Intended for healthcare professionals


BMA claims GMC guidance on conscience goes too far

BMJ 2007; 335 doi: (Published 04 October 2007) Cite this as: BMJ 2007;335:688
  1. Clare Dyer, legal correspondent
  1. BMJ

The BMA has clashed with the UK General Medical Council about draft guidance from the GMC for doctors who object to providing certain medical services on the ground that they conflict with their personal beliefs.

In its response to the draft of Personal Beliefs and Medical Practice the BMA argues that the guidance goes beyond doctors' widely accepted right to opt out of certain procedures that involve matters of life and death, such as abortion, contraceptive services, and the withdrawal of life prolonging treatment. The association claims it could confuse patients and give doctors a licence to discriminate.

But the GMC insists that the draft guidance does not contradict current guidelines in its core text, Good Medical Practice, which does not limit conscientious objections to life and death matters. It says that the new guidance is intended to supplement Good Medical Practice by giving more detailed and practical information in response to growing numbers of inquiries about matters of faith and other areas of personal belief.

The BMA said the draft advice seemed “to extend the right of conscientious objection to any procedure with which doctors have a moral, cultural, or religious disagreement.” The association called for a limited list of clearly defined procedures to which doctors would be entitled to conscientiously object.

Tony Calland, chairman of the BMA's medical ethics committee, said, “Doctors are not there to judge patients but to treat them. It would not be appropriate or ethical for a doctor to refuse to help a patient because their own personal beliefs were in conflict with how an individual patient led their life.

“This guidance is confusing and inconsistent and will not benefit doctors or patients. On the one hand doctors are being advised not to discriminate on the basis of their personal beliefs regarding a patient's gender, sexual orientation, or race, but on the other hand the guidance seems to give doctors a mandate to opt out of any procedure to which they have an ethical objection.

“The BMA is extremely concerned about how far these objections could extend. For example, could a doctor refuse to refer a lesbian couple for fertility treatment, refuse to carry out a sexual health test on a homosexual, or object to treat a Jehovah's Witness who has refused a blood transfusion?”

The GMC said in a statement, “As the regulator we foresee considerable difficulty in determining which treatments should be covered by our guidance on conscientious objections, and those which doctors should be forced to provide or face disciplinary action from the GMC.

“Doctors may exercise conscientious objection to clinical procedures within the limits set out in our guidance. Doctors cannot allow their views about a patient's lifestyle or beliefs to affect their treatment of that patient.”

Consultation on the draft guidance closed on 21 September, and a final version is expected to be published in 2008.