In its response to the consultation on the guidance, the BMA has urged the GMC to think again and work with the Association to develop guidance that protects both doctors and patients.
It is widely accepted that doctors can conscientiously object to a limited number of procedures that have traditionally surrounded life and death issues, for example referring women for and carrying out abortions (unless there is a medical emergency and the woman's life is at risk), providing contraceptive services and withdrawing life-prolonging treatment.
However, under current GMC rules, doctors who conscientiously object to these procedures have an obligation to explain to patients how to see another doctor who would be willing to help them or, if necessary, to refer patients on to such a doctor. The new draft GMC advice appears to extend the right of conscientious objection to any procedure with which doctors have a moral, cultural or religious disagreement. The BMA considers that the rights of doctors to opt out of some procedures have to be balanced with the rights of patients not to suffer discrimination and so would like to see a limited list of clearly defined procedures to which doctors can conscientiously object. Otherwise, patients refused treatment may be confused about whether the doctor feels it is not clinically right for that patient or objects to the treatment or to the patient's lifestyle or simply that it is unavailable on the NHS.
The BMA also believes that medical students should not be able to opt out of learning about procedures which are part of their core curriculum and to which they have a conscientious objection. The BMA is concerned by anecdotal reports of medical students claiming conscientious objection to learning about the moral arguments surrounding abortion and the clinical impact of alcohol. GMC guidance on personal beliefs and medical practice should make it clear that such objections are not acceptable.
Chairman of the BMA's Medical Ethics Committee, Dr Tony Calland, said today:
"Doctors are not there to judge patients but to treat them. It would not be appropriate or ethical for a doctor to refuse to help a patient because their own personal beliefs were in conflict with how an individual patient led their life.
"This guidance is confusing and inconsistent and will not benefit doctors or patients. On the one hand doctors are being advised not to discriminate on the basis of their personal beliefs regarding a patient's gender, sexual orientation or race, but on the other hand the guidance seems to give doctors a mandate to opt out of ANY procedure to which they have an ethical objection. The BMA is extremely concerned about how far these objections could extend. For example, could a doctor refuse to refer a lesbian couple for fertility treatment, refuse to carry out a sexual health test on a homosexual or object to treat a Jehovah's Witness who has refused a blood transfusion?"
The BMA's Medical Ethics Committee (MEC) believes that patients should be notified in advance if doctors conscientiously object to the limited number of procedures from which they can opt out. For example the MEC suggests that good practice would be for GPs to state if they object to abortion in their practice leaflets.