A shared faith?

THE issue of doctors discussing their faith with patients is a contentious one and it has sparked intense debate on all sides.

It made headline news in May 2011 when a complaint was made to the General Medical Council by the mother of a 24-year-old man about a GP in the south of England. She claimed the doctor had pushed religion on her son by discussing Christianity with the vulnerable young patient. The GMC investigated the complaint and issued a formal warning to the doctor, stating that his actions risked “bringing his profession into disrepute”.

The doctor has since challenged the warning – which would remain on his record for five years – and denies abusing his position but he may now face a GMC fitness to practise hearing. The case raises important questions for doctors. Consider the following scenario:

“I just feel so confused, why would this happen to me, to my child? I can’t make sense of it. It’s so unfair!” Tears stream down Mrs Brown’s face. She made the appointment to get a fit note to excuse her from work. Her 11-year-old daughter Jasmine had recently been admitted to hospital for investigations and she had just received the diagnosis of Crohn’s disease.

As an ST3 I know it’s part of my role as her GP to listen to Mrs Brown’s concerns and expectations regarding her daughter’s condition and to provide information and advice. But how far should my support for her go? She is clearly psychologically distressed and counselling may help her come to terms with the diagnosis. However, as a Christian it is my personal belief that she could also find spiritual comfort in the knowledge that there is a God who cares for her and her daughter. Should I say anything about this? What is the right thing to do?

Rights and responsibilities

Just like everyone else, doctors have their own cultural and individual core values and personal belief systems which affect their day-to-day practice. These values can at times conflict with the views of patients, and may give rise to concerns about carrying out or recommending particular procedures.

Referring a pregnant patient for a termination procedure or prescribing contraception are examples of clinical situations where doctors can be conflicted between their duty of care to their patient and their own views. Doctors are entitled to basic human rights including freedom of thought, conscience and religion. But patients also have entitlements to care and treatment to meet clinical needs.

So what is the right thing to do in a situation where your own personal beliefs conflict with a patient’s rights? It is important to be aware of the GMC’s guidance on this matter in Good Medical Practice and also in the supplementary guidance Personal Beliefs and Medical Practice.

The guidance is very clear regarding doctors’ personal beliefs: “You must not allow any personal views that you hold about patients to prejudice your assessment of their clinical needs or delay or restrict their access to care. This includes your views about a patient’s age, colour, culture, disability, ethnic or natural origin, gender, lifestyle, marital or parental status, race, religion or beliefs, sex, sexual orientation, or social or economic status.”

Personal beliefs, therefore, must not influence assessment of clinical need or delay or restrict access to care. So if a patient requests a termination, must a doctor make that referral even if it conflicts with their own personal beliefs?

The guidance explains that patients have a right to be given information about their condition and the options available to them. It states:

“Patients may ask you to perform, advise on or refer them for a treatment or procedure which is not prohibited by law or statutory code of practice but to which you may have a conscientious objection. In such cases you must tell patients of their right to see another doctor with whom they can discuss their situation and ensure that they have sufficient information to exercise that right.”

Where patients are not able to make their own alternative arrangements, the guidance clearly highlights the doctor’s duty to ensure arrangements are made, without delay, for another doctor to take over their care. The guidance warns doctors – regardless of their personal beliefs – not to obstruct patients from accessing services or leave them with nowhere to turn, and to always respect their views.

The same duty of openness that is expected of doctors in person also covers printed information such as practice leaflets. Literature must detail any treatments or procedures that you may have chosen not to provide or arrange due to a conscientious objection, but which are not otherwise prohibited.

So in the case of a doctor with a conscientious objection to termination, he or she clearly has a duty to inform the patient of the treatment options available and make the necessary arrangements for her to access the care she is entitled to. For trainees, in practical terms, this would involve discussing the matter with your GP trainer and coming to an agreement as to how to manage this situation appropriately. It is always better to discuss this hypothetically before it arises in a live consultation.

A fine line

And now for Mrs Brown – should the doctor disclose her faith in an attempt to support the patient through this difficult time in her life? The guidance from the GMC is very clear on this matter in warning doctors that they must not talk to patients about their personal beliefs – whether they are political, religious or moral – in a way that might exploit their vulnerability or cause them distress.

However it then goes on to state that, for some patients, acknowledging their beliefs or religious practices might form an important part of a holistic approach to their care. In some cases, discussing personal beliefs in a sensitive way may be beneficial and allow the doctor to work in partnership with the patient to address their treatment needs.

But there is a fine line to be tread. On the one hand, doctors are advised to respect patients’ rights to hold religious beliefs and to take those beliefs into account whenever they may be relevant to treatment options. But on the other hand, doctors must respect a patient’s wishes if it is clear they do not want to discuss personal beliefs.

Back when I was a trainee I was advised by my trainer to use this gem of an open question that I have employed many times since: “Do you have a faith that would help you cope at a time like this?”

This question allows the doctor to sensitively explore the patient’s own beliefs, if they wish to share them, without imposing their own beliefs on to a patient when they are feeling most vulnerable.

If Mrs Brown were to answer yes to this question, the doctor could explore the support her faith could provide her. If she says no and has no interest in such things then that is the end of the matter. Either way her wishes are respected.

Dr Susan Gibson-Smith is a medico-legal adviser at MDDUS