Dr. Michael Wilkes: Conscientious objection

Published: Thursday, Dec. 12, 2013 - 12:00 am

At age 85, Betty has end-stage colon cancer. She’s receiving treatment and at the moment is doing well. However, her life expectancy is far less than one year. This weekend she tripped and fractured her hip. She needed surgery. She had an advanced health care directive that said she didn’t want resuscitation if her heart stopped beating for whatever reason.

However, the orthopedic surgeon who needed to do the surgery didn’t agree with that approach. He refused to do the surgery unless she reversed her advanced directive and allowed them to do CPR – at least until he was done providing his hip care.

Do doctors have the right to refuse to perform certain procedures on their patients on moral or religious grounds, or does their duty to respect their patient’s wishes override personal moral objections? Are doctors allowed to only offer patients treatments or care options that they agree with?

Say a cancer doctor doesn’t agree with hospice care. Can he or she refuse to offer this option to a person? Do we want doctors to impose their own personal morals rather than accepted medical options on patients?

Some doctors argue that health providers are the moral agents of society and need to uphold the standards of the profession, which require respect for patient autonomy and respect for their preferences. Others feel each doctor should be allowed to be guided by his/her own values and become conscious objectors if they wish. The problem with this latter approach is that there is no way for a person to know ahead of time the morals and values of our doctors to select one who will provide the care we want.

A recent study of medical students reports that half expressed the belief that they could refuse to do any procedure they did not wish to perform. Remember, these are students – they are not actually providing the care. Can students refuse to learn about procedures they object to? Say, providing pain medication at the end of life, offering hospice care, or learning about abortions on their gynecology rotation?

As reported by the Journal of Medical Ethics, another survey of medical students show students cite their conscience in their refusal to perform or offer abortions, to prescribe birth control or even to examine a member of the opposite sex because of their religion. Do we want to have doctors who have never examined a woman’s body or vice versa? Can we call these people doctors if they only have been trained on half the population?

Strictly religious male students argue that they can learn from books and take examinations to prove their knowledge. But some things can’t be learned by reading. For example, I don’t think we can we learn to drive a car by reading a textbook. And what happens when such a student is assigned to work in the emergency room or the hospital ward where they will be asked to care for a woman?

While we certainly need a more diverse work force in health care, we also need to assure that all doctors have basic competencies. Regardless of our personal beliefs we need to offer people all legal and reasonable options for care regardless of the doctor’s own moral beliefs.

When conscientious objectors won’t offer a legal treatment, they need to refer the person, without prejudice, to someone who will provide a more complete range of options. This needs to be the law, and it is not now.


Michael Wilkes, M.D., is a professor of medicine at the University of California, Davis. Identifying characteristics of patients mentioned in his column are changed to protect their confidentiality. Reach him at drwilkes@sacbee.com.



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