Intended for healthcare professionals

Rapid response to:

Education And Debate Ethical dilemma

Education and debateDealing with racist patientsDoctors are people tooCommentary: A role for personal values … and managementCommentary: Isolate the problemCommentary: Courteous containment is not enough

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7191.1129 (Published 24 April 1999) Cite this as: BMJ 1999;318:1129

Rapid Response:

Individual Conscience v Organisational Policy

To look back at the 20th Century is to fear what happens when people
are “just following orders”, and Pippa Gough is right to condemn this
defence of acquiescence to prejudice and abuse. However, I feel uneasy
when she writes “How much easier this doctor would have found the
situation if there had been a clear organisational policy setting out the
action to be taken in the situation described”. It might not be easier at
all and it could contradict the “just following orders” point. Suppose
the policy was that treatment should be withheld from an abusive patient
and
the doctor’s personal conviction was that treatment should never be
withheld, no matter how repugnant or wrong was a patient’s behaviour? She
should still follow the dictate of her own conscience, in defiance of
“organisational policy”.

Dr. Selby, whose conscience has troubled her for ten years, has shown
some courage in exposing a true dilemma, to which none of the solutions is
easy. However, I agree with all three commentators that nothing in a
professional relationship precludes one from answering gratuitously
expressed views by speaking one’s own mind fearlessly, as well as
preventing an individual patient from offending or hurting others.

Competing interests: No competing interests

25 April 1999
Ed Cooper
Consultant Pediatrician
Newham General Hospital, East London