Statement on physician conscientious objection

Foundation: Comisión Central de Deontología de la Organización Médica Colegial Española.
sourceSpanish: Comisión Central de Deontología de la Organización Médica Colegial Española (Central Commission of Deontology of the Spanish Medical Association).
language original: Spanish.
Approval: General Assembly of 31-V-1997.
Publication: Revista OMC 52, June 1997.
Copyright: No.
Checked on 16 May 2002.

Declaration of the WTO Central Commission of Deontology on conscientious objection of physicians

Introduction

1. Conscientious objection by physicians has recently become, both within and outside the profession, the subject of discussion. It is logical that, as the ethical pluralism of our society multiplies and becomes more explicit, the number of episodes of conscientious objection on the part of doctors increases issue , i.e., situations of conflict arise between, on the one hand, what is prescribed by law, ordered by health managers or desired by patients, and, on the other, what doctors can do in conscience.

2. The Central Commission on Deontology, Medical Law and Visas has recently been questioned on some aspects of conscientious objection of physicians, such as their ethical dignity, the actions to which it can be applied, or the extent and intensity of corporate protection of the objecting physician.

3. There are not many points of deontological and legal reference letter on conscientious objection. The current Code of Medical Ethics and Deontology does not neglect conscientious objection, but deals with it incompletely. On the other hand, none of the specific legal norms on objectionable subjects (current laws on abortion or human assisted reproduction, for example) include reference letter on conscientious objection.

4. In order to guide the conduct of physicians, the Central Commission on Deontology, Medical Law and Visas considers it appropriate to offer the present Declaration to fill in and confirm the deontological doctrine on conscientious objection, to guide the professional conduct of physicians, and to contribute to the social discussion and to pave the way for a comprehensive, legal and deontological regulation of conscientious objection subject.

Ethical, sociological and legal principles

1. A physician's refusal to perform, on ethical or religious grounds, certain acts that are ordered or condoned by authority is an action of great ethical dignity when the reasons given by the physician are serious, sincere and consistent, and concern serious and fundamental issues. The objector feels a deep moral repugnance towards the acts that he or she conscientiously rejects, to the extent that to submit to what is ordered or requested would be tantamount to betraying his or her own identity and conscience, to tarnishing his or her dignity as a moral agent. As article 18 of the guide of European Medical Ethics states, and our Code of Medical Ethics and Deontology repeats almost verbatim, "It is ethical for a physician, on the basis of his personal convictions, to refuse to intervene in reproductive processes or in cases of termination of pregnancy or abortion".

2. As a sign of civic maturity and moral and political progress, modern societies accept the gesture of peaceful objection, without reprisals or discrimination against the objector, in common respect for the principles of ideological freedom and non-discrimination as fundamental rights of individuals, enshrined in all Constitutions. Tolerance of genuine conscientious objection is something connatural to today's society, in which ethical pluralism is accepted as a privileged reality, to which other values, highly functional and effective, but of inferior ethical dignity, must be sacrificed.

3. Conscientious objection is also a basic legal right, which does not exist because it has been recognised by law, but is recognised by law because it signifies and manifests the civil respect due to the moral identity of persons. The ruling of the Constitutional Court of 11 April 1985, in response to resource of unconstitutionality raised against the Organic Law reforming article 417 bis of the former Penal Code, states, among other things, that such conscientious objection exists in itself, that is, that it does not need to be regulated, as it forms part of the fundamental right to ideological and religious freedom recognised by article 16.1. of the Spanish Constitution. Its exercise, adds Spanish constitutional jurisprudence, is directly applicable, as it is one of the fundamental rights.

Practicalities

1. The exercise of conscientious objection can give rise to tense and potentially conflictual situations. When objecting, physicians should always show a calm and respectful attitude towards patients, colleagues and authorities whose convictions differ from their own, as stated in Articles 27.1. and 35.3. of the Code of Medical Ethics and Deontology. In such a peculiar status , any violent gesture is out of place.

2. Conscientious objection, which refers to the refusal of certain actions, has nothing to do with the refusal of persons. The objecting physician, while refraining from performing the objected act, is nevertheless obliged, especially in an emergency, to provide any other medical care, antecedent or subsequent, to the person undergoing the objected intervention.

3. It would be ethically intolerable for a member of the medical profession who conscientiously objects in the institution where he is a salaried employee to practise the objected action when he is self-employed. Such conduct would be a sign of moral duplicity which would bring the medical profession into serious disrepute, since it would reveal that the profit motive is the essential motive for his behaviour. The Central Ethics Commission is of the opinion that in the legislation that will eventually regulate professional conscientious objection, those who make spurious and unworthy use of conscientious objection should be penalised as severely as possible.

4. With a view to providing the financial aid and advice to the high school indicated in article 27.2 of the Code of Medical Ethics and Deontology, the Central Commission on Deontology, Medical Law and Visas suggests the creation of a procedure, voluntary and confidential, by means of which the objecting member informs the President of the high school where he/she is registered of his/her status as an objector.

5. On the employment side, conscientious objection may never be an advantage or a disadvantage for the objecting physician. It shall not give rise to situations of "punishment" or marginalisation, nor to negative discrimination. The Medical Association should oppose with all its might any advertisement for positions in public or private institutions where objecting physicians would be discriminated against for the very fact of their objection. Regardless of what the Courts of Justice may determine about the illegality or unconstitutionality of such advertisements, the Medical Association must intervene from deontological and statutory positions to assert the right of all members, without distinction, not to be restricted in their professional practice when it is carried out in a correct deontological manner (General Statutes of the Medical Association, Art. 42.e.).

6. Similarly, conscientious objection may never be used by the objector to obtain employment advantages. A physician who conscientiously objects in order to reduce his or her burden of work or to exclude himself or herself from unwelcome services would be demeaning to his or her ethical dignity. The objecting physician will demonstrate the rectitude of his or her intention by willingly performing the task assigned to him or her to replace the work from which he or she has conscientiously abstained.

7. There is no doubt that, in the future, as the ethical pluralism of society becomes more pronounced, the number of actions that doctors can refuse in conscience will increase issue . It seems clear that, in addition to the classic objection to abortion, to human reproductive interventions (sterilisation, contraception and contragestation, assisted fertilisation, clinical embryology), others may be added, such as, for example, the pacifist refusal to collaborate with military medicine, to practise euthanasia, to collaborate in medical suicide financial aid , or to carry out certain clinical protocols. Doctors may also refuse to comply with orders of an economic or administrative nature imposed by the health authority if they violate their conscience and freedom or could cause harm or damage to patients.

8. However, it will never be legitimate to trivialise the subject objected to. If, on the one hand, an upright conscience imposes with non-negotiable firmness the duty to object when the objective seriousness of the subject demands it, it obliges, on the other hand and with the same firmness, to show a broad and friendly tolerance towards legitimate ideological and professional diversity.