Some doctors don't mention controversial options

By Megan Rauscher

NEW YORK (Reuters Health) - A substantial minority of doctors do not feel obligated to inform their patients about medical procedures that they themselves object to on moral or religious grounds, or to refer patients to another doctor for the treatment, according to a survey of U.S. physicians.

The refusal of some physicians and pharmacists to prescribe or dispense emergency contraception has sparked heated debate about conscience and clinical practice, note the authors of a special article in the New England Journal of Medicine this week.

"On the one hand, most people believe that health professionals should not have to engage in medical practices about which they have moral qualms," Dr. Farr A. Curlin and colleagues from the University of Chicago note in the report. "On the other hand, most people also believe that patients should have access to legal treatments, even in situations in which their physicians are troubled about the moral implications of those treatments."

Curlin's group asked 1,820 U.S. doctors from a variety of specialties for their opinions on this issue via a mailed survey. A total of 1,144 doctors responded to the survey.

Sixty-three percent of doctors felt that it would be ethical for the doctor to plainly explain their moral objections to a requested procedure to their patients.

Eighty-six percent felt that doctors have an obligation to present all possible options to patients. In cases where the doctor objects to the requested treatment on moral grounds, 71 percent believe they have an obligation to refer the patient to another doctor who does not object to the requested treatment.

"However, the number of physicians who disagreed with or were undecided about these majority opinions was not trivial," the authors say. They estimate that more than 40 million Americans may be cared for by doctors who do not believe they have to disclose information about medically available treatments they consider objectionable.

In addition, nearly 100 million Americans may be cared for by physicians who do not think they have an obligation to refer the patient to someone who will provide a treatment they object to.

It was "not surprising," Curlin said, to find that doctors who were religious were less likely to believe that doctors had an obligation to disclose information or refer patients for medical procedures with which they disagreed on moral grounds.

Curlin and colleagues say patients who want information about legal but morally controversial treatments may need to inquire proactively to determine whether their doctor would accommodate such requests.

"I hope this paper fosters frank, respectful conversations between doctors and patients," Curlin told Reuters Health, in an effort to anticipate areas of moral disagreement and to negotiate acceptable accommodations before crises develop.

SOURCE: The New England Journal of Medicine, February 8, 2007.