A few months ago it was the directive that nurses had to declare their “white privilege”
before attending to their patients. NOW The Medical Board of Australia
draft code of conduct that will apply to all Australian doctors
requires doctors to be “culturally safe” and comply with a patients’
beliefs about gender identity and sexuality, with no provision given for
a doctor to differ in their professional judgements.
“….We are concerned with the
possible interpretation of ‘culturally safe’, that it should not impact
on good health outcomes and good medical practice”, the group has
stated. “We are concerned that ‘respectful practice’ is significantly
different to ‘respectful of the beliefs and cultures of others’ and that
this change also could impact on good health outcomes.
“Respect for a patient does not
equal respecting ‘cultural beliefs and practices’ that may be
antithetical to good medical practice.”
Other possible areas of conflict
relate to treating Body Dysmorphic Disorder, dealing with patients
affected by Islamic cultural issues (such as female genital mutilation
and child marriage), and with issues stemming from indigenous cultural
practices, such as sub-incision and pay-back…”
“…The Medical Board of Australia
draft code of conduct that will apply to all Australian doctors requires
doctors to be “culturally safe” and comply with a patients’ beliefs
about gender identity and sexuality, with no provision given for a
doctor to differ in their professional judgements. A doctors’ group
convened by Dr Lachlan Dunjey of Perth, has expressed concern for the
future of medicine in Australia in light of the changes.
“We are concerned with the possible
interpretation of ‘culturally safe’, that it should not impact on good
health outcomes and good medical practice”, the group has stated. “We
are concerned that ‘respectful practice’ is significantly different to
‘respectful of the beliefs and cultures of others’ and that this change
also could impact on good health outcomes.
“Respect for a patient does not
equal respecting ‘cultural beliefs and practices’ that may be
antithetical to good medical practice.”
Dr Dunjey hopes language of the
2009 Code of Conduct remains unchanged in the new version: “‘Culturally
safe’ does not necessarily equate to medically safe … ‘Respecting’ can
be taken to mean agreeing with, affirming, and accepting that we cannot
challenge false medical belief and inappropriate treatment.”
“To actually achieve good medical
outcomes for patients, doctors have to be free to challenge difficult
problems that patients might seek to avoid, such as “excess weight,
excess alcohol, dangers of sexual behaviours – at the very least to tell
medical truth”, he said.
Other possible areas of conflict
relate to treating Body Dysmorphic Disorder, dealing with patients
affected by Islamic cultural issues (such as female genital mutilation
and child marriage), and with issues stemming from indigenous cultural
practices, such as sub-incision and pay-back.
The other point of contention
concerns access to medical care and making sure doctors do not
discriminate against patients on what are described as “medically
irrelevant grounds”. These guidelines include “race, religion, sex,
gender identity, sexual orientation, disability or other grounds, as
described in anti-discrimination legislation.”
The group has expressed concern over
the addition of gender identity and sexual orientation to this list.
One of the reasons for questioning this provision, Dr Dunjey says, is
that the term “medically irrelevant” is not appropriate for the
additional grounds.
“Gender identity is relevant in so
many ways, including age, experience, psychological factors and, last
but not least, any possible therapeutic intervention, both medical and
surgical, with life-long outcomes and consequences. Likewise, sexual
orientation is also medically relevant preventively and therapeutically
with regard to past and current sexual practices.”
The group believes the wording of the 2009 version of the Code is ethically sound and should therefore not be changed.
The doctors insist that “a good
health outcome is what we are about. It is intrinsic to good medicine
and Good Medical Practice.”
It is also unclear whether doctors
will be compelled to act contrary to their own conscience regarding
patient requests for referrals. Labor MPs in Queensland, including
Deputy Premier Jackie Trad, have demanded that Queensland doctors be
compelled to refer women for an abortion, and thus violate the
conscientious beliefs of many doctors.
What is clear is that the new
guidelines will have a chilling effect on the freedom of doctors to
publicly debate the merits of medical treatments. Section 2.1 of the
code warns doctors,
“you need to acknowledge and
consider the effect of your comments and actions outside work, including
online, on your professional standing… you should acknowledge the
profession’s generally accepted views… when your personal opinion
differs”
The Medical Board is already
bringing an Australian GP before the Medical Board for retweeting on
Twitter. If the Code of Conduct is changed, this would stifle free
speech and debate. The threat of deregistration would silence dissenting
doctors who speak out — or even retweet — on debatable topics.
According to the Code of Conduct
(1.2), “serious or repeated failure” to meet its standards may result in
a doctor losing the right to practise medicine.
The draft Code can be accessed on
the Medical Board of Australia website via this link. The public can
provide written submissions by email, marked: ‘Public consultation on
Good medical practice’ to medboardconsultation@ahpra.gov.au by close of
business on August 3, 2018…”