Understanding Conscientious Objection and the Acceptability of its Practice in Primary Care

Abstract

Ethically challenging or controversial medical procedures have prompted increasing requests for the exercise of conscientious objection, and caused concerns about how and when it should be practised. This paper clarifies definitions, especially with regard to discrimination, and explores the restrictions, duties, and practical limitations, in order to suggest criteria for its practice. It also argues that a conscientious refusal to treat, where there is therapeutic doubt, is a valid form of conscientious objection. An email survey sent to General Practitioners (GPs), explored the adherence to the suggested criteria, and assessed the outcomes, in terms of acceptability, impact, and difficulties experienced by the GPs, their colleagues and their patients. The results demonstrate high acceptability of conscientious objection, and better outcomes when the suggested criteria are adhered to. The GPs would support education to improve the practice of conscientious objection to a professional level, which could further improve outcomes and acceptability.

KEYWORDS:

• Conscientious objection
• criteria
• education
• guidelines
• general practice

Acknowledgements

To my family and friends for their patience in proof-reading, ideas and suggestions. To Trevor Stammers for his continuing support throughout my studies.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 The General Medical Council registers medical professionals with a license to practise before they work in the UK

2 Attributed to the Greek physician and teacher Hippocrates of Kos – who is often called the father of medicine – the true author of the oath is unknown, and there may have been several authors.

3 NHS: National Health Service in the UK founded in 1948.

4 This forms a valid request for ‘religious based exemption’, as it arises from the traditions of the religion, societal or internal personal values, but it is not a morally nor ‘religious based CO’ to a procedure.

5 MDDUS, The Medical and Dental Defence Union of Scotland is a mutual defence organisation, founded by and for healthcare professionals, with an expert staff of doctors, dentists, lawyers and risk advisers who are leaders in the medico-legal and dento-legal fields.

6 This was finally withdrawn from the website on 10.08.22 following a 3 year debate with the author, about the confused presentation (personal communication).

7 Examples of these refusals could be: not prescribing medicines tested on animals, which are based on animal rights; or medicines made with gelatin, and refusing to work on particular days, both of which are religious-based exemptions; and refusing to offer contraception, as a matter for CO.

8 The survey was designed using guidance from JISC Online surveys, an online survey tool established and designed by JISC, a non-profit set up to support digital learning within Higher Education. The survey tool is GDPR compliant and Certified to ISO 27001 standard. Data is stored on St Mary’s University servers accessed from a securely encrypted personal computer (formerly BOS). https://www.onlinesurveys.ac.uk/help-support/ [Accessed 13/06/22]

9 The participant information sheet is available on request.

10 The full data for 114 respondents is available.

11 Questions 7 and Q.8 are difficult to categorise simply as either adherence to criteria, or as outcomes, as they may reflect the way it was practised or the effects and impacts on others.

12 Using Spearman's Rank Correlation statistical test, for 4 pairs the critical value of r is 0.90 for a correlation of 95% and 0.95 for 99% confidence this is highly significant at 0.9791, (p = 0.01).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.