Ethics and Medico-Legal Committee will consult with State and Territory AMA offices to ensure members have the opportunity to provide their views on this very important issue. We will keep members informed of the progress of the review, consultation opportunities, and the policy decision-making process. 

In the meantime, if you have any questions regarding the review of AMA policy on conscientious objection or would like to express your views on this topic, please email ethics@ama.com.au.


Published: 17 Aug 2018