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Controversial guidelines for UK doctors


by Michael Cook | 20 Apr 2012 | 5:58:32 PM


http://www.bioedge.org/index.php/bioethics/bioethics_article/10026


http://www.gmc-uk.org/Draft_explanatory_guidance___Personal_beliefs.pdf_48499491.pdf   Related item


The General Medical Council, the UK body which registers and disciplines doctors, is proposing controversial amendments to its guidelines for good patient care. A proposed draft, released this week, declares that doctors may not even refuse requests for sex-change surgery.

The new guidelines stipulate that unless conscientious objectors are protected by law – British doctors have the right to refuse to participate in abortions – they may not refuse access to "appropriate" services or cause "distress" to patients. "We expect doctors to be prepared to set aside their personal beliefs so they can provide effective patient care in line with Good Medical Practice," says the GMC.

This is the correct approach. It is completely unacceptable for Drs and other medical professionals to allow their personal feelings interfere with their practice. That other anomalies exist is not a reason to add more.

Medicine must be free of dogma, political, religious or otherwise. The only criteria must be the welfare of the patient.

No doubt these people will drag up other example they claim go against that principal. I doubt they will have any more validity than this one. But the counter must be the same, existing anomalies don't justify adding more.

Quote from: spacial on April 23, 2012, 05:42:59 PM
This is the correct approach. It is completely unacceptable for Drs and other medical professionals to allow their personal feelings interfere with their practice. That other anomalies exist is not a reason to add more.

Medicine must be free of dogma, political, religious or otherwise. The only criteria must be the welfare of the patient.

No doubt these people will drag up other example they claim go against that principal. I doubt they will have any more validity than this one. But the counter must be the same, existing anomalies don't justify adding more.

"Freedom of conscience" is an inviolable natural right.  James Madison called it the "first civil liberty."  One must not coerce or force another to do something that violates their most fundamental beliefs.  Humans are not machines; they have a free will, and if a doctor, or other medical professional, chooses to not give or preform a service based on  principle, it must be respected.

I feel like if your personal beliefs prevent you from doing your job properly, then you shouldn't have that job.

As an example, a young woman from Georgia was removed as a counselor-in-training at her college last year because she refused to work with LGBT patients, saying that accepting their "lifestyles" went against her religious beliefs. The American Psychological Association stood behind the school's decision (and the woman's court case was thrown out) because their ethical guidelines for all counselors mandate that practitioners not allow their personal beliefs to interfere with treating their patients.

A person can exercise their "freedom of conscience" just finewhen they aren't on the clock.

Quote from: Butterflyhugs on April 26, 2012, 03:30:06 AM
I feel like if your personal beliefs prevent you from doing your job properly, then you shouldn't have that job.

As an example, a young woman from Georgia was removed as a counselor-in-training at her college last year because she refused to work with LGBT patients, saying that accepting their "lifestyles" went against her religious beliefs. The American Psychological Association stood behind the school's decision (and the woman's court case was thrown out) because their ethical guidelines for all counselors mandate that practitioners not allow their personal beliefs to interfere with treating their patients.

A person can exercise their "freedom of conscience" just fine when they aren't on the clock.

From the linked article:

"The problem is that 21st century British medicine now involves practices which many doctors regard as unethical. This latest guidance by the GMC [General Medical Council] will therefore be seen by a many as a further attack on the right to practise independently in accordance with one's conscience which lies at the heart of being a true health professional. I suspect it will also further undermine the credibility of the GMC."

By forcing physicians to perform a procedure they consider unethical, you violate their rights.  Oregon, for instance, has a euthanasia law.  Should physicians be forced to provide suicide-on-request, even if it conflicts with the fundamental principle of primum non nocere?

If a practice or procedure is in enough demand, there will always be a provider, without coercing the unwilling.

QuoteIf a practice or procedure is in enough demand, there will always be a provider, with coercing the unwilling.

That's nowhere near true, especially when you consider the difficulties that low-income people have with getting around in places without extensive and affordable public transportation systems (think rural America).

If you can't count on your local doctor to take care of your medical needs, but also can't get anywhere else...what's left?

Sorry, my post should have read "without coercing the unwilling."  I think you understood my meaning.

Doctors are not automatons.  They, like all humans, have free will.  Should they check their ethics at the door?  They did that in Nazi Germany, Soviet Russia, Tuskegee, and militarist Japan.

The issue is whether a physician should be forced into providing a service the s/he thinks unwise, unwarranted, or unethical, because the patient/client wants it or the government mandates it.  That is a very slippery slope.

Your example of rural America is not really apropos.  There are plenty of "country doctors" who will not perform certain procedures because they are ill-equipped to do so - they refer their patients to "the city."

Quote from: Jamie D on April 26, 2012, 04:36:38 AM
Doctors are not automatons.  They, like all humans, have free will.  Should they check their ethics at the door?  They did that in Nazi Germany

http://en.wikipedia.org/wiki/Godwin's_law

I appreciate your passion for the subject, butterflyhugs, but the historic examples of medical atrocities and the lack of medical ethics are very real.  Some would say, unconscionable.

I am a civil libertarian, and believe that coercion by a government, or civil society, is wrong.

And I believe that if you don't agree with "21st century British medicine," then you shouldn't be a 21st century British medical doctor 

Sorry Jamie D you're dead wrong.

The freedom of choice is when they took the job. If they don't like it, they don't take the job.

As for certain instances, where procedures are controversial, a special dispensation is sometimes granted to allow a Dr to not be involved.

But that doesn't mean any Dr can pick and choose which procedures he will or won't do. The dispensation is decided by others.

Incidently. the implication report is that sex change surgery must be done on demand. That is not the case at all. The principal is that the patient must be considered for srs on request. The Dr may not simply dismiss the patient because he doesn't agree with the procedure.

Quote from: spacial on April 26, 2012, 04:03:03 PM
Sorry Jamie D you're dead wrong.

The freedom of choice is when they took the job. If they don't like it, they don't take the job.

As for certain instances, where procedures are controversial, a special dispensation is sometimes granted to allow a Dr to not be involved.

But that doesn't mean any Dr can pick and choose which procedures he will or won't do. The dispensation is decided by others.

Incidently. the implication report is that sex change surgery must be done on demand. That is not the case at all. The principal is that the patient must be considered for srs on request. The Dr may not simply dismiss the patient because he doesn't agree with the procedure.

I respectfully disagree.

Lawyers can turn down a case.
Accountants can turn down a case.
Businessmen or businesswomen case refuse service or do business with potential customers.

They all have the freedom of choice to accept or decline business based on their business ethics.  It must not be any different for doctors.

Quote from: Jamie D on April 27, 2012, 06:12:15 PM
I respectfully disagree.

Lawyers can turn down a case.
Accountants can turn down a case.
Businessmen or businesswomen case refuse service or do business with potential customers.

They all have the freedom of choice to accept or decline business based on their business ethics.  It must not be any different for doctors.

Not the same thing at all.

But in any case, your personal point of view would seem to be irrelevant.

Quote from: spacial on April 27, 2012, 06:32:53 PM
Not the same thing at all.

But in any case, your personal point of view would seem to be irrelevant.

It seems my "personal point of view" is what the draft suggests

52. You must explain to patients if you have a conscientious objection to a particular procedure while following the guidance in paragraph 54. You must tell them of their right to see another doctor and make sure they have enough information to exercise that right. If it is not practical for a patient to arrange to see another doctor, you must ensure that arrangements are made for another suitably qualified colleague to take....

4. However, in many cases, there is no law that specifies patients' or doctors' rights in relation to individual procedures. In these cases doctors should be free to practise medicine in accordance with their beliefs, provided that in doing so they are not denying patients access to appropriate medical treatment or services, or causing distress to patients.

5. You may choose to opt out of providing a particular procedure because of your personal beliefs and values. But you must not refuse to treat a particular patient, or group of patients because of your personal beliefs or views about them.

The Christian Institute



Job fears for doctors who object to providing sex change ops


Fri, 27 Apr 2012

http://www.christian.org.uk/news/job-fears-for-doctors-who-object-to-providing-sex-change-ops/


Doctors who refuse to provide 'sex change' operations could be struck off, under new General Medical Council (GMC) draft guidance.

Doctors could also breach the guidance if they are unwilling to prescribe contraception to an unmarried person but willing to prescribe it to a married person.

The guidance, 'Personal beliefs and medical practice', was issued by the GMC last Thursday and is subject to consultation.







Doctors 'forced to carry out sex-change ops' under rules meant to 'marginalise Christian medics'


By Daily Mail Reporter | PUBLISHED: 19:53 EST, 21 April 2012 | UPDATED: 19:58 EST, 21 April 2012


http://www.dailymail.co.uk/news/article-2133366/Doctors-forced-carry-sex-change-ops-rules-meant-marginalise-Christian-medics.html


Christian doctors have criticised a new ruling that they claim will force them to carry out sex-change operations against their will.

Under new guidelines drawn up by the General Medical Council, they will no longer be able to refuse to perform the operations on the grounds that they are against their religious beliefs.

Until now, section five of the GMC code said: 'You may choose to opt out of providing a particular procedure because of your personal beliefs and values.'







Doctors "forced to carry out sex change ops", says the Daily Mail


Retrieved from the Internet on April 29, 2012 by SJ


http://www.complicity.co.uk/blog/2012/04/forced-to-carry-out-sex-changes/


I'm coming a couple of days late to this as the Daily Mail thoughtlessly published their piece whilst I was offline at the weekend, but it's still worth a blog post to clarify the issues. According to an article they've run, (Caution: Daily Mail Link) Doctors are being "forced to carry out sex change ops" under "new guidelines" by the General Medical Council. (GMC)

(Edited to add: The GMC guidance is available on their web site. (PDF Link). The relevant piece is the footnote to paragraph 5 on page 3)

More utter rubbish from the Mail.

Support for gender problems is simply not to be included with abortions as a matter of conscience to GPs. There is nothing to stop any GP from refusing to treat any condition and referring the patient to someone else. As in fact, they must do with abortions!

How anyone can claim that such support form GP could be a matter for their conscience has yet to be indicated.

The Mail's headline reads: Doctors 'forced to carry out sex-change ops' under rules meant to 'marginalise Christian medics'

Total garbage. the only Dr to do such operations would be specialists in specialist clinics.

So, a surgeon takes a job as a surgeon, providing SRS, in a clinic set up to provide SRS, then suddenly find the American god and decides he isn't going to work!

Yeah right!

Quote from: Jamie D on April 27, 2012, 08:54:26 PM
It seems my "personal point of view" is what the draft suggests

52. You must explain to patients if you have a conscientious objection to a particular procedure while following the guidance in paragraph 54. You must tell them of their right to see another doctor and make sure they have enough information to exercise that right. If it is not practical for a patient to arrange to see another doctor, you must ensure that arrangements are made for another suitably qualified colleague to take....

4. However, in many cases, there is no law that specifies patients' or doctors' rights in relation to individual procedures. In these cases doctors should be free to practise medicine in accordance with their beliefs, provided that in doing so they are not denying patients access to appropriate medical treatment or services, or causing distress to patients.

5. You may choose to opt out of providing a particular procedure because of your personal beliefs and values. But you must not refuse to treat a particular patient, or group of patients because of your personal beliefs or views about them.

;

If you read the caviats to that last paragraph:

Quote5 You may choose to opt out of providing a
particular procedure because of your personal
beliefs and values.* But you must not refuse to
treat a particular patient, or group of patients
because of your personal beliefs or views about
them†. And you must not refuse to treat the
health consequences of lifestyle choices to
which you object because of your beliefs.

Quote* The exception to this is gender reassignment since this procedure is only sought by a particular group of patients (and
cannot therefore be subject to a conscientious objection – see paragraph 5). This position is supported by the Equality
Act 2010 which prohibits discrimination on the grounds of gender reassignment.

† The Equality Act 2010 prohibits discrimination on the grounds of nine protected characteristics: age, disability,
gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual
orientation.

If I'm reading that right, it means doctors cannot opt out of providing SRS because of the nature of the procedure. It would seem to suggest that an objection to the method of treatment itself is different to an objection to the people who seek it. And since only a certain group of people seek it, it is discrimination against those people.

Like... hmm... if you opt out of abortion because you believe abortion itself is wrong and all life is sacred, then that's different to refusing to provide that service to someone because they got themselves pregnant in a way you object to, like out of wedlock or whatever.

It strikes me as slightly odd since performing SRS isn't something that all doctors are able to do. And having an objection to something you deliberately chose to specialise in seems a bit strange. The only thing I can think is that this refers to doctors putting patients forward for SRS rather than carrying out the procedure themselves.

It strikes me as slightly odd since performing SRS isn't something that all doctors are able to do.

Correct

Quote from: SephirahThe only thing I can think is that this refers to doctors putting patients forward for SRS rather than carrying out the procedure themselves.

From the 3rd article there:

QuoteFirstly, these are very specialised surgeries and you can't just rock up to an operating theatre and carry one out without quite a bit of training and it's not an area one accidentally stumbles into.
...

The idea of being "forced" to carry out such an operation is ludicrous. The guidelines are there simply to prevent GPs from blocking patients who want to access these services, not push people into specialisations they don't want to pursue.

That seems reasonable to me, as it's attempting to counter much of what is wrong with the "gatekeeper" model. That Daily Mail article is way off base.