Study: Some doctors won't tell patients about treatments they oppose on moral grounds

A number of doctors do not feel obligated to tell patients about medical options they oppose morally, such as abortion and teen birth control, and believe they have no duty to refer people elsewhere for such treatments, researchers say.

The survey of 1,144 doctors around the country is the first major look at how physicians' religious or moral beliefs might affect patients' care.

The study, conducted by University of Chicago researchers, found 86 percent of those responding believe doctors are obligated to present all treatment options, and 71 percent believe they must refer patients to another doctor for treatments they oppose. Slightly more than half the rest said they had no such obligation; the others were undecided.

"That means that there are a lot of physicians out there who are not, in fact, doing the right thing," said David Magnus, director of Stanford University's Center for Biomedical Ethics.

According to an American Medical Association policy statement, doctors can decline to give a treatment sought by an individual that is "incompatible with the physician's personal, religious or moral beliefs." But the physician should try to ensure the patient has "access to adequate health care."

The survey did not examine whether these doctors act on their beliefs -- that is, whether they actually withhold information or refuse to refer patients. But the researchers calculated that tens of millions of Americans might be going to such doctors.

"Conscientious objection is fine ... as long as it doesn't conflict with the rights of the patient," Magnus said. "You can't abandon the patient or essentially coerce the patient by saying you won't do the procedure or refer them to someone else."

The study is published in today's New England Journal of Medicine and led by Dr. Farr Curlin, a University of Chicago ethicist and internist.

The findings were based on a survey mailed to 1,820 practicing U.S. family doctors and specialists, chosen randomly from a national database; 63 percent responded.

Doctors describing themselves as very religious, particularly Protestants and Catholics, were much less likely than others to feel obligated to tell patients about controversial treatments or refer them to other doctors, and were far more likely to tell patients if they had moral objections.

Overall, 52 percent said they oppose abortion, 42 percent opposed prescribing birth control to 14- to 16-year-olds without parental approval, and 17 percent objected to sedating patients near death.

Female doctors were much more likely than male ones to feel obligated to refer patients for treatments they personally oppose, far less likely to present their own objections to a patient and slightly more likely to disclose all treatment options.

Dr. Jeffrey Ecker, chairman of the committee on ethics at the American College of Obstetricians and Gynecologists, said he was encouraged that most doctors agreed patients deserve to be told about all appropriate medical options and referred to other doctors when needed.

"There is reason to be concerned about those that don't do it," Ecker said. He added that it is possible many doctors in the survey who opposed such disclosures and referrals may be practicing in specialties where they don't face those issues.

He said doctors must let patients explicitly know if they are opposed to particular services.

One big problem area, Magnus said, involves emergency room doctors and emergency contraception for rape victims. He said it is considered standard care to offer the morning-after pill, but that is not done in some Catholic hospitals, according to one small study. Ecker said doctors opposed to emergency contraception should avoid working in an ER for that reason.

Curlin noted prior research by his team found doctors may be a bit more religious than others -- 46 percent of doctors said they attend religious services at least twice a month, compared with 40 percent of the general public. But he found doctors are less likely to carry their religious beliefs into their daily work, with 58 percent saying they do so, versus 73 percent of the general public.

Curlin said that in light of the new survey findings, if a patient "anticipates wanting a controversial treatment and they don't know already if their physician opposes it, then they should ask."

"I hope it leads to more substantive conversations between doctors and their patients," he said.

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On the Net: http://www.nejm.org

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