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Submission from CMF to the 'Core Values Initiative' of the Medical Profession

Published: 5th July 1995

Introduction

Christian Medical Fellowship is interdenominational and has as members well over 4,000 British doctors who are Christians and who desire their personal and professional lives to be governed by the Christian faith as revealed in the Bible. We have members in all branches of the profession and regularly make submissions on a whole range of ethical matters to Governmental and other bodies.

We welcome the opportunity to comment on the 'Core Values Initiative' and set out in full here our own Affirmation on Christian Ethics in Medical Practice as the basis from which we make our subsequent brief comments:

We are accountable to God in all we do and, therefore, we shall endeavour to conduct our private and professional lives in accordance with the standards of Christ:

In Relation to Human Life

1. To acknowledge that God is the Creator, the Sustainer and the Lord of all life.
2. To recognise that man is unique, being made in the 'image of God', and that he cannot be healthy in body and mind unless he lives in harmony with the natural worm around him, which he neither ignores nor exploits.
3. To promote a sense of vocation in the work by which men serve one another, and to honour and recommend the Creator's rule of one day's rest in seven.
4. To maintain the deepest respect for individual human life from its beginning to its end, including the unborn, the helpless, the handicapped and those advanced in age.
5. To uphold marriage as a lasting bond, being the divinely appointed means for the care of children, the security of the family and the stability of society.
6. To recognise that sexual intercourse is intended by God only for the marriage relationship and, hence to advocate premarital continence and marital fidelity.

In Relation to Patients

1. To give effective service to those seeking our medical care irrespective of age, race, creed, politics, social status or the circumstances which may have contributed to their illness.
2. To serve each patient according to his need, subordinating personal gain to the interest of the patient and declining to take part in collective action which would harm him.
3. To respect the privacy, opinions and personal feelings of the patient and to safeguard his confidences.
4. To speak truth to the patient, as he is able to accept it, bearing in mind our own fallibility.
5. To do no harm to the patient, using only those drugs and procedures which we believe will be of benefit to him.
6. To maintain as a principle that the doctor's first duty is to his patient, whilst fully accepting our duty to promote preventive medicine and public health.

In Relation to Colleagues

1. To deal honestly with our professional and administrative colleagues and to fulfil those just requirements of the State, which do not conflict with these basic ethical standards.
2. To work constructively with colleagues in scientific research and in training doctors, nurses and paramedical workers, for the benefit of individual patients and the advance of health care throughout the world.

General Comments on the 'Core Values' Report

It follows from the Affirmation above, which represents our 'core values' and has much in common with the Report, that we warmly welcome the 'Core Values Initiative'. We are glad it has been set up and are generally very supportive of its wide-ranging review.

Others have commented that the consultation involved a rather narrow spectrum of the profession only, but we recognise that the ongoing initiative will involve the profession at large, other health care professions, representatives of the patients' perspective etc, and we would welcome the opportunity to be involved more specifically in future.

We are pleased to see that the Report acknowledges that we have moved away from the era of 'doctor paternalism' towards one of 'patient autonomy', and that it further recognises that the best health care involves a partnership. This has been well described as 'a partnership between two experts: between the doctor, who is an expert in her own specialty, and the patient who is an expert in two things - how he feels, and what he wants'. We endorse this partnership model, but are anxious to maintain the fight balance, and some of our specific comments below reflect this concern.

It is against this background of warm general support that we make the following specific criticisms and suggestions, which are intended to be as constructive and positive as possible.

Specific Comments on the 'Core Values' Report

1. We find the Report too vague on the substance of ethics

We fully recognise that in two days the Consultation could not possibly have gone into detail on ethical principles and practice, but nevertheless must draw attention to the vagueness of the expression (p3) 'ancient virtues distilled over time'. Despite the examples quoted of some of these 'basic and ancient virtues', we think the discussion of this whole area lacks substance.

This is not the place for a technical discussion of 'virtue ethics', nor to document the evidence that ethical principles have over time been diluted rather than distilled, but we feel strongly that the final conclusions of the 'Core Values Initiative' must be more disciplined and detailed on ethics.

2. We commend the emphasis on ethics in undergraduate education and continuing professional development

We are delighted to note (p11) that 'Medical education should provide... ethical commitment', but would repeat our point: What ethics? We believe the Judaeo-Christian tradition provides the best basis, and would generally endorse, for example, the Declaration of Geneva in its original form as an appropriate expression of a Code of Ethics.

We fully support the suggestion (p 14) that 'Consideration should be given to all new graduates taking a formal oath at the time of graduation based on the Hippocratic ideal and binding them to respect for human life and the service of their patients'. However, a young man or woman is not suddenly going to become or remain an 'ethically committed' doctor by raising the fight hand on graduation day. Detailed consideration needs to be given to the content and teaching of ethics, as well as to the selection of students for medical training.

3. We detect uncertainty about the profession's responsibilities to society

We note an apparent conflict between (pg) 'The profession should not swim against the tide of change in society' and (p10) 'Doctors are agents of social change... '. We think it is essential the profession decides to what extent doctors are there to be the technicians of society to whom patients bring their bodies for servicing or repairing, and to what extent doctors as individuals and corporately play a part in educating society about what real health really involves. The politics of so-called 'sexual health' provide a good example here.

In short we believe the profession has been too passive for our patients' good as the pendulum has swung from doctor paternalism to patient autonomy. The pendulum must return to the centre. The word 'doctor' has a literal meaning of 'teacher' - we have a responsibility to be teaching society, recognising the limits of our competence to do this and that the teaching process must involve dialogue.

The teaching process must always be reinforced by appropriate actions, which may on occasion bring conflict. The profession will sometimes have a responsibility to try to turn the tide and this will require us to deny the unhealthy demands of patients and any unjust requirements of the State.
4. We would commend a constructive relationship between doctors and 'management'.

Doctors have a duty to work constructively with local, regional and National health service management for the good of patients and society. We also have a duty together to resist work practices that may harm staff, and 'management' that is not directed at equitable, efficient, and effective health care.

Conclusion

We make these few criticisms and suggestions in the most constructive spirit possible, repeat our warm welcome of the Report, and offer ourselves for service in the ongoing initiative.

For further information:

Steven Fouch (CMF Head of Communications) 020 7234 9668

Media Enquiries:

Alistair Thompson on 07970 162 225

About CMF:

Christian Medical Fellowship (CMF) was founded in 1949 and is an interdenominational organisation with over 5,000 doctors, 900medical and nursing students and 300 nurses and midwives as members in all branches of medicine, nursing and midwifery. A registered charity, it is linked to over 100 similar bodies in other countries throughout the world.

CMF exists to unite Christian healthcare professionals to pursue the highest ethical standards in Christian and professional life and to increase faith in Christ and acceptance of his ethical teaching.