UK Expands Conscientious Objections in New Training Guides

Marcia Frellick

December 11, 2017

Updated trainee guidelines in the United Kingdom change the scope of conscientious objections allowed for trainees providing sexual and reproductive health services. They also address the way the objections should be handled.

Guidelines released December 7 by the Faculty of Sexual and Reproductive Healthcare (FSRH) state that any clinician who wants to opt out of care because of personal beliefs must agree to reveal these objections to their colleagues or employer so that other care arrangements can be made for patients. Those arrangements should in no way cast a value judgment on patients.

These guidelines cover all trainees whether they are pursuing a diploma or are seeking other general training through the Faculty.

A representative from the American College of Obstetricians and Gynecologists (ACOG) says the guidelines in the United States are similar.

Patient Care First

Asha Kasliwal, MBBS, MD, FSRH president, and Jane Hatfield, FSRH chief executive, explain the updated guidance in an editorial in BMJ Sexual & Reproductive Health.

The FSRH guidelines, which were previously updated in 2014, said healthcare professionals in the United Kingdom were within their legal rights to opt out of abortion care but said physicians and nurses must be able to provide all forms of contraception in order to be awarded the Faculty's diploma.

Criticism emerged from people who said that conflicted with some practitioners' personal beliefs and was discriminatory.

After discussions with members, a wide spectrum of views emerged, including objections to abortions and to fitting intrauterine devices as emergency contraception, as well as the belief that clinicians should respond to a patient's needs no matter what a clinician's personal beliefs are.

The FSRH acknowledged that it could not cover all controversial services with guidelines and recognized that clinicians' views may change over time.

"Finally we arrived at the key principle that a patient should never be put at any disadvantage as a result of the views of any healthcare professional they see," the authors write.

The crux of the updated guideline is this, "[W]e welcome members with a range of views, and we will award the relevant Faculty qualifications to those who fulfil all training requirements and are willing to show that they will put patient care first, regardless of their personal beliefs."

Sandra Carson, MD, ACOG's vice president of education, told Medscape Medical News, "We're very much in line with that," citing guidelines that have been in place since 2007. ACOG guidance focuses on physicians; the UK guidelines added nurses in 2014.

Dr Carson said ACOG believes patients have a right to the full range of services they are seeking but also believes a physician has a right to his or her own beliefs. When those things conflict, a physician is expected to refer the patient to a provider who can deliver the care.

"For residents it is in our educational objective to know about and perform abortions and also to know about and administer all types of contraception. If a resident has personal beliefs that would prevent him or her from doing that, then they can opt out. It would then be upon them to refer," she said.

She noted that residents' views may change as they progress through practice and as they listen to patients' stories. That can go both ways, she said, from wanting to perform more procedures to wanting to perform fewer.

As to whether the global view is shifting toward opt-out policies, she noted that others often look to countries like the United States and the United Kingdom when setting policy.

However, she said, "There's such a huge cultural and emotional aspect of when life begins and pregnancy termination and even the rights of the mother and father that it's hard to generalize from country to country."

The FSRH is a faculty of the Royal College of Obstetricians and Gynaecologists and an independent charity whose goals include advancing the education and training of healthcare professionals in sexual and reproductive healthcare.

The authors and Dr Carson have disclosed no relevant financial relationships..

BMJ Sex Reprod Health. Published online December 7, 2017. Extract

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