Doc's Moral Beliefs: Patient's Problem?

A doctor's beliefs may affect his or her willingness to present all the medical options—including controversial procedures such as abortion— to patients, according to a survey from the University of Chicago.

The study is published in the Feb. 8 issue of The New England Journal of Medicine. It was done by University of Chicago doctors, including Farr Curlin, MD.

The researchers mailed surveys to 2,000 U.S. doctors, representing all medical specialties.

The surveys asked what a doctor's obligations are when a patient requests a legal medical procedure to which the doctor morally objects.

The vast majority—86 percent—said physicians are obligated to present all the medical options to patients, regardless of their personal beliefs.

However, 8 percent disagreed, and 6 percent were undecided on the issue.

In addition, 63 percent said it would be ethical for morally conflicted doctors to "plainly" explain their moral objections to their patients.

And when asked if such conflicted doctors were obligated to refer patients to doctors without objections to the requested procedure, 29 percent either said "no" or were undecided.

Start Talking

"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," write Curlin and colleagues.

Curlin's team offers this advice to patients: Talk to your doctor about your views on thorny medical issues before a health emergency forces the discussion.

"Physicians and patients might engage in a respectful dialogue to anticipate areas of moral disagreement and to negotiate acceptable accommodations before crises develop," write Curlin and colleagues.

"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," Curlin says in a University of Chicago news release.

Curlin is an assistant professor of medicine and a member of the university's MacLean Center for Clinical Medical Ethics.
About the Study

A total of 1,144 doctors completed the survey—a bit less than two-thirds of those contacted.

They worked in specialties including family practice, pediatrics, internal medicine, psychiatry, surgery, and obstetrics and gynecology.

Here's a quick look at the group:

• Nearly three-quarters were men.
  
• Almost eight in 10 were white.
  
• 90 percent said they attend religious services at least once per month.
  
• About one-in-three noted religion as a key part of their lives.

Survey Details

The survey included this question: "If a patient requests a legal medical procedure, but the patients' physician objects to the procedure for religious or moral reasons, does the physician have an obligation to present all possible options to the patient, including information about obtaining the requested procedure?"

That question resulted in the 86 percent to 8 percent split.

When asked if morally conflicted doctors are ethically permitted to "plainly" describe their objections to patients, 63 percent said yes, while 22 percent said no, and 15 percent were undecided.

When asked if morally conflicted doctors had an obligation to refer the patient to someone who didn't object to the requested procedure, 71 percent said yes, 18 percent said no, and 11 percent were undecided.

Thorny Issues

The survey also covered the doctors' personal beliefs about three controversial clinical practices: sedating dying patients to unconsciousness, abortion for failed contraception, and the prescription of birth control to teen age 14-16 years without parental consent.

Not all the doctors answered those questions, although in each case, about 1,100 did.

Of the doctors who answered the sedation question, 83 percent didn't object while 17 percent objected to that practice.

On the abortion question, 48 percent of respondents didn't object and 52 percent objected to that practice.

And for the teen birth control question, 58 percent didn't object while 42 percent objected to that practice.

The survey didn't ask doctors about their own personal experiences in treating patients.

Therefore, it's not clear if the doctors had faced such dilemmas or if they treat their patients based on the opinions they expressed in the survey.

SOURCES: Curlin, F. The New England Journal of Medicine, Feb. 8, 2007; vol 356: pp 593-600. News release, University of Chicago Medical Center.