The Current Situation

1. The Current Situation Nathan O’Dea PGY2 Wollongong Hospital

2. Just starting out… • Eight years of study • Four years of undergraduate study including an honours year • Four years of Post Graduate Study • Twelve months of Internship • Expect five years to specialise • A decade since leaving school – still very early days • Surprising result of early days in medicine • Expectation to practice outside of what one ought • Aggression against well-meaning practitioners Starting out

3. Declaration of Geneva • Promulgated by the United Nations in 1948 • A response to the collaboration of doctors in atrocities in Fascist Europe • Easy messages • Give due respect to teachers • Keep the patient’s health and life as the first priority • Difficult and unpopular messages • Respect life from its conception, even under threat • Not to use the profession in a way contrary to the laws of nature Starting out

4. Conscientious Objection is practical and more common than you realise • Conscientious Objection is a result of humility, not arrogance • Yes it is an act of omission, but conscientious objectors contribute to society • There is a wrong approach to conscientious objection – namely failing to inform, to support your stance or engage your peers. • The right way – know your stuff. • Conscientious objection is under threat • From new and proposed legislation • From within health institutions themselves The key points

5. Affirmation to others who are just starting out. • There is no choice to be made between conscience objection and practice of medicine. • Keep focus on the relief of human suffering – be conscious of the pathology that is being treated. • Conscientious Objection requires fortitude. the key message

6. Medicine uniquely enjoys self regulation. • The foundation of this is beneficence. • The profession believes in conscientious objection. • Australian Medical Association (AMA) Code of Ethics • Medical Board of Australia Good Medical Practice • Royal Australian and New Zealand College of Obstetricians and Gynaecologists Where do we stand? The profession

7. Plenty of current examples • Not merely the ‘big ticket’ items • How would you respond if you were, • A medical student required to implant contraceptives? • An Intern required to comply with withdrawal of medical treatment from an elderly patient? • A resident who has been asked by your patient to write a medical certificate for convenience? • A resident whose job it is expected to prepare and assist at terminations of pregnancy? • All of these occurred to myself or someone close to me 1. What conscientious objection looks like today

8. No longer a concept of human suffering • That is, no longer a concept of human pathology vs. normal human physiology • Conscientious objectors are often attacked for being selfish, obstructionist, arrogant etc. • Conscientious objection – recognising what you ought not to do. • Recall the Declaration of Geneva – a doctor is obliged to not use their knowledge against the laws of nature • Real arrogance in medicine is when using your skills outside of the relief of human suffering. 2.Conscientious objection is borne out of humility

9. The act is negative, but the contribution to society positive • The patient’s health and life is at the centre of your thought • Conscientious objection is difficult – powerful vested interests are challenged 3.Contribution of a conscientious objector

10. Prima non-nocereis appropriately protected by conscientious objection • Should not distract you from beneficence • Looking for a fight • Failing in your profession is opposes the principle of conscientious objection 4. The wrong way to be a conscientious objector

11. Be transparent – be ready to declare your objection • Be a good professional first and proficient in your field • Have the correct synthesis behind your arguments 5. The right stuff

12. Conscientious objection was once popular and expected in this country. • Abortion Law Reform Act of Victoria. • Reproductive Health (Access to Terminations) Bill 2013.  • A doctor’s conscience is no only longer welcome - it is punished. • There has been a decline in our status as a profession. • These new laws represent a challenge to our being • Parliamentarians are using their conscience vote to deny conscience to health care workers. 6. Conscientious objection is under threat

13. Conscientious objection is practiced by your workmates everyday - it is a practical exercise. • There are others before you who have not had to compromise their conscience to practice medicine. • There is a wrong way to be a conscientious objector. • The proper approach is to be professional, transparent, consistent and considered. • The health professions conscience is under threat – it will require strength to practice humbly with in the bounds of your profession and according to your oath. summary