Intended for healthcare professionals

Rapid response to:

Analysis And Comment Ethics

Conscientious objection in medicine

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7536.294 (Published 02 February 2006) Cite this as: BMJ 2006;332:294

Rapid Response:

Is Savulescu displaying double standards?

Editor

While sharing the distress and distaste felt by many other
correspondents, the views expressed by Savulescu [1] are perhaps not so
surprising. He has previously advocated positions which many in the
medical mainstream would find disturbing, including the commercial sale of
body parts and the legalisation of performance-enhancing drugs in sport
[2,3].

I agree with him that paternalism can cause problems. However, he
appears to consider consumerism to be the only alternative. This ignores a
huge body of literature on the patient-centred method [4, 5]. The patient-
centred approach explicitly allows the doctor’s views and judgements to be
considered. If Savulescu really thinks that autonomy has few limits, I
would not wish to be on the same plane as him when he decides to exercise
his autonomous right to tell the pilot how to fly the plane.

As other correspondents have pointed out, a doctor’s values can
strongly enhance patient care. Removing all values would return us to the
worst, most narrow-minded biomedical approach to patient care.

Perhaps the most serious flaw in what I consider to be a
disappointing article is his apparent display of double standards. In one
of his better articles, he points out how apparently well-meaning
individuals can cause deep offence through their choice of words[6]. He is
particularly critical of those who give advice to people they do not know
well. As he says, “When it has no chance of being received well, advice
such as this cannot be defended”[6]. I do not feel Savulescu has made much
effort to understand those of us in medicine (the vast majority) who are
influenced by our values.

Why did Savulescu choose to write the article in such an offensive
way? Why, when he could see the distress that he has caused, has he not
sent a rapid response to apologise to those of us working hard at the
coalface trying to deliver a patient-centred health service?

As he says elsewhere, “We should choose carefully what we say”[6]. In
at least this aspect I can agree with Savulescu.

[1] Savulescu J. Conscientious objection in medicine. BMJ 2006; 332:
294-297.

[2] Savulescu J. Death, us and our bodies: personal reflections. J
Med Ethics 2003; 29: 127-130.

[3] Savulescu J, Foddy B, Clayton M. Why we should allow performance
enhancing drugs in sport. Br J Sports Med 2004; 38: 666-670.

[4] Mead N, Bower P. Patient-centredness: a conceptual framework and
review of the empirical literature. Social Science and Medicine 2000; 51:
1087-1110.

[5] Stewart M. Towards a global definition of patient-centred care.
BMJ 2001; 322: 444-445.

[6] Savulescu J, Foddy, B, Rogers, J. What should we say? J Med
Ethics 2006; 32: 7-12.

Competing interests:
None declared

Competing interests: No competing interests

10 February 2006
Christopher J Harrison
GP
Brooklands Medical Practice M23 9JH