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What happens when we disagree with our patient

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You probably remember from your own uni days, medical students don’t always agree with patients, either. Sometimes, a patient’s wishes conflict with our nascent medical judgement, our personal conscience, or both.

The latter conflict was considered at AMSA’s recent Council Meeting, where we adopted the Conscientious Objection and Access to Care Policy (2013), available at www.amsa.org.au.

AMSA’s policy recognises that doctors have a right to exercise a “conscientious objection”, and are free to refuse to provide any non-emergency services to which they conscientiously object. However, patients rely on us to provide impartial information so that they may make an informed choice as to which option is best for them. Exercising a personal objection must not infringe the patient’s right to be provided with information about, and access to, all available management options.

AMSA believes that denying or impeding access to such information is contrary to the Medical Board of Australia’s Code of Conduct and is, in any case, inappropriate.

This is a hot topic because of a piece of draft legislation currently before the Tasmanian Parliament, and because of a decision by a Melbourne GP that is being investigated by the Medical Board.

Clause 7 of the Reproductive Health (Access to Terminations) Bill 2013 (Tas) says that, “…if a woman seeks a termination or pregnancy options advice from a medical practitioner and the practitioner has a conscientious objection to terminations, the practitioner must refer the woman to another medical practitioner who the first-mentioned practitioner reasonably believes does not have a conscientious objection to terminations.”

AMSA supports this subclause, but the AMA does not.

Another disputed area pertains to the word “refer”.

In the case of having a conscientious objection, some doctors do not want to write a formal medical referral to a colleague.

AMSA believes that the clause notes allay this concern: “It will be up to the medical practitioner and counsellor to decide how to refer – neither will be obliged by this clause to write a written referral detailing the patient’s medical history as one might do with a referral to a specialist – instead it will be sufficient if the woman is provided with the name and contact details of an alternative provider who does not have a conscientious objection.”

It is pertinent that the referral is to another practitioner who the first practitioner knows does not have a conscientious objection. This aims to ensure the patient receives timely and accurate information on any procedure he or she may desire.

In major cities it would hopefully be possible to go directly to such a person, but in regional areas with few GPs, placing such an obligation on all practitioners may make a big difference to patients.

Section 8 of the Abortion Law Reform Act 2008 (Vic) imposes similar requirements on doctors as the aforementioned Tasmanian Bill.

Even though a doctor may disagree with abortion, for example when an abortion is requested because of the fetus’s gender, a refusal to refer may constitute a breach of the Act. AMA (Victoria) has suggested that to prevent this problem, doctors with conscientious objections place a tactful notice in the waiting room and on their website. It is important to remember that providing a referral to a colleague who is willing to discuss all available options does not necessarily mean a woman will persist with her initial request for an abortion.

AMSA believes that a doctor should have a right of conscientious objection. AMSA also believes that the exercise of an objection must not, directly or indirectly, impede a patient’s access to care. Where a course of management for a patient is legal, any doctor who holds a conscientious objection to the provision of such management should declare their objection to their patient, and provide an effective referral to another health practitioner who does not hold such an objection.

AMSA supports clause 7 of the Tasmanian Bill and section 8 of the Victorian Act, and would be grateful for the AMA to join us. Let’s make it simple: be impartial, or refer.

Benjamin Veness is the president of the Australian Medical Students’ Association and is studying medicine and a Master of Public Health at The University of Sydney. Follow on Twitter @venessb and @yourAMSA