The Medical Ethics Alliance is a coalition of six World Faiths and Hippocratic medical and nursing bodies. It seeks to inform and initiate discussion within and without the profession where ethical matters are involved. We have studied the draft which we find broadly helpful, but would wish to make a few general observations.
1 The medical profession is reflective of society as a whole and has many doctors of different religious and cultural backgrounds and doctors are in a close contact with vulnerable patients at important times of their lives. In this we agree that they must fully respect the beliefs and values of all patients. We therefore endorse the core guidance given in Good Medical Practice.
2 Many doctors draw inspiration from the from their own faith background and values. These make them what they are and cannot be separated from their professional lives. In the multi national and multi faith profession that we enjoy today this represents a positive contribution to the welfare of patients. It is also likely to provide doctors with one of the motivations in their professional lives.
3 There is, furthermore, a strong residual Hippocratic tradition shared by doctors of all faiths and none, whether born here or coming into this country, which we think the draft draws upon but does not directly acknowledge. Nevertheless, that ethic has been weakened by legislation, most noticeably with regard to the status of unborn human life.
4 We have good reason to think that, not withstanding the conscience clause in the Abortion Act 1967, those with a conscientious objection to abortion have difficulty in making a career in obstetrics and gyaenocology. This is particularly the case when seeking training posts. Difficulties are put in the way of applicants both by employing authorities and senior colleagues.
5 In your draft document at 21 this is dealt with but does not realistically address the position of junior doctors . In practise, we think many potentially good trainees are excluded. Given the wide nature of modern obstetrics and gynaecology, we think there is scope for those with alternative interests such as oncology and urology who could make a considerable contribution and should not be involved in abortion. We would welcome a stronger statement from the GMC addressing this point.
6 Junior Doctors may find themselves unable to carry out certain treatment plans.This may arise in many different specialities from geriatrics to psychiatry. Furthermore, these dilemas may not be foreseeable when appointed. In these circumstances the only course of action open to the junior doctor is to inform the senior doctor managing the patient and withdraw from treatment. It then falls to the senior doctor to find another doctor. It would not be appropriate for the doctor who does not carry the ultimate responsibility for treatment to find another doctor. We are aware of difficulties created for anaesthetists, for example, who are asked to treat a woman undergoing an abortion in the middle of an otherwise routine list or where tube feeding is being withdrawn from a patient who is not dying.
7 Many patients approach their doctors with religious and cultural values that may not be familiar to many doctors. In this regard women doctors of similar cultural background may be sought by patients. This is a positive contribution to the welfare of patients, and whilst not wishing to segregate medical practice, a recognition of this in the draft would be helpful. For example women of Muslim background may wish to be treated by women gyaenocologists.
We broadly welcome and support the core guidance. With regard to specific recommendations, we would like the GMC to address the problem of junior doctor training in obstetrics and gynaecology more realistically.
In general, we would welcome more recognition that doctors from a variety of faith and cultural backgrounds may have a contribution to make to the care and comfort of patients in a multi cultural society.
Even though the GMC must make recommendations in the particular legal environment of our society, we would prefer to see some more explicit reference to the ethical code that has been traditionally characteristic of medicine and which is still strongly held by many members of the profession, whether born in this country or entering from abroad where such traditions are still strongly held.