Conscience-based medicine: is it warranted?
The right of doctors to practise conscience-based medicine is debated by two doctors in the 7 November issue of The Medical Journal of Australia.
Paediatrician Dr Brian Conway believes that doctors should be able to practise in accordance with their conscience. He said that this enables healthy diversity and is the ultimate safeguard for patients.
“Conscience-based medicine is practised with concern for patient wellbeing, recognising patients’ dignity and worth,” he said.
Dr Conway describes a scenario involving a child with cancer on the edge of death in hospital: the child’s parents secure a court order to enforce their wishes that everything be done to revive their daughter, while the medical team believe this would force them to participate in child abuse and deprive the child of a peaceful death.
“Parents’ wishes are normally a good guide to their child’s needs and best interests but, in this case, the treating team may be best placed to identify better options,” Dr Conway said.
“Conscience may guide the doctor to refuse a particular request, such as this resuscitation,” he said.
“The state legal mechanism fails the dying girl because it does not acknowledge her need for conscientious care by her clinicians.”
In an opposing view, ethicist Professor Julian Savulescu said the place to decide what kinds of values should govern public institutions and practices was in a public forum, not by the bedside.
“Only a fully justified and publicly accepted set of objective values results in ethical medicine as a proper public service with agreed and justified moral and legal standards to which doctors should be held,” Professor Savulescu said.
“. . . deciding what a patient’s best interests are requires input of the patient’s values, but is not determined entirely by them. It is partly, but importantly, an objective judgement,” he said.
He said people should be free to live according to mistaken values or religious values.
“But they should not have the liberty to coerce, directly or indirectly, other people to live according to their own values, even if they are medical professionals.”
The Medical Journal of Australia is a publication of the Australian Medical Association.
The statements or opinions that are expressed in the MJA reflect the views of the authors and do not represent the official policy of the AMA unless that is so stated.
CONTACTS: Dr Brian Conway 0410 476 764 / 08 8161 7000
Professor Julian Savulescu 0011 44 7525 758 878 (morning UK time)
