Conscience, Religion Alter How Doctors Tell Patients about Options
Many physicians feel no obligation to tell patients about legal but morally controversial medical treatments or to refer patients to doctors who do not object to those treatments, report researchers from the University of Chicago in the Feb. 8, 2007, issue of the New England Journal of Medicine.
The medical profession appears to be divided, the researchers note, not just in its attitudes about providing controversial practices such as terminal sedation, abortion or birth control for teens, but also in its judgments about what doctors should do when patients request a legal procedure to which their doctor objects.
The study found that although 86 percent of doctors did feel obliged to present all options in such cases, only 71 percent said they would feel obligated to refer the patient to a doctor who did not object to the requested procedure, and 63 percent believed it is ethically permissible for a doctor to describe his or her objection to the patient.
This affects millions of people, the authors note. "If physicians' ideas translate into their practices, then 14 percent of patients--more than 40 million Americans--may be cared for by physicians who do not believe they are obligated to disclose information about medically available treatments they consider objectionable. In addition, 29 percent of patients--or nearly 100 million Americans--may be cared for by physicians who do not believe they have an obligation to refer the patient to another provider for such treatments."
"Our survey data point to a basic dilemma facing patients and physicians in our plural democracy," said study author Farr Curlin, MD, assistant professor of medicine and a member of the MacLean Center for Clinical Medical Ethics at the University of Chicago. "Because patients and physicians come from many different moral traditions, religious and secular, they will sometimes disagree about whether a particular medical intervention is morally permissible."
The researchers mailed a 12-page questionnaire to 2,000 physicians from all specialties; 1,144 (63 percent) responded.
They asked physicians if they had objections to three controversial clinical practices. Only 17 percent objected to terminal sedation (sedating dying patients to the point of unconsciousness), but 42 percent objected to prescription of birth control to teenagers without parental consent, and 52 percent objected to abortion for failed contraception.
They also asked physicians about their sense of obligation when patients request such procedures. Should physicians "present all possible options?" May a physician who objects to a procedure "plainly describe why?" If the physician objects, does he or she "have an obligation to refer the patient to someone who does not object?"