Doctors can object to procedures, not specific patients, under revised religious discrimination bill

Doug Hendrie

12/12/2019 2:28:42 PM

RACGP President Dr Harry Nespolon cautiously welcomed the revisions, saying the college will ‘carefully consider’ the revised bill.

Christian Porter and Scott Morrsion
Attorney-General Christian Porter and Prime Minister Scott Morrison released the revised bill for public comment this week. (Image: AAP)

Under the revisions, conscientious objectors could refuse to provide treatments to which they objected on religious grounds, as long as the refusal is a blanket ban.
Speaking at a press conference, Attorney-General Christian Porter said the revised bill means it would be acceptable for a GP to, for example, refuse to ‘engage in hormone therapies’ for transgender patients broadly, but not for an individual patient only.
The revisions are intended to rule out discrimination, Mr Porter said.
‘What [the bill is] meant to do is protect people who establish and communicate a conscientious objection based on religious grounds to undertaking a certain procedure,’ he said.
RACGP President Dr Harry Nespolon cautiously welcomed the revisions, saying the college would ‘carefully consider’ the revised bill.
‘GPs should never be forced to participate in medical treatments where they have a conscientious objection,’ he told newsGP.  
‘It is best if patients know beforehand whether a GP objects to a particular treatment … usually done through signage in the practice or a conversation with the receptionist at the time of making an appointment.’
But Dr Nespolon stressed the need to have a plan in place for objecting GPs to refer patients to another GP. 
‘GPs cannot allow [conscientious] objection to impede access to legally available treatments,’ he said. ‘If a GP does conscientiously object then, ideally, they should refer the patient to another GP, preferably in the same practice or at least one nearby. This should be done in a timely and effective manner.’
‘I appreciate, however, that this does present ethical concerns for some GPs who view it as tantamount to not conscientiously objecting in the first place.’
The Medical Board of Australia’s Code of Conduct states that doctors should inform their patients if they hold a conscientious objection to a specific procedure, while ‘not using your objection to impede access to treatments that are legal’.
Associate Professor Mark Morgan, GP and Chair of the RACGP Expert Committee – Quality Care (REC–QC), has previously told newsGP that the best situation would be to refer to another GP in the same practice.
He suggested that GPs who conscientiously object should be ‘non-judgemental, empathic and sensitive with good communication’ while declining the request.
‘You want this person on side and to remain on side so the therapeutic relationship can be maintained, whether or not you’re actively involved,’ he said. ‘[I]f you are uncomfortable directly being involved in care, you have a duty to direct the patient to a provider of services.’ 
The revised bill may have other implications for GPs, as it will permit religious hospitals and aged care providers to consider a person’s faith when employing staff.
The revised bill is currently out for consultation until the end of January.

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Penny W   13/12/2019 2:06:57 PM

> ‘I appreciate, however, that this does present ethical concerns for some GPs who view it as tantamount to not conscientiously objecting in the first place.’

Tough! If you don't want to treat patients to the best of your ability, get out of the game. We take on the duty to not abandon care when we accept the privileges that go along with being a doctor. You can't have one without the other.

Dr Simon Holliday   13/12/2019 10:15:02 PM

Many people perceive GPs as morally authoritative and already fear being shamed. We already have considerable refusal powers. I have looked after one chap on a methadone programme 15 years. He is now being a great dad and working full-time. A year ago, I hoped to transfer his care to his local GP. He agreed to take this chap on and then rand back. The GP owner of the practice told him they didn't want that kind of patient at their practice and so the employed doctor was told to refuse to take on the methadone prescribing. I inquired in a de-identified fashion to the HCCC whether GPs could refuse to provide life-saving evidence-based medicine. The HCCC replied that doctors could indeed refuse to provide treatments freely (outside life-threatening emergencies).
For this reason, I feel the motivation for the Religious Freedom bill is populist branding rather than social need.

Penny W   16/12/2019 12:08:24 PM

Dr Simon:

As much as these stories are tragic, we still need to recognise that doctors must not be forced to provide service against their wishes or best interests. I have a right to not to see patients that are aggressive, disruptive, cause myself or the practice undue stress, or excessive financial burden.

We have fairly established in law however that one cannot abandon care, one must refer off if outside your comfort or experience.

The religious freedom bill removes even this duty, which is a step too far, and allows doctors to actively obstruct individuals in seeking to have their care needs met.

Dr Paul Vernon Jenkinson   18/12/2019 11:34:16 AM

Beneficence,non-maleficence,justice and autonomy are the principles all doctors are bound to adhere to.
They adhere to these principles within the boundaries of their own ethical framework.
If that ethical framework does not threaten harm within a society,and especially if it always seeks to protect,no person(including a patient) or body,especially government,has any right to cause any change by force of any type.
My belief is that this legislation is an opportunity for malicious change by
subsequent governments.
For a truly free society ,which is an ideal Western democracies strive for,a constant obsessive monitoring of this legislation will be essential.