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11 Apr 2019

BY DR CHRIS MOY, CHAIR, AMA ETHICS AND MEDICO-LEGAL COMMITTEE

The AMA has now approved an updated Position Statement on Conscientious Objection 2019 (which replaces the position statement from 2013). In an ethics column I wrote on this issue last August, I informed members that the AMA’s Ethics and Medico-Legal Committee (EMLC) was specifically going to examine whether the AMA should have an explicit policy on ‘effective referral’.

An effective referral is where a doctor with a conscientious objection to participating in a certain treatment or procedure (e.g. abortion, voluntary assisted dying) has an obligation to refer the patient to another doctor who the practitioner reasonably believes does not have a conscientious objection to providing that treatment or procedure. This does not necessarily mean that the other doctor supports the treatment or procedure, but that they have a balanced view and can provide the patient with relevant health care.

However, some doctors consider that an effective referral implies that they must refer the patient to a doctor who would specifically ‘do what they would not do’ – and therefore feel that such a requirement, by extension, effectively compels them to participate in a treatment or procedure to which they conscientiously object.

Among doctors (as well as the wider community), there are wide, and often strong, differences of opinion on whether doctors have a duty to effectively refer a patient in cases of conscientious objection. These were clearly expressed by members when State and Territory AMA offices were consulted to engage their views on whether the AMA should have an explicit policy on effective referral.   

Members had divergent views sometimes dependent on the type and urgency of the treatment being considered, and the general expectations of the medical and wider community in these circumstances. For example, the view that doctors should effectively refer if they conscientiously object to termination of pregnancy was much stronger than that for voluntary assisted dying.

The majority view of AMA State and Territory offices was to retain the current position of not having an explicit policy on effective referral but to continue to emphasise that patient’s access to care should not be impeded.

As such, Federal Council agreed not to move to include an explicit position on effective referral in this Position Statement on conscientious objection because of its overarching nature. They supported the view of several State and Territory AMAs, however, that an explicit position on effective referral may be considered when revising individual, context-specific position statements such as those on reproductive medicine (which includes termination of pregnancy, contraception, surrogacy, IVF, pre-implantation genetic diagnosis) and euthanasia and physician assisted suicide.

On a matter where there are sometimes intense sensitivities with regard to the rights of individual doctors weighed against the potential for patient care to be affected, the tone and emphasis of the statement has shifted. Instead of taking a prescriptive ‘thou shalt not’ approach which might be counterproductive by being confrontational, the Position Statement takes a reflective approach where a doctor is asked to focus on what really should matter the most: the impact of their decisions on the patient in front of them. For example, Paragraph 2.4 of the statement advises the following:

        The impact of a delay in treatment, and whether it might constitute a significant impediment, should be considered by a doctor if they conscientiously object, and is determined by the clinical context, and the urgency of the specific treatment or procedure. For example, termination of pregnancy services are time critical whereas other services require less urgency (such as IVF services).

If you have any questions in relation to the Position Statement on Conscientious Objection 2019, please send them through to ethics@ama.com.au . The Position Statement is accessible on the AMA website at https://ama.com.au/position-statement/conscientious-objection-2019 .

 

 

 

 


Published: 11 Apr 2019