This article appears in the May 2011 Edition of the Catholic Medical Quarterly
Are Catholic academics unintelligent or dangerous subversives?
Dr Adrian Treloar FRCP, MRCPsych, MRCGP.
Dr Robert Hardie SFO,
News of a substantial return to common sense by the International Committee of Medical Journal Editors.
In 2009, new guidance agreed by senior medical journal editors suggested that members of religious organisations might have to declare their faith as a “conflict of interest” when submitting scientific papers. The guidance did not appear to relate to atheists or others with strong beliefs and appeared to license the view (already seen in medical literature) that being Catholic is a legitimate reason to have your scientifically expressed views questioned. Having corresponded with the ICMJE we are happy to report a return towards common sense.
In August 2009 i two commentaries were commissioned (from both sides of the debate) by the Editor of the British Journal of Psychiatry upon a research article on abortion. One commentator (PC) was criticised in the Correspondence column as she “presents herself as `not a member of any campaigning organization', and also lists a number of her other activities to do with abortion and related issues.” She was then publicly “outed” with a strong suggestion that her views carry less weight because “she is a sincere member of the Roman Catholic Church”, and that “in these debates we all start from a position determined in part by personal background, and readers will not fully understand comments unless such things are known.” The article by PC had contained purely scientific arguments and was alongside another specifically commissioned to present both sides of a complex debate. One former President of the Royal College of Psychiatrists responded to that public “outing” thought that PC “has been asked to wear her religious belief publicly, like some yellow Star of David, with the intention to undermine the validity of her professional opinion.” ii
In 2009 the BMJ prominently reported how Len Doyal was, quite wrongly, shouted down in Cork when presenting his views on assisted suicide. While rightly pointing out the importance of freedom of speech he did then associate the opposition to his views with “the hate shown towards me personally by some people on the grounds of religion”.iii Actually this was an argument about Euthanasia presented in secular terms and not to be derailed by dismissing euthanasia as a religious issue. And yet at other times he has publicly joined with many others and used observations about religion in an apparent attempt to minimize the cogency of arguments against his position iv
Again, in 2009 the BMJ, responding to an article on assisted suicide (again put in entirely secular terms) by Lord Carlisle, Dr Bowkerv also sought to dismiss opposition to assisted suicide as a religious issue when he asked if “In the current and different context should onebe constrained to the alternatives for the religious reasons of others, or by the concerns of those who would not commit suicide given similar disabilities whether terminal or not?” He clearly thought that opposition to legalization of assisted suicide may be diminished by describing it as religious.
In all these cases, people who appear to dislike or distrust religions, sought to stigmatize the argument by association with religion rather than demonstrating where the arguments were scientifically lacking. Surely reducing arguments by stigmatizing those who make them is academically wrong.
Seen in the round, and given that these letters were all published by “responsible” editors of major journals, it is clear that these attacks belie a strong view that being Catholic may require a health warning on scientific papers.
Politicians too have objected to finding their arguments debased upon the basis of their political allegiance. vi As McCartney et al point out6 “surely all researchers (and editors) have values and priorities—and, even if they do not closely fit a particular party political description or a very coherent ideological category, they remain irreducibly political.” So while we are perhaps not alone, there is a broad issue. As McCartney et al suggest6 “moves towards declaration may have the unintended consequence of undermining the conditions of rational engagement in pursuit of scientific understanding”.
Given the stigma and attacks against secular argument on the grounds of faith, Catholics and non-Catholic Christians are bound to be anxious about declaring their faith. There is evidence that doctors are denied positions and disciplined in medicine when their beliefs are made known. As long ago as 1989 medical school applicants were observed not to get in if their Catholicity was known.vii Others too find difficulty in applying for posts viii and then find difficulty in working. ix x In our own careers while seeking to be excellent doctors many of us have always avoided declaring our faith, fearing an impediment to a career. One of us was told that a conscientious objection to abortion or contraception would prevent a career in General Practice etc. But in fact he was valued by that practice and became a partner there. Subsequently, perhaps unexpectedly, several patients specifically came seeking post abortion counseling, knowing that he did not refer for abortion. Rather than being an impediment, his ethical views seemed to bring a richer diversity and opportunity to those women.
There is also a legal issue. Religious Discrimination law as well as Human Rights legislation on the Freedom of Religion is, we believe, infringed by any guidance that sees faith as a conflict of interest and impediment to scientific argument. Happily the GMC guidance on beliefs rightly points out that “All doctors have personal beliefs which affect their day-to-day practice.” How could guidance either enable people with differing degrees of agnosticism or atheism to be “rated” for degree of conflict of interest. Do all Catholics think the same about contraception? Are only those Catholics who present evidence that might support the Church position on such matters the less scientific ones? Should a submission from a Hindu on the problems of bovine insulin be rejected if it is scientifically sound simply because the author’s religious or ethnic background makes scientific fact suspect?
In 2009 the International Committee of Medical Journal Editors
reached agreement on a standard from for declaring conflicts of
interests which specified that membership of a religious organisation
may need declaring. It was clear from this that being a Catholic was
considered something that readers may need to take into account when
assessing scientific data. Of course, given that atheists are not
usually members of a religious organisation there was a strong further
inbuilt encouragement of the anti-religious bigotry set out above.
Discussed within the CMA(UK) it was thought that non-financial conflict
of interest would only occur if someone was speaking on behalf of an
Association, or seeking to influence, promote or damage that
association. Where none of those are the case we have to contend that
there is no conflict of interest. Indeed declaring membership of any
organisation as a conflict of interest risks being seen by many as, in
part, a statement from that organisation and thus there is a
considerable danger that by declaring a conflicts of interest, authors
may wrongly usurp the authority of associations.
The sum of all was simple. If people of faith are forced to declare a religious association in ICJME guidance then there is evidence that
- They will suffer prejudice with their arguments being more easily dismissed by others
- They may reasonably fear that writing in the medical literature will harm their careers and thus become the victims of religious discrimination
- When speaking in their personal capacity, ICMJE guidance might cause the public to misunderstand what is written as a formal expression of the views of a Church or faith organizations.
- Such intrusiveness may violate rights to freedom of religion
We therefore contended that ICJME requirements are not a reason to declare faith and must not be used as a reason to belittle the arguments of those who have faith. A change was required in the ICJME wording to make it legally and ethically acceptable.
One of us fed back to ICJME the issues while submitting a peer reviewed publication. That person also asked the BMJ to comment and after a while correspondence copied to him between senior people at the BMJ did agree that they thought it unreasonable to declare faith as a conflict of interest. There was a suggestion that Council Members should declare their membership of Council, although we replied that that was in itself perverse as being a Council member does not make you an officer of the CMA, is not paid and when council members speak they do not do so on behalf of Council. Certainly being a CMA Council Member is not analogous to being a council member of the BMA. Having made that reply the correspondence ended, thus leaving the position of not declaring religious belief acceptable and reasonable.
A real victory
Subsequently, in what is a substantial victory for common sense and the avoidance of bigotry, the ICJME has, in its most recent update of the formxi, removed reference to membership of religious organisations as an example of a conflict of interest. In their announcement of the change they stated they were removing “the queries ….. nonfinancial competing interests” as a result of “concerns about the ethics of inquiring about nonfinancial associations”. xii
But there do remain substantial challenges. The bigotry set out earlier in this article remains. A declaration of religious belief has been required in some NHS Appraisals. We must absolutely defend our right to make reason and evidence based arguments in the public forum. Catholics are not unintelligent;- they have a right to be heard and to be heard outside of the fog of bigotry and persecution . The CMA (UK) (formerly the Guild of Catholic Doctors) has spent 100 years working to defend patients as well as at times doctors and all health care workers. There remains much to do. But we can win and will win with reasoned argument.
- i Cooper J, Abortion and mental health disorders John E. Cooper, The British Journal of Psychiatry (2009) 194: 570.
- ii Sims A. Disclosure of religious beliefs. British Journal of Psychiatry (2009) 195: 368.
- iii Doyal L. Euthanasia and free speech in Ireland. BMJ 2009;338: b2109
- iv Hunt T, Rees M, …. Doyal L et al. The Times 10th January 2007. Stem Cell Research. http://royalsociety.org/news.asp?id=5788
- v Bowker M. Assisted dying debate. Life is a terminal condition. BMJ 2009;339:b3682
- vi McCartney, G, Garnham, L, Gunson D, Collins C, When do your politics become a competing interest? BMJ 2011; 342:d269
- vii G D Roberts and A M Porter (1989)Medical student selection--time for change: discussion paper.J R Soc Med. ; 82(5): 288–291.
- viii Macdonell H. Doctor rejected for his conscience. Scottish Daily Mail 7 October 2000.
- ix Eliis R. GP who told patients to think twice about abortion is cleared of breaking medical guidelines. Daily Mail 7th July 2008. http://www.dailymail.co.uk/health/article-1032640/GP-told-patients-think-twice-abortion-cleared-breaking-medical-guidelines.html
- x Dolan A. Doctor is axed from panel over failing to back gay adoption . Daily Mail 20th July 2009-11-15
- xi International Committee of Medical journal Editors http://www.icmje.org/coi_disclosure.pdf
- xii Toward More Uniform Conflict Disclosures: The Updated ICMJE Conflict of Interest Reporting Form ICJME http://www.icmje.org/updated_coi.pdf