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Members’ Forum - 18 November 2013

18 Nov 2013

In the 4 November edition of Australian Medicine, Australian Medical Students’ Association President Ben Veness raised the issue of conscientious objection, and highlighted AMSA’s policy, which recognised the right of doctors to exercise their conscience and refuse to provide any non-emergency services to which they conscientiously object.  But the policy also stated that exercising a personal objection must not infringe the patient’s right to be provided with information about, and access to, all available management options. Many AMA Members shared their opinions on the issue.
You acknowledge the importance of, and AMSA's support for, the right of a doctor to conscientiously object to provide any non-emergency medical treatment, while at the same time stating that there should be an obligation from a patient to a doctor that the objector knows does not object to providing that treatment. However, you do not address the obvious elephant in the room: many conscientious objectors would deem they are facilitating the treatment they object to (say, abortion) if they send a patient to someone who they know will provide it. This is an informal referral, and laws requiring this effectively force the doctor who considers this level of participation in the chain of care to be facilitating it, and (as I would) would still be morally compromised. A law that tells me "we respect your right to conscientiously object, but only to the extent that is convenient to us - we'll interpret what you can actually object to" sidesteps the need for this right to be absolute, otherwise it doesn't really exist at all. Further, from a practical point of view, I think you would find that many conscientious objectors would act in breach of this law by refusing to refer regardless. This would then lead to professional but, more worryingly, legal implications, and a whole lot of de-registered doctors.
Submitted by Tom (not verified)

There would surely be a significant proportion of doctors, many of them well-known, intelligent, reasonable, well-intentioned people, would refuse to refer, and so would be in breach of the legislation. Is it really appropriate to require all members of the profession to do some action when such a significant portion of the profession would have sincere ethical difficulties with taking this action? The argument in favour of this legislation seems to be premised on the idea that if patients are not referred to another doctor who can perform the termination, then they will be unable to find a doctor to perform the termination. But, surely, they can generally just look up another place on Google/Yellow Pages etc.? At the end of the day, isn't this just too much of a contentious issue for there to be legislation mandating certain actions when there is such a widespread variance of views across the profession? By way of comparison, in the legal profession, I doubt there would be any comparable statutory requirement imposed on lawyers in circumstances when such a significant percentage of the legal profession would have sincere ethical difficulties with that requirement.
Submitted by Macca (not verified)

Great discussion. I share in your concerns Tom. It seems the validity of conscientious objection is being questioned. A referral of even an informal kind is still a medical form of management that I would see as partaking in the care of a patient. Interested to hear about the form of discussion that occurred before AMSA took this stand.
Submitted by Sam (not verified)

Chair of AMA Ethics Committee Dr Elizabeth Feeney discussed what doctors needed to consider when a major public health emergency occurred, such as the recent bushfires in NSW.  Several AMA members gave their suggestions.
I would like to put in a plug for doctors to contribute to the response to disasters by joining organisations that are able to organize and train responders to disasters. There are many that do this, both in the voluntary and paid spheres. From St John Ambulance to Red Cross and the ADF, to name just a few. The point is that well-meaning but poorly-prepared help is frequently worse than no help at all. So Liz's point about thinking about it well in advance is perhaps the most important. We also have our statutory obligation under the Medical Practitioners Acts, and now AHPRA legislation, to provide care when called upon to do so, but this is unlikely to be invoked except for those caught up in a disaster. The provisions of the Acts do not compel us to provide care at our own peril as I understand it. That is a personal decision, and also strays into my original point. You need to be prepared to provide care in a disaster. It's nothing like anything else you, do unless you undertake out-of-hospital care. Well done Liz for raising this.
Submitted by Finlay Macneil (not verified)

The AMA has called on the nation’s Health Ministers to act immediately to head off a looming critical shortage of medical training places that threatens to derail the careers of hundreds of aspiring doctors and undermine efforts to improve access to health care. One AMA member agrees with the AMA call.
A coordinated plan to facilitate the complete training of our ever-increasing numbers of medical students is urgently needed. I see so many dedicated, motivated and exceptional young medical students who are dedicating their lives to completing a medical degree and becoming a doctor. This looming disaster is something most of them are unaware of, and could create long delays in completing what is already a very long training programme.
Submitted by Dr Bill Johnston (not verified)

There could be a mass exodus of doctors from the Queensland public hospital system unless draconian changes to employment conditions are quickly reversed, the AMA has warned. AMA members share their view.
"But Queensland Health Minister Lawrence Springborg has so far defied calls to reverse the decision, declaring the change in employment terms had been forced on the Government by a spiralling overtime bill for public hospital specialists." The response to this is that there is a failure of workforce planning by Queensland Health. Surely, overtime functions as a useful disincentive to overworking individual doctors. The solution, when particular doctors are earning significant overtime on a regular basis, is to respond to the obvious unmet need by employing another specialist. Without overtime, where is the incentive to plan appropriately to meet the clinical need and to ensure safe working hours? How does the AMA ensure that this concern gets shared with the public? The proposed individual contracts are not in SMOs interests, but they are clearly not in the public interest either.
Submitted by Rebecca Wild (not verified)

The day A Current Affair invaded my practice: GP recounts damage caused by TV show stunt on medical certificates. Many AMA members expressed their view on the issue.
ACA were very lucky that Dr Chambers himself was not depressed or fragile at the time they chose to publicly humiliate him and trash his professional reputation on national prime-time television in response to his genuine attempt to help a patient presenting as in need of medical care. GPs do, after all, have higher rates of depression and suicide than the general population, and it stuns me that ACA apparently never learnt from the experience of their colleagues at 2Day FM (c.f. Jacintha Saldanha) that the deceitful entrapment of one person in order to amuse the many will sooner or later lead to tragedy. Just as well, for all of us, that Dr Chambers is evidently made of strong-enough stuff.
Submitted by John Mahony (not verified)

It is not difficult to deceive a doctor into issuing a sick leave certificate, especially when the purported patient comes prepared to deceive. He can always tell the doctor symptoms he knows will help him get the certificate. This sort of so-called investigative journalism is deplorable because it gives the vulnerable public the wrong impression of how doctors carry out their duties.
Submitted by Leslie Chen (not verified)

The only thing sadder than ACA is the number of people who watch it.
Submitted by b (not verified)

What astounds me is the hypocrisy involved in ACA making the allegation that the GP made fictitious and deceitful declarations when quite clearly their whole story was a factitious and deceitful (public) defamation itself. I would not be surprised if there was a defamation case in this. What a rubbish program, doing nothing but stirring up hate and distrust in society where it never existed, all for ratings!

On a slightly separate but related note, I would warn fellow medical colleagues to be wary of more genuine patients making surreptitious (often audio only) recordings of consultations on their smartphones, and would also ask patients who do this to think about the damage that might be done to a professional relationship if caught. Most doctors will probably consent to being recorded if asked up front, but catching a sneaky recording device will almost certainly sever any trust in a doctor-patient relationship.
Submitted by Tom Forbes (not verified)

As well as legal action for defamation, if a Medicare rebate was claimed as part of this consultation, then that amounts to Medicare fraud by the "patient" (i.e. the ACA producer). I hope the doctors involved notify Medicare of this incident, if this is the case.
Submitted by A Tauro (not verified)

Published: 18 Nov 2013