Medico-legal - Personal belief in the practice

MDU adviser Dr Kathryn Leask explains how religious beliefs affect decisions made in the surgery.

Many GPs have encountered situations where a patient's personal beliefs affected the way that a consultation was carried out or the treatment options available. But it may be that a GP also finds that their own beliefs conflict with providing a particular treatment.

It is important that doctors are able to deal sensitively with any situation involving their own or their patients' religious or moral beliefs. In doing so, they should follow the GMC's guidance in Personal Beliefs and Medical Practice, which expands on more general guidance in its core publication, Good Medical Practice.

The new guidance sets out how doctors can ensure their personal beliefs do not adversely affect their relationships with or treatment of patients.

A treating doctor has a duty to make sure the patient has the necessary information to make a decision

Patients' beliefs
Patients' personal beliefs may be fundamental to their sense of well-being and can help them to cope with pain or other negative aspects of illness or treatment. However, this may occasionally lead to some uncertainty about how they should be treated.

For example, a female patient's ethnic, religious or cultural background may preclude an examination by a male doctor. In such situations, communication with the patient about what will be involved in the examination and the offer of a chaperone are particularly important.

While religious beliefs can bring comfort, they may also lead patients to ask for procedures that others may not feel are in their best clinical interests, or to refuse treatment that their doctor believes is clinically necessary.

GPs may be asked for advice by patients whose religious beliefs mean they wish to make an advance decision refusing certain treatments. For example, Jehovah's Witnesses will not consent to receive a blood transfusion.

In general, adult patients who have capacity to make decisions about their care have the right to refuse any medical treatment, but the treating doctor has a duty to make sure that the patient has all the information necessary to ensure that such a decision is an informed one. However, it is important to note that an advance decision cannot compel a doctor to do anything unlawful or to carry out a treatment which is not in the patient's best interests.

If a GP is aware of the existence of an advance decision, it is appropriate to include this as part of the relevant information when making a hospital referral. In the case of Jehovah's Witnesses, the hospital may be able to refer them to one of the hospital liaison committees established by the Watchtower Society (the governing body of Jehovah's Witnesses) to support those faced with treatment decisions involving blood.

While some patients may refuse treatment for religious reasons, others may request a particular treatment because they believe it is essential to the practice of their religion, such as male circumcision. The GMC in 0-18 Years: Guidance for All Doctors, states that both the law and the GMC permit doctors to undertake procedures that do not offer immediate or obvious therapeutic benefit, so long as they are in the child's best interests and are carried out with consent.

The GMC's guidance on personal beliefs (paragraphs 12-16), sets out the need to act in the patient's best interest, and this includes assessing the child's and/or his parents' cultural, religious or other beliefs and values. If the child is competent, doctors should obtain their consent, otherwise consent should be obtained from both parents, if possible.

If parents cannot agree and disputes cannot be resolved informally, doctors should seek legal advice about applying to the court. The GMC's guidance makes clear the steps that doctors who carry out male circumcision should follow, including acting within their competence and keeping up to date with developments in practice.

Doctors' beliefs
GPs who have a conscientious objection to undertaking work such as male circumcision or arranging a termination of pregnancy can refuse, but they should not allow this to adversely affect patients' access to the care they need. The GMC's guidance states: 'While we do not impose unnecessary restrictions on doctors, we expect them to be prepared to set aside their personal beliefs where this is necessary in order to provide care in line with the principles in Good Medical Practice' (paragraph 8).

Where a GP has a moral objection to a procedure, he or she needs to tell patients of their right to see another GP, ensuring that patients have enough information to exercise that right.

If patients cannot readily make their own arrangements to see another doctor, doctors are expected to ensure that arrangements are made, without delay, for another doctor to take over their care and not obstruct patients from accessing services.

The GP remains responsible for providing any care that is immediately necessary before patients are transferred to the care of another doctor.

GPs are expected to be open with patients, both in person and in printed materials such as practice leaflets, about any treatments or procedures they choose not to provide or arrange because of a conscientious objection.

GPs are advised to explain their concerns to the practice manager or senior partner so that this can be made clear in practice communications and that alternative arrangements can be made, where practical.

Trust and good communication are essential components of the doctor-patient relationship and it may be difficult for patients to talk openly if they believe the doctor has strong personal beliefs about an aspect of care or treatment.

However, if, as a GP, you are aware that a patient holds strong personal views that are relevant to the treatment or care proposed, it may be useful to discuss these during a consultation, if the patient does not object.

  • Dr Leask is a medico-legal adviser for the MDU

Learning points
Religious beliefs in practice

1. Patients' personal beliefs may be fundamental to their sense of well-being.

2. Be sensitive when dealing with a situation involving religious or moral beliefs.

3. A treating doctor has a duty to make sure that the patient has all the information necessary to make an informed decision.

4. GPs who have a conscientious objection can refuse work but they should not allow this to adversely affect patients' access to care.

Resources

  • GMC. Personal Beliefs and Medical Practice. 2008
  • GMC. 0-18 Years: Guidance for All Doctors. 2007
  • GMC. Good Medical Practice. 2006 www.gmc-uk.org/guidance/

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