Introduction
1. Beliefs and values, and cultural and religious practices are central to the lives
of doctors and patients. All doctors have personal beliefs that affect their
day-to-day practice. Some doctors’ personal beliefs may give rise to concerns
about carrying out or recommending particular procedures for patients.
Patients’ personal beliefs may be fundamental to their sense of well-being
and could help them to cope with pain or other negative aspects of illness or
treatment. Personal beliefs may also lead patients to ask for procedures that
others may not feel are in their best clinical interests, or to refuse treatment.
2. This statement explores the ways the Council expects doctors to approach
some of the issues arising from their personal beliefs and those of their
patients. It attempts to balance doctors’ and patients’ rights – including the
right to freedom of thought, conscience and religion, and the entitlement to
care and treatment to meet clinical needs – and advises doctors on what to
do when those rights conflict.
3. While the Council does not impose unnecessary restrictions on doctors, we
expect doctors to be prepared to set aside their own beliefs where this is
necessary in order to provide care in line with the principles outlined in Good
medical practice.
Doctors’ personal beliefs and patient care
4. Your first duty as a doctor is to make the care of the presenting patient your
first concern, whatever their medical need. Patients are entitled to expect that
you will offer them good quality care based on your clinical knowledge and in
accordance with this statement.
5. Investigations or treatment should be provided on the basis of the
assessment you and the patient make of his or her needs and priorities, and
on your clinical judgement about the likely effectiveness of the treatment
options.1
6. You must not allow any personal views that you hold about patients to
prejudice your assessment of their clinical needs, negatively affect your
relationship with them or delay or restrict their access to care. This includes
where you believe that the patient’s actions have contributed to their condition
as well as your views about their age, culture, disability, ethnic or national
origin, gender, lifestyle, marital or parental status, race, religion or beliefs,
sex, sexual orientation, or social or economic status.
1 Good medical practice, clause 21
7. You should not normally discuss your personal beliefs with patients. You
must not impose your beliefs on patients, or cause distress by the
inappropriate or insensitive expression of religious, political or other beliefs or
views. Equally, you must not put pressure on patients to discuss or justify
their beliefs (or the absence of them). Recognise when your actions might
not be acceptable or might be offensive to patients2.
8. However, you must advise patients – both in person and in printed materials
such as practice leaflets – about any treatments or procedures that you
choose not to provide or arrange because of your personal beliefs, but which
are not otherwise prohibited.
9. Challenge colleagues if their behaviour does not comply with this guidance.
Ensure patients receive all the information they want or need
10. Give patients all information they want or need to know about:
• Their condition and its likely progression.
• Treatment options, including expected risks, side effects, costs and
benefits3.
11. You must not withhold information about the existence of a procedure or
treatment because carrying it out or giving advice about it conflicts with your
personal beliefs.
12. If you have an ethical concern about providing a service that is not prohibited
by law or a statutory code of practice, you should be aware of who else in
the area can provide this service. You should advise patients who request
this service of the options available to access the service.
13. In such cases you must tell patients of their right to see another doctor with
whom they can discuss their situation and must ensure that they have
sufficient information to exercise that right. In deciding whether the patient
has sufficient information, you must explore with the patient what information
they already have, and what information they may need.
Making a referral
14. If the patient cannot readily make their own arrangements to see another
doctor you must ensure that arrangements are made, without delay, for
another doctor to take over his or her care. You must not obstruct patients
from accessing services or leave them with nowhere to turn. Ensure that your
staff understand and comply with this guidance.
15. Work with colleagues in ways that best serve the presenting patients’
interests4.
16. If you refer the patient, ensure that the practitioner you refer to has
appropriate training, expertise and experience and is able to provide the
services requested with appropriate care and skill in accordance with this
guide.
2 Statement on cultural competence, clause 15c
3 Good medical practice, clause 13. For more information, refer to the Council’s statement on
Information and consent.
4 Good medical practice, foreword.
17. Whatever your personal beliefs may be about the treatment or procedure in
question, you must be respectful of the patient’s dignity and views.
18. Take steps to ensure the patient’s privacy is respected and protected.
19. The local funding agency should ensure that all the costs to the patient of
travelling outside the area for services are met when there is no other
practitioner in the area who can provide that service. Advise the patient
about how to access that funding.
20. If your role involves arranging treatment or carrying out procedures that
conflict with your personal beliefs, you should explain your objection to your
employer or contracting body. You should explore constructively with them
how to resolve the difficulty without compromising patient care, and without
placing an unreasonable burden on colleagues5.
Advance directives
21. Always respect a patient’s wishes expressed in an advance directive, unless
the patient is being treated under specific legislation such as the Mental
Health (Compulsory Assessment and Treatment) Amendment Act 1992.
Advance directives have legal standing under the Code of Health and
Disability Services Consumers’ Rights. If you hold a moral objection, you
should transfer responsibility for the patient to another doctor6.
Patients’ personal beliefs
22. Trust and good communication are essential components of the doctorpatient
relationship. You must respect patients’ rights to hold religious or
other beliefs and should take those beliefs into account where they may be
relevant to treatment options. However, if patients do not wish to discuss
their personal beliefs with you, you must respect those wishes.
23. Demonstrate the ability to work with the patient’s cultural beliefs, values and
practices in developing a relevant management plan7. Work in partnership
with patients by:
• Listening to them and responding to their concerns and preferences.
• Respecting their right to reach decisions with you about their
treatment and care8.
• Making sure the patient agrees before you provide treatment or
investigate their condition.
24. Respect the patient’s right to decline treatment9.
25. Occasionally, when people are unable to comment or refuse to consent to
treatment, a legal opinion should be sought whether to seek authority from
the High Court. Such cases may include:
5 Refer to the Council’s statement on A doctor’s duty to help in an emergency for guidance on
what your responsibilities are when urgent care is required.
6 Good medical practice, clause 24
7 Statement on cultural competence, clause 15d
8 Good medical practice, foreword
9 Good medical practice, clause 15
(a) a blood transfusion or caesarean section to save life; or
(b) termination of treatment to allow the patient to die peacefully,
for example patients in permanent vegetative states; or
(c) sterilisation of a patient who is unable to consent but for whom
the family and other carers, supported by medical opinion,
request the operation to enhance the quality of life of the
patient and prevent deterioration in his or her physical or
mental health10; or
(d) a dispute between parents about the treatment to be provided
to a child.
Specific requirements relating to contraception and abortion
26. The Contraception, Sterilisation and Abortion Act 1977 sets out the
procedures and requirements for an abortion as well as the responsibilities of
medical practitioners. If you work in a field where you are likely to encounter
patients requesting an abortion, you should make yourself familiar with this
Act.
27. While the Council recognises that you are entitled to hold your own beliefs, it
remains your responsibility to ensure that a pregnant woman who comes to
you for medical care and expresses doubt about continuing with the
pregnancy is provided with or is offered access to objective information or
assistance to enable her to make informed decisions on all available options
for her pregnancy including termination.
28. If you object on the grounds of conscience to providing advice or other
services with respect to contraception, sterilisation, abortion or other
reproductive health matters you are required, under section 174 of the Health
Practitioners Competence Assurance Act 2003, to inform the person
requesting the service that he or she may obtain that service from another
health practitioner or a family planning clinic. In doing so, you must ensure
that the referral is timely and complies with the guidance outlined in
paragraphs 14-20 of this document.
29. If a funder or employer decides to fund an abortion or contraception service,
do not allow your personal beliefs to interfere in the implementation of that
service.
30. You have no legal or ethical right to refuse to provide medical care to a
patient who is awaiting or has undergone a termination of pregnancy, on
grounds of a conscientious objection to the procedure. The same principle
applies to the care of patients before or following any other procedure from
which you have withdrawn because of your beliefs.
31. Access to abortion is not restricted on grounds of age11. The consent of a
parent or guardian is not required in order for a child or young person to
access abortion information or services. However, that young person must
receive the same counselling and approval by a certifying consultant as any
other woman seeking an abortion.
10 Council’s statement on Information and consent, clause 18
11 The Care of Children Act 2004.
32. There is no restriction on a doctor giving contraceptive advice, or prescribing
contraception to people under the age of 16, without consent from their
parents. Minors have the same right to privacy as any other person.
Male infant and pre-pubescent circumcision
33. You should use your professional judgement when a request is made for
routine infant and pre-pubescent male circumcision. While the preference of
the parents and their cultural and religious beliefs are important, factors like
the best available evidence regarding potential benefits and complications,
alternatives to this intervention and the child’s best interest should be
discussed with the parents.
Female circumcision
34. Female genital mutilation – sometimes referred to as female circumcision – is
a serious crime and also a child protection issue, whether undertaken in the
New Zealand or abroad. You must decline to perform these procedures and
must refuse to refer the patient to any other person or the purpose of having
these procedures performed. If you learn that such a procedure has been
performed or is being contemplated you must notify appropriate child
protection or law enforcement agencies. If you treat a patient who has
undergone these procedures, treat them with sensitivity and compassion.
Other relevant Council resources
• Good medical practice
• Statement on cultural competence
• Information and consent
• Cole’s Medical practice in New Zealand
The Medical Council of New Zealand also acknowledges the work done by the
General Medical Council in this area, particularly its resource booklet “Personal
beliefs and medical practice”.
March 2009
This statement is scheduled for review by March 2014. Legislative changes may make this statement obsolete
before this review date.
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