Conscientious objection rules changed in new ethics guide for doctors

Doctors who opt out of performing abortions will have to provide follow-up care for women who have had the procedure, under new ethics guidelines for the profession.

Doctors “must provide care, support and follow-up for patients who have had a lawful procedure, treatment or form of care to which you have a conscientious objection”, according to the ninth edition of the Medical Council’s guide on ethics and professional conduct, to come into effect next January.

“Conscientious objection may arise in a number of different situations. The revised guide does not assume links to any one treatment, procedure or form of care,” a spokeswoman responded when asked if the change would affect doctors opting out of providing abortions.

The additional provision on conscientious objection is one of many changes to the guide, which was last updated in 2019.

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The new edition revises guidance for doctors on using social media, acting as expert witnesses and “managing situations with patients”, according to the Medical Council.

There are also updated sections on the responsible use of health resources, advocating for patients and services and professional conduct.

The word “must” is used 150 times, compared with 120 times in the eighth edition of the guide. Use of the word “should”, by contrast, has fallen from 275 times to 182.

In a new section on expert witnesses, doctors are reminded that in legal proceedings, their first duty is to be of assistance to the court in providing an “independent” expert opinion.

“You must be honest and objective in all your spoken and written statements. You must make clear the limits of your knowledge and competence. You must not act as an expert witness in areas outside your scope of practice, experience and expertise.”

In a section on end-of-life care in the old guide, doctors were advised that “usually, you will give treatment that is intended to prolong a patient’s life”, though there is no obligation to start if it, inter alia, is unlikely to work.

This has now been reworded accordingly: “You should not start or continue treatment, including resuscitation, or provide nutrition and hydration by medical intervention, if you consider the treatment” is, inter alia, unlikely to work.

Doctors “must raise concerns where you believe that patient safety or care is being compromised by the practice of colleagues, or by systems, policies and procedures in the organisations in which you work,” the new guide advises.

“You must practise, promote and support a culture of open disclosure.” This is defined as an “honest, open, compassionate, consistent and timely approach to communicating with patients, and, where appropriate, their family, carers and/or supporters, following patient safety incidents”.

“You should strive to use resources equitably, efficiently and sustainably, consistent with evidence-based patient care, and in the context of planetary health and the environment,” the guide states.

“If you are concerned that a colleague may be putting patients at risk or is otherwise unfit to practise you must escalate those concerns,” it continues.

Doctors are advised to keep personal and professional use of social media separate and to avoid, as far as possible, communicating with patients on these sites.

“If you give clinical advice online, you should always identify yourself by name. You are legally liable for anything you publish on your own social channels and should take this into consideration when posting content or advice publicly.”

Doctors are also advised patients may wish to record their consultation: “If they wish to do so you should facilitate their request”.

On relationships between colleagues, the previous edition stated that “before entering into a sexual relationship, supervisors and their trainees should consider the power imbalance in the relationship and the potential for exploitation or conflicts of interest to arise”.

The new edition states: “You should not engage in a sexual or improper relationship with a colleague where there is a significant power imbalance”.