{ The Current Situation Nathan O’Dea PGY2 Wollongong Hospital

 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

 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

1. Conscientious Objection is practical and more common than you realise 2. Conscientious Objection is a result of humility, not arrogance 3. Yes it is an act of omission, but conscientious objectors contribute to society 4. There is a wrong approach to conscientious objection – namely failing to inform, to support your stance or engage your peers. 5. The right way – know your stuff. 6. Conscientious objection is under threat  From new and proposed legislation  From within health institutions themselves The key points

 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

 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

 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

 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

 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

 Prima non-nocere is 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

 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

 Conscientious objection was once popular and expected in this country.  Abortion Law Reform Act of Victoria.  Reproductive Health (Access to Terminations) Bill  Reproductive Health (Access to Terminations) Bill  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

 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