Open Letter to the World Medical Association on Conscientious Objection

On 11-12 August the World Medical Association in conjunction with the American Medical Association is hosting a meeting of experts in Washington DC to discuss the International Code of Medical Ethics. Among other revisions to the code it is being proposed that the code include a paragraph on conscientious objection. The meeting will consider whether this should require any doctor who objects to make effective and timely referral to a doctor who does not object.

The following letter, signed by over 100 professors, directors of research centres, physicians and others concerned with medical ethics, urges the WMA not to impose an obligation on physicians to refer patients for procedures that the physician sincerely and reasonably considers unethical.

If you would like to co-sign the letter with them, you can do so here.

We the undersigned hold that to fulfil their professional duties to patients, to uphold the integrity of the medical profession, and to avoid harm to society as a whole, physicians must commit themselves to acting ethically in the practice of medicine and must always refrain from actions that they judge to be unethical. The duty of a physician to practise with conscience includes the duty not to act contrary to conscience.

A physician who, in good conscience, and in line with a reasonable body of medical opinion, judges a procedure to be harmful, discriminatory, unjust or otherwise unethical must not be placed under a professional, contractual or legal obligation to identify and refer to another healthcare professional who would provide the procedure. This stance is articulated and embodied in the WMA policy on euthanasia and assisted suicide which states that:

No physician should be forced to participate in euthanasia or assisted suicide, nor should any physician be obliged to make referral decisions to this end.

There are wider implications of making effective referral compulsory in the context of conscientious objection. For example, if a physician who objects in conscience to a legally-sanctioned medical procedure is obliged to identify and make effective referral to another physician who does not object, then in some jurisdictions a physician who objected to participation in “enhanced interrogation”, or to capital punishment, or to force feeding of a prisoner who is on hunger strike, or to “conversion therapy” could be forced to facilitate these procedures by effective referral. However, to require a conscientious objector to facilitate delivery of a procedure to which they have a serious ethical objection is a direct attack on their conscience and moral integrity.  

A principled conscientious objection is always to a procedure and not to a person. Physicians must not refuse to treat a particular patient or group of patients because of beliefs about them unconnected with the medical appropriateness of the procedure. In particular, physicians must not refuse to treat criminals or enemy combatants or refuse to treat the health consequences of the patient’s way of life, choices, or beliefs.

A physician must ensure that conscientious objection is exercised in a way that takes full account of their duty of care for the life and health of the patient. The physician should also seek to minimise any disruption of patient care. If a clinician cannot in good conscience provide what the patient requests, the physician should, where appropriate, respectfully explain the reasons for the decision and should, where appropriate, inform the patient of other options that are available to them, including the option to seek a transfer of care to some other healthcare professional. However, the physician is not ethically obliged to provide, and must not be coerced into providing, effective referral of a patient for procedures that the physician sincerely and reasonably considers unethical.

A list of signatories is given here: