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Wednesday, February 7, 2007

Conscience and controversy in the doctor's office

Most physicians believe it is ethically acceptable to tell patients if they find a legally available medical procedure morally objectionable, but most also feel obligated to present all treatment options and refer patients to other clinicians who don't share their opposition, according to a nationwide survey being published in tomorrow's New England Journal of Medicine.

The physicians were asked how they would respond to requests for treatments such as sedation for dying patients to make them unconscious; abortion after failed contraception; and prescribing birth control to adolescents without their parents' permission.

"Many physicians do not consider themselves obligated to disclose information about or refer patients for legal but morally controversial medical procedures," concluded the authors from the University of Chicago. "Patients who want information about and access to such procedures may need to inquire proactively to determine whether their physicians would accommodate such requests."

Male physicians and those who describe themselves as religious were most likely to say they would express personal objections and least likely to say they would disclose information about procedures they found objectionable or refer patients to providers who don't share their views, the study concluded.

The researchers randomly surveyed 2,000 doctors by mail. Of the 1,144 who responded, 63 percent said they thought it was permissible to state their moral objections, 86 percent felt physicians are obligated to present all options to their patients, and 71 percent believed they are bound to refer patients to another provider who does not object to the procedure on moral grounds.

That could mean 14 percent of patients, or more than 40 million Americans, may have doctors who do not feel ethically bound to disclose information about treatments they find objectionable, the authors wrote. And 29 percent of patients, or nearly 100 million Americans, may be cared for by doctors who do not feel they must refer patients to another doctor who would provide the service the patient requests.

The study found that 52 percent of physicians object to abortion for failed contraception and 42 percent object to contraception for adolescents without parental approval.

Patients need to be aware that their doctors might not agree with them or feel they should discuss alternatives, said Dr. Farr A. Curlin, a general internist and ethicist at the University of Chicago.

"The only resolution that is going to be workable is to have a respectful negotiation" between doctors and paients, he said in an interview today. "Doctors need to be up-front and candid with their patients about their boundaries so they can work out accommodations as best they can."

Posted by Elizabeth Cooney at 05:18 PM
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