Recent press articles have followed the story of a doctor reported to the GMC for sharing his religious beliefs with a patient. There has been a mixed reaction: some people are outraged that a doctor should presume to mention religion within the confines of a consultation; others see no harm and argue that, on occasion, religious guidance might be helpful.
Paragraph 33 of the GMC’s ‘Good Medical Practice’ provides:
“You must not express to your patient(s) your personal beliefs, including political, religious or moral beliefs, in ways that exploit their vulnerability or that are likely to cause them distress”.
That does not constitute an absolute bar on a doctor talking to a patient about his faith; the prohibition is on doing so in a way that is exploitative or causes distress. For the doctor, the practical question is what is the GMC, as the regulator, to make of it?
In this article we consider both sides of the argument.
A doctor’s primary duty, enshrined in ‘Good Medical Practice’, is to act always with integrity and in the best interests of the patient. Clearly the overriding requirement is to provide appropriate clinical care. It could be argued that a GP is also expected to treat each patient holistically, as an individual with mental, emotional and social – as well as physical – needs. Why then should he not take account of what he perceives to be spiritual needs?
No one would dispute that a doctor should act, wherever possible, to alleviate pain and distress, whether or not a “cure” for the underlying condition is available. There is little doubt that, for some patients, the assurances offered by religion can alleviate distress (which is why many hospitals, hospices and the armed forces engage chaplaincy services). If, therefore, in the context of an incurable condition (whether physical or mental), a GP considers that a conversation about faith is in the patient’s best interests, it is difficult to criticise him for engaging in that discussion.
It goes without saying that a doctor must not use his professional position to establish or pursue an improper relationship with a patient. It should be equally obvious that a doctor should not use a patient’s vulnerability as an opportunity to promulgate his own religion. A GP must not impose his views on a patient; he is, however, free to discuss any matter with the patient, so long as he has the patient’s express or implied consent.
Similarly, if a doctor were to suggest that a competent patient might be assisted by exploring religion through a particular person or organisation, can that really be said to be unacceptable, or is it analogous to a recommendation that a patient seek counselling or join a support group?
Those who see the GMC’s investigation as heavy handed might well conclude that, if a GP adheres to the primary principle of treating patients with integrity, and provides, first and foremost, good clinical care in the patient’s best interests, everything else is a matter of professional discretion.
On the other side will be those who vehemently contend that religion has no place in medical care, and a doctor who introduces it into the surgery should face severe sanctions.
The GMC, with the aim of clarifying matters, has produced detailed supplementary guidance. The guidance identifies that discussing personal religious or moral beliefs can create a risk of a patient feeling judged by a GP, which would restrict the degree of openness that would otherwise exist. It would also be unacceptable for a GP to offer his own views to a vulnerable patient (whether adult or child) who may be disproportionately influenced by them.
This side would contend that if a patient is in such an extreme condition that a GP perceives a need for spiritual help, that patient is necessarily vulnerable. The patient will almost certainly be open to influence from a professional carer and adviser, who is in a position of trust and perhaps perceived authority.
It is not enough to say that a doctor is free to discuss religion and need desist only if the patient objects. Many patients would not feel able to object, and many would not have an awareness of the boundary between the doctor’s expertise (in the medical arena in which he has been consulted) and his personal beliefs (in the religious sphere in which he has not).
The guidance makes clear that a GP must be prepared to set aside his own personal beliefs where it is necessary to serve the patient’s best interests. The difficulty is that a doctor with firm religious views is unlikely to think that a similar measure of faith is contrary to his patient’s interests. It could be argued, therefore, that he is incapable of deciding whether a conversation about religion will truly benefit the patient.
There is no doubt that this is a difficult issue. The doctor at the heart of the current controversy is facing a Fitness to Practise hearing. Whatever the outcome of that, one thing is certain; the GMC’s decision will not be universally accepted and neither will it bring the debate to an end. Many commentators, especially those with strong religious views, will continue to defend a doctor’s right to discuss his beliefs with his patients. Perhaps a salutary thought is that they would be the most offended by a doctor who encouraged their family or friends to explore a religion which is different from their own.