Volume 196 - Issue 2
Should doctors feel able to practise according to their personal values and beliefs?
Author: Murat Civaner
Med J Aust 2012; 196 (2): 109. || doi: 10.5694/mja11.11448
Published online: 6 February 2012
Published online: 6 February 2012
To the Editor: In a recent Opposing Views article, Conway claims that doctors should be able to practise according to their personal values,1 but the argument he uses is not persuasive.
The ethical dilemma in the case is not characterised correctly. Autonomous choices can be made while treatment options, based on scientific knowledge, are available. If there are no medical options to improve the outcome — if we are at the very limits of medicine — there is no duty to provide anything other than palliation. In other words, the “do no harm” principle takes precedence over the duty to treat the patient according to his or her needs. Under these circumstances, refusing to “treat” is to practise with medical knowledge and the comfort of the patient (in Conway’s example, a child) in mind, regardless of the parents’ wishes. There is no ethical dilemma in that sense. In fact, the dilemma doctors have is not clinical, but a professional one created by the court order compelling doctors to continue futile treatment, causing unnecessary discomfort that obviously conflicts with the “do no harm” principle. Hence, Conway’s case does not support his argument.
In addition, his argument may lead to the violation of patient wellbeing and of professional values. The moral problem related to defining a space for personal values in medical care is that they may conflict with professional values, legitimising discrimination. Then it would be nearly impossible to criticise doctors and institutions that refuse abortion, do not examine patients of the opposite sex on religious grounds, and refuse to operate on HIV-positive patients or to treat people with different political affiliations. It would be hard to call that kind of environment a “healthy diversity”.
As well as defending the right to health, we should protect the professional value of non-discrimination to preserve trust between medicine and society. In fact, in order to “safeguard against abuses of power, error and exploitation in medicine”,1 we have already established universal professional codes, instead of leaving the stage to the relativity of personal values.
Competing interests
No relevant disclosures.
References
- Conway BV. Should doctors feel able to practise according to their personal views and beliefs? Med J Aust 2011; 195: 496. 0_BEABFDGI