Doctors must display posters or give out information leaflets detailing any ethical objections they hold on abortion or other contentious medical issues under new guidelines published today by the medical regulator.

The General Medical Council’s recommendations state that all hospital doctors and GPs must set out explicitly any views that may colour their approach to legal treatments.

The guidance has been drawn up amid growing concerns about the possibility of a doctor’s personal beliefs conflicting with a treatment he or she is duty-bound to provide. This would include issues such as carrying out abortions in the later stages of the 24-week pregnancy limit permitted by law.

The document, Personal Beliefs and Medical Practice, states that doctors must be “open with patients – both in person and in printed materials such as practice leaflets – about any treatments they do not provide or arrange because of a conscientious objection but which are not otherwise prohibited”.

They must also set aside their own beliefs where a patient wishes it, or directly refer the patient to another doctor who does not hold the same objections.

While the guidance is set out as advice by the GMC, it stipulates: “Serious or persistent failure to follow this guidance will put your [medical] registration at risk.”

According to the GMC, referring patients for a termination is one of several moral dilemmas leading to growing concern from doctors about how they marry their personal beliefs with their professional practice. One recent survey of GPs, for the medical magazine Pulse, suggested that as many as one in four refuses to refer patients for terminations.

Doctors and patients are raising ethical concerns with the GMC at the rate of more than one a week, up 50 per cent on a year ago. Sensitive issues include abortion, cremations, nontherapeutic circumcision, contraception and the rights of Muslim doctors to wear the hijab (headscarf) or niqab (facial veil).

The Medical Defence Union said that it, too, was fielding a growing number of concerns. Recent examples have included a GP with moral objections to abortion and a hospital doctor who sought advice about a colleague thought to be trying to influence elderly patients with his religious beliefs.

Other provisions in the guidance include the right of Jehovah’s Witnesses to refuse blood transfusions. The GMC insists that no patient should be discriminated against on grounds of gender, race, sexuality or social class.

Abortion, in particular, has been at the forefront of ethical concerns, particularly from Roman Catholic and Muslim doctors. Many doctors have also said they disagree with government plans to allow them to carry out medical abortions in their surgeries. The idea is being tested in NHS pilot schemes.

The guidance could also affect Roman Catholics who fail to offer scans for pregnant women because they involve a risk of miscarriage. Other possible objections from doctors could include referrals for gender reassignment surgery, offering fertility treatments to lesbian couples or unmarried mothers, or even cosmetic surgery procedures.

The GMC guidance warns doctors and medical students: “You have an overriding duty to provide care for patients who are in need of medical treatment, whatever the cause of that medical need. It is not acceptable to seek to opt out of treating a particular patient or group of patients because of your personal views about them.”

Catholic and Muslim doctors said they feared a “brutal” interpretation of the new advice that would not respect doctors’ rights to freedom of conscience or religion.

David Jones, a Roman Catholic professor of bioethics at St Mary’s University College, London, said that doctors with a strong objection to abortion may feel like “an accessory to murder” if they directly referred patients to other doctors for the procedure, as the GMC suggests. “How this guidance will be implememented is crucial,” he said.

Jafer Qureshi, a co-founder of the Islamic Medical Ethics Forum, which advises Muslim doctors on issues including medical euthanasia and organ transplantation, added that medical students had recently complained about a “climate of intolerance” to their beliefs.

The GMC consulted 2,000 people within medical and religious organisations for the recommendations, which expand and update existing guidelines on best practice.

Care vs conscientious objection

GMC guidelines on doctors’ beliefs include

— You must not allow any personal views about patients to prejudice your assessment of their clinical needs, [including] patient’s age, culture, disability, gender, lifestyle, marital status, race, religion, sexual orientation, or economic status

— You should not normally discuss your personal beliefs with patients unless those beliefs are directly relevant to their care

— Patients may ask you to perform, advise on, or refer them for a treatment...to which you have a conscientious objection. In such cases you must tell patients of their right to see another doctor

— You must be open with patients – both in person and in printed materials such as practice leaflets – about any treatments or procedures which you choose not to provide or arrange because of a conscientious objection, but which are not otherwise prohibited

— If your post involves arranging treatment or carrying out procedures to which you object, you should explain your concerns to your employer or contracting body

— It is not acceptable to seek to opt out of treating a patient or group of patients because of your personal beliefs or views about them

Source: General Medical Council

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