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Parliamentary Joint Committee on Human Rights
13/01/2022

KHORSHID, Dr Omar, Federal President, Australian Medical Association [by video link]

[15:48]

CHAIR: I now welcome representatives of the Australian Medical Association via videoconference. I understand that information on parliamentary privilege and the protection of witnesses and evidence has been provided to you.

Dr Khorshid : That's correct.

CHAIR: If you've provided a written opening statement, would you like it to be incorporated into the Hansard transcript?

Dr Khorshid : I don't know if I've provided a written opening statement, but I'm certainly happy to give one.

CHAIR: Thank you. I'll now invite members of the committee to ask questions. I'll start with the deputy chair.

Mr PERRETT: Thank you for your very detailed submission. The AMA submission outlined several concerns it has with the bill. One of those is that section 9 of the bill may 'limit the education, training and career development opportunities for many doctors', which in turn may limit patients' access to health care, particularly in rural areas. My understanding is that health care is already stretched in some rural areas. Would you agree with that? If so, what would you expect the impact to be on people living in those areas if this bill is passed in its current form?

Dr Khorshid : Thank you very much for the question. It is important to acknowledge the critical role that both hospitals and other health services such as aged-care facilities play in the delivery of health care in Australia. It puts them in a rather different position, perhaps, to other faith based organisations in that they are supplying a necessary service, a critical service that sometimes there is no alternative to in the community, so the application of things like this potential religious discrimination bill can have an impact on health services and that is what we would be most concerned about. The specific issue the AMA has with the potential for employment to be affected by someone's faith is one that we have not really seen in practice. We have to acknowledge that we have many of these organisations around the country, some of which are very large, and we—at least, I—have not seen evidence of faith being used to affect someone's employment status or their ability to work in a facility as a visiting medical officer or anything of the sort. In fact, I, as a non-religious person, spend most of my time in private practice working in a Catholic hospital. However, we would be very concerned if the bill created a circumstance where an individual health practitioner's employment could be affected by their faith because of that critical role of those facilities in the community. But there is not necessarily a choice. Often they are providing public services under contract for state governments and it is not as though there is an alternative service down the road that either a patient or a health practitioner could access should a faith based organisation choose to act in this way.

We are concerned about the application of this bill to health facilities. In our previous submissions we have suggested they be removed. If they are going to be retained then we need to have those safety nets in place to make sure there are no negative impacts on our health service provision. It is not usually the core health service provision; it is usually in the areas where that provision may clash with the faith based organisation's views or beliefs. We have a number of circumstances where that is a little difficult to negotiate at the moment around the country. But when it comes to employment, as I said, we have not seen evidence in the past of that being a problem.

Mr PERRETT: My question particularly went to rural areas. Would you like to turn your mind to that side of the question, or do you need me to repeat that?

Dr Khorshid : With the rural side of things, the main issue would not so much be a disproportionate impact on rural facilities of these sorts of decisions being made because we have no evidence that they would be made. We have not seen them being made in the past and I am not sure that the faith based bodies that run these facilities would make decisions like that just because they were allowed to. If they did make them then, yes, you could certainly see an impact on the provision of health services in rural areas, particularly where those faith based organisations are the only option, but I don't believe that is particularly likely given that sort of behaviour has not occurred, in our view, in the past.

Mr PERRETT: Your submission raises concerns about clause 12, the statement of belief provisions. A previous submitter, Mr Irlam, from the Council on the Ageing Australia also raised concerns about the statement of belief clause and its impact on aged care. He was asked about Queensland's voluntary assisted dying laws and whether clause 12 would impact someone wanting to use those laws. Mr Irlam's view was 'We can see voluntary assisted dying as being something that people are talked out of trying to do.' Would you agree with that view of the impact of clause 12? I realise that you may have worked at Catholic hospitals. I come from Queensland, where we used to say that one in six Queenslanders was born at a Mater hospital. Would you like to make a comment on that?

Dr Khorshid : I can make some general comments, but I would need to come back to you in writing on the specifics of clause 12, which I don't have in front of me.

Mr PERRETT: Okay. Thank you.

Dr Khorshid : I could certainly say that there is a general concern that access to health services like voluntary assisted dying, which the AMA of course has mixed views on in the first place—

Mr PERRETT: Of course.

Dr Khorshid : There's no doubt that access to those sorts of health services is going to be different in—

Mr PERRETT: Could we say 'health that involves matters of conscience'? Is that the way to talk about it?

Dr Khorshid : I think that would be reasonable, yes. There are other examples, of course, with issues around pregnancy—

Mr PERRETT: Fertility health and abortion?

Dr Khorshid : Correct, yes. Yes, we do believe that the fact that these facilities are run by faith based organisations can impact access to those health services. But, as to the specific effect of clause 12 on that, I'd have to get back to you on that.

Mr PERRETT: Okay. My next question might be along those lines as well. Your submission suggests amendments to clause 15. The AMA suggests that clause 15 may cause conflict with professional standards. Can you give the committee an example of how conflicting legislation and professional standards may impact on patients? I'm not sure if you want to go to your submission.

Dr Khorshid : Yes, our submission does address this issue. We are very much of the view—and this is one of our main points—that the professional standards that apply to health practitioners, particularly to the medical profession, are well described through our Medical Board, through the code of good medical practice, through other codes of ethics like the AMA's code of ethics, and through the international agreements such as the Declaration of Geneva. These are appropriate professional standards that all doctors are held to, and they put the patient's interests above the practitioner's interests and views as the No. 1 consideration.

Mr PERRETT: Above the practitioner's faith, even?

Dr Khorshid : Including above the practitioner's faith, yes. So the interest of the patient must be the first interest. That doesn't mean there isn't a way to continue to provide health services in settings where there is a clash, but, No. 1, the patient's medical interests must be first and foremost. Therefore, if this bill conflicted with that obligation to provide the best quality healthcare that we can or with the standards that practitioners are being held to, that would concern us.

Again, the examples are in these difficult areas where doctors may have conscientious objections to care. That was why the AMA was not comfortable with the conscientious objection clause in the previous version of the bill. We're pleased that that has been removed, but we're still concerned that the bill doesn't really clarify enough that professional standards should be the first and foremost consideration. If this is going to stay in, we would certainly recommend very strongly—we've said so in the written submission—that any standards specifically applying to health practitioners be directly discussed with the Medical Board and other key practitioners to make sure that they are at least consistent with what we would call good medical practice.

Mr PERRETT: This is my final question. I think in your submission you make it very clear that the community trusts the medical profession and your ability to regulate yourselves in terms of ethics and making decisions in very, very difficult areas that we've touched on. I would certainly echo that position. I see in my community that the medical profession is trusted to self-regulate in this area. Thank you for your submission and the work that you do.

CHAIR: Dr Khorshid, I'm going to ask you one question, and then I'm going to hand to Ms Hammond. I'm curious about the percentage of regional and rural GPs that the AMA represents among its membership. Do you know that offhand?

Dr Khorshid : I don't have a number offhand as to the proportion of regional and rural GPs who are our direct members, but, as the only body that represents all doctors, we see ourselves as representing our entire profession. There are of course other bodies that represent subgroups of the profession, including rural doctors and general practitioners, but we take the overarching advocacy role in consultation with those other bodies. Our membership rates and the number of people who pay for our services are much lower than the overall number of doctors in society, but we're still representing all of them.

CHAIR: So, just to clarify, I'm looking for what kind of engagement you've had with rural and regional GPs, who frequently carry the kinds of complex issues regarding moral questions—whether it's abortion, whether it's end of life. How many of those doctors have you engaged with to understand their perspective, in terms of the number who are religious and who actually are practising Christians or practise other religions? How many of those are part of your discussions and engaged as stakeholders?

Dr Khorshid : We have, as does any advocacy and membership body, structures in place. We have our state and federal bodies. We have committees, subcommittees and councils that represent various parts of the profession, and they are engaged in our policy determinations. We've not surveyed our membership on these specific questions, if that's part of what you're asking. We've not gone out to every member and asked them what they think on these specific areas, but we do have a rural doctors committee, for instance, and we have rural doctors on our federal council. So, as we determine our positions on areas, all of our formal positions are taken through processes that give rural doctors and every other type of doctor who is represented on the AMA a voice in all of our determinations. As I said, we don't go directly to the membership on detailed consultations like the submission for this. That is handled by our executive team and our federal council, as appropriate. But we are listening to the voices of rural doctors in all our policy determinations.

CHAIR: Do you have an idea generally of how many people in your membership are religious, whatever that religion might be?

Dr Khorshid : I don't have a specific idea. I would suggest that it follows the community. The rate of doctors actively practising a religion is likely to be decreasing at the same rate it is in the community. We certainly have doctors who hold extremely strong views, very strong religious views, and they incorporate those into their lives and their practice every day, and of course we have others who don't. I think it's highly likely, with over 100,000 doctors in the community, that we have the full breadth of religion that will largely match that in the community.

CHAIR: Excellent. Thank you. I'll hand you over to Ms Hammond, who's online.

Ms HAMMOND: Hello, Dr Khorshid. Just for clarity: you are pleased that the conscientious objection clause has been removed from the bill?

Dr Khorshid : That's correct, yes.

Ms HAMMOND: That is dealt with under professional rules or state and territory laws, isn't it? Am I right there?

Dr Khorshid : Yes. Our codes of conduct specifically address conscientious objection and areas where doctors' views may conflict with the services patients need—in areas like access to abortion or voluntary assisted dying, for instance. Some state and territory laws are quite specific in areas around conscientious objection. That varies state by state, but, again, some jurisdictions have very specific laws around voluntary assisted dying and access to abortion, for instance.

Ms HAMMOND: I want to get a better understanding. I have concerns about health provision in rural and regional, but the chair has touched on those. In general terms, there are a lot of private health providers in Australia and they provide great service, but a number of them—the majority in the Catholic healthcare system—don't provide certain services now. To be accredited and to be able to open up a hospital is not just a question of 'build a building and they will come', is it?

Dr Khor shid : No. Hospitals, like the rest of our health sector, very much rely on the people that run them—the systems, the quality and safety, and in particular, in the case of medicine, the expertise of staff you're able to attract to run your facility.

Ms HAMMOND: But they go through full accreditation. Our health system and the people who work in it are fabulous, but we have a very strong accreditation system, don't we?

Dr Khorshid : We have an accreditation system for hospitals that is very strong, and the hospitals themselves have systems to ensure that the practitioners working within them are appropriately credentialled, trained et cetera. There are lots of regulatory systems all working in conjunction that underpin the safety of our hospital sector, that's for sure.

Ms HAMMOND: My thinking is that we already have a system of public health care and private health care, and we already have faith based healthcare providers—again, I'm leaving aside rural and regional, because I think that's an issue we really need to look at—that provide different services. Isn't there then an element, irrespective of this bill, to ensure that health care provision is adequate across the board, that it comes down to government contracting, identifying, reimbursing and paying—the way we set up the healthcare system across Australia to ensure that all services are provided? If one particular hospital system doesn't provide a service, we ensure that that service is provided by somebody else and is accessible to the same people.

Dr Khorshid : That's right, and it's made difficult where you have a faith based provider as the only or main provider in a geographic area. It can be tricky, then, to provide access to services that are core medical services that don't fit with that organisation's faith; that is a problem for government, as you correctly point out. In the circumstances I'm aware of, workarounds are put in place to make sure that those services are available in those geographic areas for people who need them. Where it gets more tricky would be rural and regional, where, as I said, they are the only provider. That's where some of the professional standards, and in some cases laws, that require practitioners to make effective referrals have come in, because of that concern over access to health care for people who need it.

Ms HAMMOND: My understanding of the healthcare system is that private hospitals don't actually employ that many doctors—doctors get rights to work there—but public hospitals do employ doctors?

Dr Khorshid : There is a variety of arrangements. Private hospitals do employ some doctors—definitely junior doctors and, in some cases, senior doctors in various roles—but the average private hospital is very much a visiting medical officer model, where rights of private practice are granted and practitioners practice their own trade within that facility. In doing so, they have to abide by the by-laws of that facility. In the case of Catholic hospitals, there are certain services you are just not allowed to provide. If you provide those or are even seen to be discussing them, you'd be in breach of those by-laws. Even though you're an independent practitioner, there are limitations on your practice.

Ms HAMMOND: Isn't it also the case that most VMOs would have rights at a number of hospitals and potentially have their rooms somewhere else—so they might do at another facility nearby what they might not do at a Catholic hospital or an Adventist hospital?

Dr Khorshid : That's correct. Although there are some issues with the services that are not available in faith based hospitals, at the end of the day there are alternatives. As you correctly point out, those practitioners who, as part of their normal specialty, would provide some of those services simply do so at another facility, should they choose to work in a Catholic facility.

Ms HAMMOND: This is my final question. Leaving aside rural and regional, but just in city areas, do you actually think that this bill is going to change the way things run at the moment with the provision of health care?

Dr Khorshid : As I said in response to a previous question, we have not seen any significant evidence of the employment or engagement of practitioners being affected by those practitioners' faith. As long as they're providing the services that they're supposed to be providing and they have the appropriate training and credentialing, from our experience those practitioners are able to work. It is, perhaps, different in upper-level management in those facilities. There's probably more of a requirement to be of the same faith at those levels. But, for the on-the-ground services, it's really about those services that are not allowed to be provided, and we have not seen any evidence.

Having said that, I note that, if this bill made it explicit that you are able to discriminate on the basis of faith in appointing a VMO or employing a nurse, that would limit the employment prospects of practitioners. As we've mentioned, some of these facilities are public facilities or training facilities, and we don't believe that would be a positive. That would be a regrettable move, and it shouldn't be seen to be a good outcome. But, as I said, I don't have any evidence that that behaviour would occur, because it certainly hasn't, in our view, in the past.

Ms HAMMOND: Thank you very much.

CHAIR: Senator Rice, do you have some questions?

Senator RICE: Yes, thanks, Chair. Thanks, Dr Khorshid. I just want to start by acknowledging that we're in the middle of a pandemic, thanking you for appearing before us today and thanking the AMA for all of your important work and the work of doctors, who are absolutely overworked around the country. In relation to that, do you think that this bill should be a priority as the pandemic continues? What's the impact of you having to put in time to consider this bill, for example?

Dr Khorshid : Thank you for the question. This bill is certainly not something that the AMA is pushing for, and we don't believe that there is any problem in health care that is solved by this bill. However, if the bill is needed for other reasons, we are simply seeking, through our submission, to minimise any potential negative impact on health care or access to health care for Australians. Whilst the pandemic is all-consuming, as you correctly point out, we do recognise our role as representatives of our profession, and we are more than happy to engage in discussions like this and, indeed, to push our own agenda in other areas around health care as the pandemic continues. So we're very happy. It is slightly distracting, as you point out, but the purpose of the parliament is to legislate, I guess, and we're happy to appear before you and share our views.

Senator RICE: Thank you. I now want to go to where in your submission you talk about the statements of belief. You say:

We continue to have concerns … in relation to statements of belief … where the Bill will lawfully enable statements … to offend, humiliate, insult or intimidate people or groups such as women, LGBTQIA+ people or persons with disabilities. The prohibition is only waived where a 'reasonable person' would consider the statement of belief would threaten, intimidate, harass or vilify … this threshold leaves extensive scope for bullying, harassment and intimidation of people or groups of people such as women, LGBTQIA+ people and persons with disabilities (to name a few)—that can lead to serious risk of harm to their health and well-being. This particular provision of the Bill may conflict with professional standards and guidance for doctors set by Australia's medical regulators.

Can you talk about the serious risk of harm and also about that conflict with the professional standards and guidance?

Dr Khorshid : Thank you for the question. I think our main point is that we believe our professional standards for doctors should be the overarching and highest level or the thing that drives our practice, rather than being overridden by a law that would enable conduct that would otherwise be unprofessional or illegal. Whilst many religions—most of them—wouldn't be suggesting that people make statements that offend others, there are within some religions some views the expression of which clearly has the potential to harm individuals in society, as is detailed in our submission. We don't believe that it would be appropriate for a health based organisation to make statements of belief like that that potentially harm people in order to explain why you can't access a particular type of service in a particular facility or with a particular doctor. It's potentially too great a freedom, and we believe that the professional standards should apply and that there should be no law that says a lower standard is okay in order to defend your own faith. You should still not be able to make statements, as a health practitioner, that offend vulnerable people in the society. That is ethically worrying and would be a negative direction for our health profession to be going in.

Senator RICE: So it's your understanding that, under this bill as it stands at the moment, those statements of belief would override professional standards?

Dr Khorshid : That is how I've been briefed by our council, who've had a look at the bill—that there is the potential for that to occur. We've acknowledged the change in the threshold, but we still think there is the potential there for that to occur or to be permitted under the bill. I guess you have to test it. If a law specifically allows certain conduct, and that is in conflict with professional standards as regulated by the Medical Board, I don't know what action the Medical Board might take if a practitioner still breached its standards that are expressly allowed under a different law. That gets a bit complicated. I guess we're saying we'd like there not to be any conflict there—that the standard should be crystal-clear and one that all, or the majority, of the medical profession would aspire to and agree with.

Senator RICE: Thank you. Yes, the fact that there is that lack of clarity and that it seems that those statements of belief would override it is of great concern. I asked one of the religious organisations this morning about statements such as a patient with HIV-AIDS being told that that was a punishment from God, and their response was, 'Oh, well, surely they wouldn't be able to say that, because it would be going against their professional standards.' But what you're saying is: no, under this legislation as it's drafted, they would be able to say that, even though it potentially would be against professional standards.

Dr Khorshid : Yes, that's our understanding. It's certainly our concern, and we would like absolute clarity. We think it would be preferable that practitioners be very well aware of their obligations, as they are currently, and that that not be muddied by a new law that potentially creates confusion about what is okay and legal and what is not.

Senator RICE: Finally, I just ask you to go to that. If this legislation were enacted and then we had, as other witnesses have described, legal cases for decades, what might be the potential implications for medical professionals who were then caught up in long-running case law trials? Is that of concern to the AMA?

Dr Khorshid : Certainly we don't want to see our members or members of our profession acting in ways that would land them in that situation in the first place. There's no doubt that, if doctors are making statements in public that result in them getting caught up in legal action, that is extremely stressful. It affects the quality of their practice. It affects things like medical indemnity premiums, for instance, that all other doctors have to pay to help fund that kind of action or defence. It offends doctors who've tried to do either the right thing or the thing that they believe is right according to their faith and what they believe this law says. So I think all of that should be prevented if at all possible, and hence we've made these statements in our submission.

Senator RICE: Thank you. Actually, I have one last question. On the first page of your submission, you said:

… it is essential that the provisions in any Religious Discrimination Bill maintain the level of protection offered by existing State and Territory anti-discrimination laws; otherwise, there is potential to further marginalise particular groups of individuals that may already face stigma and uncertainty when trying to access health care or particular health services …

Can I read from that that, given that this legislation does override state and territory laws, you don't support that element of it?

Dr Khorshid : We believe the standard that has been set by the state and territory antidiscrimination laws is appropriate and that any move to downgrade that protection for people would be a negative move, yes.

Senator RICE: Thank you.

CHAIR: Senator McLachlan.

Senator McLACHLAN: Can you give us some data on how many complaints or unprofessional conduct investigations you conduct in a year in relation to people that have acted in accordance with their stated religious beliefs? I'm really looking for what the size of the problem is from the association's perspective and, in fact, how many have refused to give medical care because of their religious beliefs.

Dr Khorshid : We don't have great data on any of that. As I said, we're not the regulator, so we wouldn't receive the complaints anyway. That would probably be a good question for the regulator. They, of course, take complaints on all aspects of medical care, as well as the practice of other health professionals. I think that, like in many of these very difficult areas that get discussed, sometimes the potential for problems is bigger than the actual size of the problem. I think we focus on what could happen a lot of the time, rather than what is happening. I acknowledge the point that I think you're making, which is that this may not have a massive impact size wise. But I think the impact on the vulnerable groups can be very disproportionate to what you might call the impact on the overall provision of health care in Australia. The groups that are vulnerable in these areas have already got a number of health and mental health issues that they're dealing with, and adding to those in order to provide freedoms for other people is something that we would certainly struggle with.

Senator McLACHLAN: The view that you're expressing there is anecdotal, I take it, rather than evidence based?

Dr Khorshid : It is anecdotal, but it's based on the views of the people with whom we engage as we develop our policy in these areas. I can't give you any data on the quantity of the issues that come up with regulators or how often they arise in the community. I don't have any data on that.

Senator McLACHLAN: Could you take on notice for me whether AMA has formed a view on the number that have come out of complaints? Obviously your association would look at how many complaints are going through to determine its codes of conduct. If there's a publicly stated view, I'd appreciate it. You can take that on notice.

Dr Khorshid : Okay. I'll get back to you on that.

Sena tor McLACHLAN: How does a person who's a member of your body and is of strong faith have a voice? I was a little unclear on your responses to the chair. Are they just a member, or do you seek their views out in particular, as you would other views?

Dr Khorshid : We have a number of different ways to gather the views of our membership. Some of that is passive, so members who have strong views on issues write to us and we respond and collate that kind of feedback. On areas of particular controversy, we will sometimes go out to the members and survey them. An example of that was when we were forming our position on euthanasia and physician assisted suicide, where we knew there were going to be very strong views, on both sides of those arguments, within the profession and we felt unable to come to a position as a group of, for instance, 30-odd people on a federal council of the AMA. We sought to engage the membership formally in that way.

The views of members who participate in the AMA, in our state bodies and our federal body, are obviously sought on a range of issues, and the members who participate are of a range of different backgrounds. There are people in our structures with very strong religious views and there are people who don't have those views. But we don't have a special interest group of doctors of Christian faith, for instance. We don't have that kind of structure. We have an incredible breadth of advocacy that we work on, and our capacity to go to the broad membership—we have just under 30,000 members—on each issue is very limited. They don't respond. It's too much. And we have a huge agenda that we have to deal with on a relatively quick basis. With the submissions of ours that are required on issues like this, often we only have a few weeks in which to collate them. You can't go to every member on every issue, but we certainly do on issues that we feel need the full attention of the membership.

Senator McLACHLAN: Thank you for that. I have no further questions.

CHAIR: Senator Pratt, I believe that you may have a question. I'll just flag that we have five minutes left. We might have to put some on notice.

Senator PRATT: I do have a question. Thank you to the AMA for your evidence today. In the context of what you were saying previously with regard to the data about the number of practitioners that might be affected by these changes, in terms of those that have had complaints made about them, would such data be a true reflection of the problem if there are practitioners who currently feel constrained in their conduct because of the restraints of the current regulation, which does uphold professional standards and ethics?

Dr Khorshid : We're quite comfortable with the idea that our members are constrained in their behaviour by their professional standards. That's the whole point of having them.

Senator PRATT: I am too. I guess I'm trying to come to terms with the other senator's question. He was trying to negate the significance of the problem by saying the problem isn't very large anyway, whereas you drew the evidence back to it still being significant because of the impact on vulnerable communities. But, if you were to license such behaviour, could we use the current data about it not being that much of a problem as a reflection on whether or not this is a desirable outcome?

Dr Khorshid : I would agree with your point that we couldn't use our experience with doctors' behaviour now to predict what might occur if the laws were changed. We would hope that doctors would choose to abide by their codes of conduct, even if other behaviour was legalised, but we can't be certain as to exactly what would occur, and some people do have very strong views in a number of areas. So, yes, I do agree with your point.

Senator PRATT: Can you give me an outline of where that conduct is currently codified? I know it's codified in the context of reproductive rights, medical care of the dying, and some health care in relation to gender.

Dr Khorshid : Those are the areas where we've seen problems—where access to health care has been experienced by patients to have been limited by the views of doctors, particularly in those rural areas where you don't have a choice of doctor. That's why, as you mentioned, we are seeing it codified specifically in certain circumstances. However, the broader requirement to act in the patient's best interest is codified through the Medical Board of Australia's code of conduct, Good Medical Practice, and through our own ethics et cetera, as I mentioned before, including the World Medical Association's Declaration of Geneva and, of course, the International Code of Medical Ethics.

Senator PRATT: Our previous witnesses, from the Australian Women's Health Network, spoke about issues such as domestic violence and the kinds of referrals that they make. They're concerned that women who have been subjected to violence have been told by various services or religious bodies that they should return to the primacy of that relationship. Would such a statement be consistent with good medical ethics, and, if the primacy of marriage is one of the beliefs that is supported by this legislation in the context of medical care, what ramifications could you see coming off that?

Dr Khorshid : To begin with, ethically any advice coming from a medical practitioner to a victim of domestic violence should be to the benefit of that individual and their circumstances at the time. Of course circumstances will be different. A practitioner's faith shouldn't determine the advice that is given to a patient who is presenting having been a victim of domestic violence. That's crystal clear.

Senator PRATT: I would very much agree. So what does that mean in the context of a statement of belief around those things in a room where a medical consultation has taken place or in broader practice or broader advocacy—in someone's role as a doctor if they're appointed to a board, or something like that?

Dr Khorshid : We would be of the view that that is an example where the statement of belief could create harm in the community. It could also create confusion as to a practitioner's obligations and make it less clear to the practitioner as to what is acceptable behaviour and what is their responsibility as a leader in the community. Obviously, we have medical practitioners who may well be leaders in religious communities as well as being medical practitioners, but, in our view, when you have on the hat of being a medical practitioner you must abide by the codes of conduct, the legal frameworks, that underpin our practice, because, as has been mentioned in our submission, the role of a doctor is a highly respected role. It's one that must not be misused for other purposes. In many communities just being a doctor means your voice is extremely loud and influential, and that's why, as we've stated very clearly in our submission, we would not like to see any conflict between a religious discrimination bill and our codes of conduct as they exist at the moment.

CHAIR: Thank you, Senator Pratt. Could you ask your last question on notice please. I need to go to Senator O'Neill.

Senator PRATT: What kinds of amendments to the bill would you like to see to resolve those potential conflicts between a professional code of practice and this legislation?

CHAIR: Dr Khorshid—

Dr Khorshid : I'll—

CHAIR: Yes, could you take it on notice. Thank you.

Senator O'NEILL: Dr Khorshid, I don't know if you heard the evidence of the Australian Women's Health Network. As a person of faith with a particular view, I hold that strongly and I'm pleased that I can do that in this pluralist democracy. But I was very concerned by the degree of anxiety about access to services that they had, which was put on the public record today. In your responses so far you've indicated it's really AHPRA that has responsibility for looking after these matters of professional negligence or mistreatment. Senator Rice is chuckling because we've got another inquiry going on with AHPRA, particularly about cosmetic cowboys and the claims that are made as to professional capacity. I would appreciate a response—I guess it will have to be on notice—to the claims that were made, because they have certainly raised my concerns. I know that access to services in regional and rural areas is very problematic, but I think what they said today was so frightening. For people who hold a non-faith view or people of faith who hold a particular view about particular issues to be unable to access services is a problem.

My particular question, though, is with regard to guidance around social media, because that's one of the platforms where these issues could be contested. AHPRA provide the social media guidance for health practitioners, including in relation to social media use in a doctor's private capacity. At this point of time can you foresee a situation in which a doctor or another health professional breaches AHPRA's professional standards but it's a breach that cannot be dealt with by AHPRA or the medical board, because an attempt to do so could constitute discrimination under the Religious Discrimination Bill? If you need to take that on notice—

Dr Khorshid : I think the short answer is: yes, we're concerned about that. But I'm happy to take that on notice and provide a clearer answer. On your question on women's health and access to services, I didn't hear that evidence.

Senator O'NEILL: The secretariat will provide it for you, Dr Khorshid, so that you can have a look at that. It was concerning. I think we really need to acknowledge the full breadth of perspectives about life matters, conscience matters et cetera. But where those range of views exist in a community and people are unable to access a service, that is highly problematic.

CHAIR: Thank you for appearing before the committee today, Dr Khorshid, and for giving your time. The committee requests that answers to questions taken on notice are provided to the committee secretariat by close of business 20 January. They will provide you with the information that has been alluded to.

Dr Khorshid : Thank you very much.

CHAIR: Thank you. That concludes today's hearing. On behalf of the committee, I would like to thank all those who've made submissions to the inquiry and made representatives available today. I would also like to thank Broadcasting, Hansard and the secretariat staff for their assistance today.

Committee adjourned at 16:36