A heavy drinker facing a teetotal GP will be familiar with that frisson of disappoval – especially since the advent of the blood test betrayed the lies about how many units have been consumed. A woman with an inconvenient pregnancy who asks a Catholic doctor for an abortion will know the same feeling; as will the odd – one uses the word advisedly – Jehovah’s Witness who is admitted to Accident and Emergency and refuses a blood transfusion.

Doctors, for their part, face just as unpleasant an encounter with those patients unable to hide their dislike at being treated by someone who is black, Catholic, Jewish, Muslim, gay, foreign or female.

Never was the irony of this conflict zone better encapsulated than in the case, some years ago, of a member of an exceedingly posh Scottish golf course who had a heart attack. The female doctor who rushed to treat him was initially ejected from the clubhouse because she had used the men-only entrance.

Up until now, though, both patients and professionals have tended to muddle through. And generally patients have become more tolerant – or at least less vocal in their intolerance – than they were.

In all this, doctors have relied on longstanding advice from the General Medical Council (GMC), which requires them to treat patients with respect, whatever their life choices and beliefs. If carrying out a particular procedure conflicts with a doctor’s belief, he or she has been obliged to tell patients this and to make sure they understand that they can see another doctor.

But this simple advice is no longer sufficient in a more complicated world, where religion casts its cloud more darkly than ever. Militancy of belief is increasingly pressing. When airport check-in staff fight to wear a cross, and teachers go to court to wear a veil, we know we live in a challenging world.

In all too many instances, the medical profession is at the sharp end. As if we needed reminding, last week a 53-year-old consultant paediatrician, Victoria Anyetei, was fatally stabbed in her car in her driveway in Dartford. Police are to investigate her patients’ relatives.

The new conflicts in medicine include the signing of cremation certificates; the wearing of the veil; offering IVF to gay patients, circumcision and gender reassignment. Old problems, specifically abortion, have intensifed. (Did you know, for instance, that some doctors now refuse to offer either abortion or contraception, and advertise this fact in leaflets in their practice? Almost like that old pub sign: please do not ask for credit as refusal often offends.)

The GMC, responding to a growing number of pleas for help, has reviewed its practical guidance and been specific for the first time on some issues. The new code has gone out for consultation on www.gmc-uk.org and meaty stuff it is.

Some Muslim doctors, according to the tenets of their faith, are unwilling to sign cremation certificates. On this, the GMC is admirably hardline, declaring that doctors, regardless of their religious objection to cremation, must sign, largely because delay could cause unnecessary distress.

Veils – as worn by doctors, not patients – are another area of contention. The GMC has recently received a considerable number of inquiries from hospital managers and doctors asking for advice on this.

Its view, the result of long internal discussions, is that doctors must respond to a patient’s individual needs and overcome any barrier to effective communication. To do this may require them to set aside personal and cultural preferences. In other words, take it off if it’s an issue for the patient. Cop out or clever solution? There will certainly be patients unable to express their unease, and what of their rights?

The advice on circumcision, which some believe carries risks and should not be permitted on children who cannot consent, is in favour of maintaining the status quo. Doctors should proceed on the basis of the child’s best interests, and this means taking into account religious beliefs.

The guidance on abortions is interesting, given recent suggestions that so many doctors are reluctant to perform abortions that it can be hard to find staff. Under the law, doctors have the express right to refuse to participate in an abortion but equally do not have the right to refuse it on grounds of conscientious objection where a patient needs medical care.

However, the new advice states that conscientious objectors – for all termination, gender and IVF issues – do not have to refer the patient directly to another doctor.

What they have to do is “ensure the patient has sufficient information to exercise their right to see another doctor with whom they can discuss the situation”. It states that the patient “must not be left with nowhere to turn” and if they are not capable of making their own arrangements to see another doctor, the first doctor must do it for them without delay.

Does this satisfy, in an age where conscientious-objector doctors are growing in number? To what degree should a professional be obliged to open the door to a service which they regard as intrinsically wrong, but which is perfectly legal? The GMC hopes it has created a “reasonable” requirement to do so.

And here, I confess, I become impatient with any consultation that tries, essentially, to keep everyone happy and cause offence nowhere. Sometimes “reasonable” can be misleading; and sometimes offence can be healthy. We reach a point where there is a real danger of indulging conscientious objectors – be they members of a religion, or people who believe it is a sin to wear leather shoes, or those who believe IVF babies are wrong. We need to be sure which party has the greater moral right: the one that indulges in strong personal beliefs; or the one which is entitled to a legal, professional service.

For me the latter’s right will always be ascendant. In a consumer, largely secular culture, patients need a doctor who doesn’t want to provide a legal service for personal reasons to refer them immediately, and directly, to a colleague who will.

Anything short of that is to infringe upon the patient’s equally powerful rights and freedoms – and providing “sufficient information to exercise their right” is clearly open to obfuscation and delay. We are in danger, not for the first time, of betraying the majority for the minority.

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