Controversial treatments: Where does religion fit?
Controversial treatments: Where does religion fit?
Some let own beliefs guide handling of treatments
Most physicians polled for a recent study say they feel an obligation to present all options to patients seeking legal but controversial procedures that the physicians object to, but more than one-quarter say they would not feel compelled to refer the patient to a doctor who did not object to the objectionable procedure.
But while 86% of doctors say they would feel obligated to disclose all options to patients about controversial treatments (terminal sedation, abortion, or birth control for teens) and 71% said they would feel obligated to refer patients to other physicians who don't object to the procedures, the authors of the study say the number who disagree or are undecided is not insignificant.
"If physicians' ideas translate into their practices, then 14% of patients — more than 40 million Americans — may be cared for by physicians who do not believe they are obligated to disclose information about medically available treatments they consider objectionable," writes lead author Farr Curlin, MD. "In addition, 29% of patients — or nearly 100 million Americans — may be cared for by physicians who do not believe they have an obligation to refer the patient to another provider for such treatments."
Curlin and his colleagues at the University of Chicago reported their findings in February 2007 in the New England Journal of Medicine. The study reflects the opinions of 1,144 physicians across all specialties.
Regardless of whether the physician feels obligated to refer the patient to another doctor for a procedure the treating physician objects to, 63% say it is ethically acceptable for them to tell the patient why they object.
Curlin, assistant professor of medicine and a member of the MacLean Center for Clinical Medical Ethics at the University of Chicago, says his group's survey data point to a basic dilemma confronting physicians and patients.
"Because patients and physicians come from many different moral traditions, religious and secular, they will sometimes disagree about whether a particular medical intervention is morally permissible," Curlin says.
Objections linked to gender, personal beliefs
Curlin and his colleagues report that doctors' objections to performing the controversial practices, referring to other physicians for the procedures, or telling patients about their objections were closely associated with the physicians' gender, religious characteristics, and whether they personally objected to one or more controversial clinical practices.
Physicians who are male, more religious, and who personally objected to controversial practices were more likely to believe it is acceptable for doctors to tell patients about their objections, and less likely to believe physicians must present all options to patients and refer them to a clinician who does not object to the requested procedures.
"This study suggests that those most likely to be asked to act against their consciences are the ones most likely to say physicians should not have to do so," Curlin says.
The evidence raises basic philosophical questions, according to the study's co-author, John Lantos, MD, professor of pediatrics and medicine and associate director of the MacLean Center for Clinical Medical Ethics. "Is there room within the profession for radically different approaches to care based on moral or religious opinions?
"Should doctors leave their personal religious beliefs at the door, or are those beliefs such a central element of personal identity that the very notion of leaving them at the door is incomprehensible?"
Lantos says colleagues' reactions to the study results drew mixed reactions, with most taking a middle ground, believing that doctors have a right to follow their consciences, but that patients also have the right to legal, medically approved treatment."
This "straddling the fence" middle ground puts the burden on patients, Curlin suggests.
"Patients should know that physicians are divided on this issue," he says. If patients talk with their physicians about controversial treatments ahead of time and detect areas of moral disagreement, he adds, they should try to work out an approach that is acceptable to both physician and patient before a crisis occurs.
Sourcess/Resource
For more information, contact:
- Farr Curlin, MD, assistant professor of medicine, University of Chicago (IL) department of medicine; member, MacLean Center for Clinical Medical Ethics at the University of Chicago. Email: [email protected].
- Curlin FA, Lawrence RE, Chin MH, et al. Religion, conscience, and controversial clinical practices. N Engl J Med 2007; 356:593-600.
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