Freedom of conscience must be respected as a right in itself, although safeguards must be put into place to ensure that the most vulnerable are not discriminated against through the premise of conscientious practice.
The Maltese Association of Psychiatry (MAP) recognises the imminence of the topic of conscientious objection, particularly given the stage at which the Equality Bill is presently being discussed at the Parliamentary Committee level. It also recognises that the inclusion of supremacy clauses within the bill in question will make it superior to other laws and as such, if a clause on conscientious objection is not included within this bill, it may be denied in practice later on despite being included in newer legislation.
However, given that psychiatrists, along with all other mental health professionals, work with some of the most vulnerable sectors of our society, they find themselves in an increasingly delicate situation when discussing the topic of conscientious objection.
The MAP would like to reiterate that it holds itself strongly against any argument which may deprive equal access to healthcare for minority patients including those diagnosed with mental illness or substance use disorders, those who identify as LGBTIQ, religious and ethnic minorities, and asylum seekers, even if these arguments are based on the premise of conscientious practice. Indeed, from the standpoint of holistic and responsible care, no arguments based on personal ethical convictions can supercedes the duties of doctors in tending to the needs of these minority populations.
It would therefore help to understand the intended meaning of conscientious objection. The ‘conscience’ is defined as a person’s moral sense of right or wrong, and serves as a guide to one’s behaviour. ‘Conscientious objection’ thus refers to one’s refusal to participate in or commit certain acts or behaviours after deeming them to be wrong. It entails a sense of ethical conviction. When one adopts a particular stance based on his conscientious beliefs, one should have arrived to such a stance through honest reflect of the values at play in the clinical scenarious being considered.
The practice of conscientious objection is thus evidently an inherently complex matter, particularly since it will inevitably be applied in sensitive clinical scenarios, such as end-of-life issues and requests for access to treatment. One is also free to adopt divergent beliefs, which indeed forms the cornerstone of the right for freedom of conscience. Diversity of opinion is reflective of a democratic and plutocratic society, which is to be commended. However we must ensure that this does not lead to some practitioners refusing life-saving treatment or basic access to healthcare on the basis of their own personal ethical convictions. This would inadvertently go against the very ethos of our medical professions and would go against the very code of ethics endorsed and enforced by the Medical Council.
In light of these considerations, and keeping our most vulnerable at heart, the Maltese Association of Psychiatry conditionally supports the clause proposed by the Medical Council on conscientious objection. Such a clause however needs to be clarified to include a clear definition of ‘conscientious objection’, setting out specifically which treatments or interventions can be conscientiously objected to as opposed to leaving it open to individual interpretation. The guidelines which are being drafted by the Medical Council must also ensure that the implementation of conscientious objection does not lead to abuse and discrimination of the most vulnerable. Psychiatrists remain determined in ensuring that our laws protect minorities, while ensuring that healthcare workers do not deviate from the good medical practice expected from our profession.