Submission to the World Medical Association Re: International Code of Medical Ethics revision

Abstract

This submission responds to the World Medical Association (WMA) request for public feedback about a proposed revision to the International Code of Medical Ethics (ICME). Amendments to Paragraphs 14 (Patient-centred practice) and 27 (“Conscientious objection”) are the principal concern.

Paragraph 14 (Patient-centred practice) expresses the central principle of the ICME. Current controversies about freedom of conscience in health care frequently manifest fundamental disagreement about the meaning of terms used here: “care”, “health”, “well-being” and “best interest.” The Project recommends that “care” be replaced with “recommendations and treatment.”

What is thought to be in a patient’s “best interest” can be disputed for a variety of legitimate reasons. The ICME should indicate the role and obligations of physicians by specifying that recommendations and treatments must be only those a physician “believes in good faith” to be in a patient’s best interest, “belief” making clear that the judgement is that of the physician, and “good faith” indicating reasonableness, good will and absence of duplicity, prejudice or discrimination.

The proposed text of Paragraph 27 (“Conscientious objection”) is anomalous in relation to medical practice because it ignores the role of conscience in medicine and adopts an inadequate and prejudicial analytical framework. It does not attempt or even suggest how to accommodate physician integrity and patient requests when they conflict. It is also anomalous in relation to existing WMA policy and related functionally interdependent paragraphs in the proposed ICME.

The Project proposes an amended Paragraph 27 that

∙ reflects the role of conscience in medical practice;
∙ identifies conduct morally relevant to participation in contested procedures;
∙ recognizing the potential for conflict between physicians and state or other authorities, brings other provisions of the ICME into play;
∙ includes brief guidance about physician obligations to provide information and ensure patient safety and continuity of care.

The Project recommends that the ICME be supplemented by WMA policy on physician freedom of conscience. It strongly urges that a planned WMA conference should focus on conscience in medical practice, not "conscientious objection."

Keywords: conscience, referral