Do physicians have the right to refuse to provide treatments to which they object on moral grounds? If they refuse, are they obligated to present all treatment options or to refer the patient to another physician who does not object to the requested procedure? There has been much debate over these questions, but little is known about what physicians think their obligations are in this situation.
A cross-sectional survey addressing these questions was sent out to a stratified, random sample of 2000 practising American physicians (9% could not be contacted). More than 60% of the physicians responded (1144/1820). The researchers looked at what judged these physicians to be their ethical rights and obligations when patients request a legal medical procedure to which the physician objects for either religious or moral reasons. These procedures included contraception in adolescents without parental approval, abortion for failed contraception, or terminal sedation in dying patients.
Most physicians surveyed believed the following.
It is ethically permissible for doctors to explain their moral objections to patients (63%).
Physicians are obligated to present all treatment options (86%).
Physicians are obligated to refer the patient to another clinician who does not object to the requested procedure (71%).
When the researchers looked at specific scenarios, only 17% of those who responded objected to terminal sedation. More than 50% objected to abortion due to failed contraception, and 42% to prescription of birth control without parental consent.
Those who objected to referring a patient or presenting all options were more likely to be male, to be religious, or to have personal objections to morally controversial clinical practice.
Bottom line
Although most physicians believe that they are obligated to disclose all treatment options or to refer if a patient requests a morally controversial but legal procedure, patients might not be aware that some physicians do not consider themselves to have these obligations.
Footnotes
Source: Curlin FA, Lawrence RE, Chin MH, Lantos JD. Religion, conscience, and controversial clinical practices. N Engl J Med 2007;356(6):593–600.
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