Catholic Medical Quarterly Volume 72 (4) November 2022


An Open Letter to the World Medical Association on Conscientious Objection

On 11-12 August the World Medical Association in conjunction with the American Medical Association is hosted a meeting of experts in Washington DC to discuss the International Code of Medical Ethics. Among other revisions to the code it was being proposed that th code include a paragraph on conscientious objection.The meeting considered whether this should require any doctor who objects to make effective and timely referral to a doctor who does not object.

The following letter, signed by over 200 professors, directors of research centres, physicians and others concerned with medical ethics, urged the WMA not to impose an obligation on physicians to refer patients for procedures that the physician sincerely and reasonably considers unethical.

The CMQ reproduces here the letter which was sent by the Anscombe Centre.

ABC LogoWe the undersigned hold that to fulfil their professional duties to patients, to uphold the in­tegrity of the medical profession, and to avoid harm to society as a whole, physicians must commit themselves to acting ethically in the practice of medicine and must always refrain from actions that they judge to be unethical. The duty of a physician to practise with conscience includes the duty not to act contrary to conscience.

A physician who, in good conscience, and in line with a reasonable body of medical opinion, judges a procedure to be harmful, discriminatory, unjust or otherwise unethical must not be placed under a professional, contractual or legal obligation to identify and refer to another healthcare profes­sional who would provide the procedure. This stance is articulated and embodied in the WMA policy on euthanasia and assisted suicide which states that:

No physician should be forced to participate in euthanasia or assisted suicide, nor should any physician be obliged to make referral decisions to this end.

There are wider implications of making effective referral compulsory in the context of conscientious objection. For example, if a physician who objects in conscience to a legally-sanctioned medical procedure is obliged to identify and make effective referral to another physician who does not object, then in some jurisdictions a physician who objected to participation in “enhanced inter­rogation”, or to capital punishment, or to force feeding of a prisoner who is on hunger strike, or to “conversion therapy”, could be forced to facilitate these procedures by effective referral. However, to require a conscientious objector to facilitate delivery of a procedure to which they have a serious ethical objection is a direct attack on their conscience and moral integrity.

A principled conscientious objection is always to a procedure and not to a person. Physicians must not refuse to treat a particular patient or group of patients because of beliefs about them uncon­nected with the medical propriety of the proce­dure. In particular, physicians must not refuse to treat criminals or enemy combatants or refuse to treat the health consequences of the patient’s way of life, choices, or beliefs.

A physician must ensure that conscientious objection is exercised in a way that takes full account of their duty of care for the life and health of the patient. The physician should also seek to minimise any disruption of patient care. If a clini­cian cannot in good conscience provide what the patient requests, the physician should, where appropriate, respectfully explain the reasons for the decision and should, where appropriate, inform the patient of other options that are available to them, including the option to seek a transfer of care to some other healthcare professional. However, the physician is not ethically obliged to provide, and must not be coerced into providing, effective referral of a patient for procedures that the physician sincerely and reasonably considers unethical.

Professor David Albert Jones, MA MA MSt DPhil.
Director, Anscombe Bioethics Centre, Oxford, UK; Pro­fessor of Bioethics, St Mary's University, Twickenham, UK; Research Fellow, Blackfriars Hall, Oxford, UK [*].

Professor Emmanuel Agius, SThB STh MA SThD.
Professor of Religious and Philosophical Ethics, University of Malta, Malta.

The Right Honourable Professor the Lord Alton of Liverpool, KCSG, KCMCO.
Visiting Professor, Liverpool Hope University; Honorary Fellow and Former Professor of Citizenship, Liverpool John Moores University, Liverpool, UK.

Professor Paul S Appelbaum, MD.
Dollard Professor of Psychiatry, Medicine, and Law, Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA.

And 220 others