Letters
Ethics
Volume 196 - Issue 2

Should doctors feel able to practise according to their personal values and beliefs?

Author:  William R Adam

Med J Aust 2012; 196 (2): 109. || doi: 10.5694/mja11.11537
Published online: 6 February 2012
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To the Editor: An ethical concern that was raised by Conway in his article supporting the freedom to practise in accordance with conscience1 related to the problems that arise when patients — specifically children — are unable to express a considered opinion on any conflict between their clinicians and their legal guardians about their best interests.

Parents know their child best, are responsible for continuing care of the patient (including during any adverse effects of treatments) as well as of any other dependants. However, they may also be guided more by strongly held beliefs than by the views of clinicians on the best interests of their child.

The law gives parents considerable rights and obligations to make decisions in the best interests of their children, but the law also recognises that children have rights, independent of the parents. When children are able to form and express opinions, these are considered; when they can’t, they are dependent on others to promote their interests.

Within this legal framework of competing rights, the solution can only be a legal one, as occurred with the patient in Conway’s example.1 Clinicians have to be prepared to go to court to put their case for the best interests of the child, and then accept the legal decision with good grace, however personally distressing. This is just another example in medicine of the need for all to work with less than desirable outcomes.

And one must always remember that not complying with a court order is an option — with consequences — that may seem ethically justifiable to a clinician or parent.

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