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Family doctors shouldn't be guided by their world view regarding treatment

Family doctor.
Family doctor. Source: ERR

In Tallinn, a young doctor working as a family physician would not prescribe the contraceptive pill due to their religious beliefs, and was forced to quit the position. According to Tartu University's professor Ruth Kalda, doctors have the right to a personal world view but are not permitted to make medical decisions based on these beliefs.

Tallinn Family Health Centre (Tallinna munitsipaalperearstikeskus) discovered that the physician, reportedly a Roman Catholic, had not prescribed the contraceptive pill to many patients, only a couple of weeks after their recruitment, ETV's current affairs show "Aktuaalne kaamera" reported. 

"It turned out that the doctor had some personal insights about some matters, for example about family planning. What made it most worrying, is that because the doctor was for replacement, we could have redirected some of the unpleasant tasks to a college," Tallinn Family Health Centre's chairman of managing board Monika Haukanõmm said. 

It is unclear to Haukanõmm why the doctor couldn't talk about the fact that there are medical decisions that don't fit with the doctor's beliefs right when the doctor was assigned to the position.

"When working as a doctor, you are still informed that it is associated with subjects that might not fit with your values and doctors should make all decisions based on that," the health center's chairman said.

According to Haukanõmm, medics with these kind of beliefs should rather work in either radiology or another specialty, where these kind of ethical dilemmas don't rise. She hopes that a student will consider it when making the specialty choice.

Haukanõmm notes that in medicine, the patient's rights are paramount.

"A doctor can't forget about a patient's right to gain the best modern treatment and not endanger a patient's life. This can't be forgotten and because of that a doctor needs to make the decisions based on medical principles rather than bringing in religion and other principles," the professor said.

According to Kalda, a doctor can decide that they are not able to make that medical decision, but in this case, the patient needs to be directed to another doctor; the patient can't simply be left without help.

Kalda emphasized that a patient's right to gain modern treatment is included in the Medical Code of Ethics and multiple laws, and the patient has the right to decide about his or her treatment. The doctor is only allowed to refuse treatment if the treatment that the patient wishes will endanger his or her health.

The health board can't say how serious of a problem it is because they only investigate specific complaints.

"There are some specific cases, where doctors have decided to not write some specific prescriptions but I don't have any knowledge about leaving people without help," head of the Health board's health care service department Pille Saar said.

According to Saar, family physicians have to follow the instructions and, for example, if a doctor doesn't extend the prescription of the contraceptive pills or doesn't vaccinate a child, he or she needs to find a new occupation.

"If values or religious principles are disturbing the doctor in their everyday work of providing evidence-based treatment, then I think that the consideration should be made that what is the way forward and if they can continue working as a doctor," Ruth Kalda said.

According to Kalda, quitting the position of a doctor is not justified when there is a single procedure which they are against, resulting from their world view, such as abortion, but are following medical instructions. However, in this case, the patient must be directed to one of their colleagues.

According to Saar, the lifelong registration of a doctor should be discussed. "So you graduate from university and your education is going to be registered, even though maybe you haven't worked for ten years; maybe your beliefs are evolving," Pille Saar noted.

According to Ruth Kalda, this would mean additional work and bureaucracy, meaning this idea should be carefully considered.

The competence of family physicians is already being tested, but this is voluntary. According to Kalda, 75-80 percent of family doctors are involved in the competency testing project.


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Editor: Roberta Vaino

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