Column

Make a contract with your doctor

Pro-abortion groups have welcomed the recent House of Commons vote to reduce the time limit for abortions. There is now no upper limit in cases of fetal abnormality or likely grave permanent injury to the pregnant woman. The decision was hailed as welcome liberalisation. But how liberalising is medicine and the legislation that is threaded through it? How free are any of us to take crucial decisions about our bodies?

At 19 Gillian became pregnant by her steady boyfriend. In panic, petrified of her parents’ reaction, she went to her GP when she missed her second period. The doctor told Gillian that since she was perfectly normal there was nothing he could do for her. Three weeks later, after much distress, she paid for the operation, but not before her mother found out.

Over the next year Gillian became increasingly withdrawn, ended her relationship with her boyfriend and rarely left her parents’ house. She began to refuse to eat with the family and her weight fell to six stone.

This time it was her parents who called in the doctor. Gillian was diagnosed as anorexic and despite a mixture of encouragement and threats continued to lose weight. Two doctors agreed that she was mentally ill. Against her wishes she was confined and forced to undergo treatment.

Whatever the merits of the two decisions it is a fact that in both cases Gillian was denied freedom of choice by doctors empowered by the law. But rather than curb powers of doctors to veto personal decisions there are moves afoot to extend them.

A growing lobby is campaigning for the right to ‘a good death’, This too seems a liberalising measure — to be kept alive when you want to die is the ultimate affront to liberty.

However the pressure group is quoting the Dutch model as good practice in euthanasia. In Holland two doctors have to agree to a person’s request to die and only a clinician can administer the final treatment.

A gynaecologist performs the abortion and supervises recovery. A psychiatrist treats mental illness. But does the fact that these are clinical practices entitle doctors to override people’s choices about whether they want a clinical intervention?

If Gillian asks an accountant to sort out her financial affairs then she will receive expert advice, but she will not need the approval of the accountant to sell her shares. Even if the accountant thinks she is crazy, no legal action can stop her.

Doctors are being encouraged to practice privately, to enter into contracts with their ‘clients’. But their potential influence over their ‘clients’ is broader than the terms of any agreed contract. Once again, so called healthcare reformers are skirting the central issues and shunning the logic of their ideas.

If a contract between doctor and patient is a good thing because patients know where they stand, then there must be no small print, no unseen clause. The Mental Health Act, the potential legislation on euthanasia, and even the changes to the Abortion Act are all deeply paternalistic.

If medical legislation is truly to be liberalised then patients should be free to contract doctors for impartial advice and whatever medical service they desire. Doctors who are unable to give objective advice, or do not wish to participate in a procedure need not enter the contract. If a doctor declines then the patient should be told of medics who will contract.

If medical practice were brought in line with other major professions the system would be much simpler, less stressful, and above all guaranteed to respect people’s wishes as they should be in adult relationships.