Some doctors do not tell patients about treatments they oppose

Some physicians do not tell patients about treatments -- such as contraception, abortion or sedation for dying patients -- that they are morally opposed to, according to a study published in the Feb. 8 edition of the New England Journal of Medicine, the Washington Post reports.

Farr Curlin, a bioethicist at the University of Chicago, and colleagues in 2003 mailed 12-page questionnaires to 2,000 physicians nationwide, receiving responses from 1,144. The study found that 42% of physicians objected to providing contraception to minors without parental consent, 52% objected to abortion after failed contraception and 17% objected to "terminal sedation." According to the study, 86% of physicians believed they should present all options to patients, 8% felt no obligation to present all options and 6% were undecided on the issue. In addition, the study found that 63% of doctors believed it was ethical to tell patients they had objections about certain treatments and that 18% felt no obligation to refer patients to another physician, while 11% were undecided. According to the Post, the study was prompted by the issue of health care providers who refuse to provide care that counters their moral and religious beliefs, such as pharmacists who refuse to fill prescriptions for emergency contraception or birth control pills and physicians and nurses who refuse to participate in providing an abortion or to prescribe contraception (Stein, Washington Post, 2/8). Study co-author John Lantos, professor of pediatrics and associate director of the University of Chicago MacLean Center for Clinical Medical Ethics, said the study is part of a larger effort to determine how physicians' values and religious beliefs shape their practice of medicine. About 45% of respondents to the survey said they attend religious services at least two times monthly (Manier, Chicago Tribune, 2/8). Men, Christian physicians and doctors with the strongest religious beliefs were the most likely to respond that it is permissible to withhold information on treatment options, Reuters reports (Emery, Reuters, 2/7). According to the Post, many states have considered legislation that would require doctors to provide patients with all legal treatments or would protect health care providers who refuse to provide certain treatments (Washington Post, 2/8).

Reaction

Curlin said the study suggests patients seeking treatments that might be controversial should learn about their medical options and choose physicians accordingly, the Baltimore Sun reports (Emery, Baltimore Sun, 2/8). "I think doctors have an obligation to disclose information to the extent that is required to be respectful to patients," Curlin said, adding that doctors are not "obligated to help patients obtain things they have strong feelings of conviction that should not be obtained." R. Alta Charo, study co-author and bioethicist at the University of Wisconsin-Madison, said, "Failure to inform completely disables a patient. It makes it impossible for them to even know what to ask or whom to ask or where to go to ask" Charo said. Al Weir, director of Campus and Community Ministries for the Christian Medical and Dental Associations, said that doctors have "the right to follow their own moral compass and their own moral integrity" (Washington Post, 2/8).

The study is available online.