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Conscientious objection

BMJ 2008; 337 doi: (Published 01 July 2008) Cite this as: BMJ 2008;337:0807264
  1. Charles Williams, fifth year medical student1
  1. 1Trinity College, Oxford University

Charles Williams considers whether doctors have a right to stand by their moral convictions

In October 2007 a small number of UK Muslim medical students made the headlines for missing lectures about sexually transmitted diseases and alcohol on moral grounds.1 In November a general practitioner, Tammie Downes, was investigated by the General Medical Council after disclosing in a newspaper interview her success in dissuading several women from having abortions.2

These stories highlight a conflict between morality and medicine. What are we to make of doctors whose morals compel them to opt out of certain tasks? Judgmental moralisers? Work shy cowards? Or courageous individuals who risk career progression for higher ideals?

Debating abortion

One flash point in the morals-medicine minefield is abortion. Before 1967 abortion was illegal in the United Kingdom but was widely practised, unsafely, in unhygienic backstreet “clinics.” The Abortion Act 1967 decriminalised abortion in certain circumstances. The act also includes a clause that states that “no person shall be under any duty, whether by contract or by any statutory or other legal requirement, to participate in any treatment authorised by this act to which he has a conscientious objection.” Very few people actively call for this clause to be repealed, but some think that doctors who have a problem with taking part in abortion should reassess their commitment to medicine or at least stay away from specialties such as obstetrics and gynaecology.

More and more abortions are taking place,2 but fewer doctors are willing to perform them. The Royal College of Obstetricians and Gynaecologists is worried at the fall in the number of young doctors willing to perform abortions,3 and the British Pregnancy Advisory Service, which carries out a quarter of terminations in England, has said that in five years' time women's access to abortion may …

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