UK doctors and the right to opt out

A survey of medical students has found that almost half believe doctors should be allowed to refuse to perform any procedure to which they object on moral, cultural or religious grounds, such as prescribing contraception or treating someone who is drunk or high on drugs.

Abortion provoked the strongest feelings among the 733 medical students surveyed, according to the study in the Journal of Medical Ethics. “The survey revealed that almost a third of students would not perform an abortion for a congenitally malformed foetus after 24 weeks, a quarter would not perform an abortion for failed contraception before 24 weeks and a fifth would not perform an abortion on a minor who was the victim of rape,” said researcher Dr Sophie Strickland.

In the UK, abortion is allowed up to 24 weeks if two doctors agree that it is medically necessary. (This is, probably deliberately, open to interpretation: one interpretation is that an abortion is medically necessary if a woman wants it. A key part of the reason is that the risk of continuing the pregnancy is greater than the risk of aborting: early abortion is pretty risk-free, and childbirth is more risky.) But if we don’t have enough doctors willing and able to perform abortions, it won’t be properly available.

Also, although the article just skims over it– I’m really shocked to hear there are medical students who want be allowed to refuse to treat a patient who is intoxicated. This isn’t a matter of refusing to perform some particular procedure that the doctor believes to be wrong. That’s hugely problematic, but at least I understand the reasoning. This is a matter of refusing treatment *in general* to someone because they have engaged in legal behaviour.

For more, go here.

12 thoughts on “UK doctors and the right to opt out

  1. I don’t think doctors should be allowed to opt out of providing treatment which is medically necessary (granting the concerns about that phrase), even on grounds of conscience. But I’m pretty sure it’s only abortion they’re allowed to refuse: I don’t think they can currently refuse to treat someone who’s intoxicated.

    I read that article as reporting a survey of medical students on what they think *should* be the case, which is worrying enough, but in fact the person from the GMC said they can’t *at present* refuse to treat people on grounds of drink or drugs. No?

  2. It would be interesting/depressing to find out what medical students would say about different races/ethnicities, disabled children, elderly individuals, etc.

  3. Heg,

    I think the intoxicated refusals do happen. As I understand it, MDs will sometimes refuse to treat intoxicated individuals (in non-emergency situations) because they cannot legally consent. In the story I linked above that was the rationale for not providing a rape kit (the woman was intoxicated and so could not consent to the kit).

    I think these refusals also happen when the MD believes the person is demonstrating “drug seeking behaviors.”

    It is true that intoxication-related refusals are somewhat different than abortion refusals since only the latter are religiously motivate while the former are more about MD self-protection from doing something to the patient without proper consent.

    Also, some doctors have refused treatments to patients who drink, smoke or are too obese.

  4. Over here in the US, we’ve got pharmacists who refuse to fill prescriptions for contraception. Some have even destroyed the paper prescription form rather than let the patient take it to a pharmacist who will fill it.

    At this point, my attitude is “you have the right to do your damn job, which means to fill every prescription you are given unless it is medically inaccurate, or to resign your license and find a job at McDonalds.”

  5. J-Bro, your attitude is understandable and pretty common. The Novel Tech Ethics group is working on the issue of conscientious refusals from a feminist perspective, which I think is pretty interesting. One thing they note that I think is unique to their approach is that conscientious refusals can sometimes serve goals of social justice (their examples are: “refusals by a reproductive endocrinologist to allow oocyte vending to occur at her clinic or not to provide LGBT people with infertility treatments when the unwritten policy of her clinic is to bar these people from it.”). It can be pretty complicated, and one would not want to ban all conscientious refusals…

  6. J-Bro, until fairly recently I don’t think it would have occurred to many people, and certainly not pharmacists themselves, that pharmacists’ “damn job” was to fill every prescription they’re given (unless it’s “medically inaccurate”, however that’s defined). Pharmacists are professionals, not technicians. Consider the substantial autonomy traditional professions (not just pharmacy) have regarding the decision to enter into and discharge specific professional relationships (attorney-client, physician-patient, etc.). Until about 5 minutes ago, culturally speaking, the propriety of that autonomy – not to mention its fundamental relationship to professionalism – was so evident and widely understood that the idea of having to legislate conscience protections for professionals would have seemed bizarre.

    Your suggestion that uppity pharmacists take jobs at McDonald’s actually highlights an underlying misconception: namely, that a pharmacist is already a sort of glorified McDonald’s cashier.

    That said, it’s hard to think of a professional excuse for destroying a lawful paper scrip under the circumstances you mention, but I suspect those cases are very rare.

  7. Doctors have the right to choose who they work on. Hence why they are doctors. As much as i disagree with that sometimes its how it is.

  8. Since this comment thread turned at some point to the topic of pharmacists’ conscience rights, I figured this was as good a place as any to pass along this update:

    A federal court in the State of Washington upheld today the constitutional right of conscientious-objector pharmacists to refuse to dispense emergency contraceptives. Eugene Volokh has the story (and a link to the opinion) here:

Comments are closed.