“Not My Cup of Tea But Should I Offer It to My Patient?”

I have posted on this blog a number of times the issue of how healthcare providers including pharmacists should react to patients who request services or medications against which the professionals have strong moral or ethical feelings. Examples of such requests would be abortion, emergency contraception, contraception to minors without parental permission, termination of nutrition and hydration, terminal sedation and others. In the public discussion within the media, the public and even ethicists have taken both sides on the issue of whether a doctor’s conscience about providing legal services or medications should play any part in the delivery of modern medical care. What hasn’t been researched well is what is the opinion of physicians themselves on this issue.

It was therefore rewarding for me to read an article in the current Februrary 8, 2007 issue of the New England Journal of Medicine by Farr A. Curlin, M.D. and others who presented the results of their study of 1820 physicians in an article titled “Religion, Conscience and Controversial Clinical Practices”. They found that 63% of the doctors that participated in the survey expressed the opinion that it was ethically permissible for doctors to explain their moral objections to the patients. Eighty percent said that physicians are obligated to present all options to the patient and 71% agreed with the concept of referring the patient to another physician who did not object to the requested procedure. Reviewing the demographics of the participants disclosed that “physicians who were male, those who were religious and those who had personal objections to morally controversial clinical practices were less likely to report that doctors must disclose information about or refer patients for medical procedures to which the physician objected on moral grounds.”

Although, the study revealed only what physicians said about the issue and not whether they actually practiced what they said. Nevertheless "if the physician's ideas translate into their practices, the 14% of patients--more than 40 million Americans--may be cared for by physicians who do not feel they are obligated to disclose medically available information they consider objectionable. In addition, 29% of patients--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." The authors concluded that "patients who want information about and access to such procedures may need to inquire proactively to determine whether their physician would accommodate such requests.” This means, I think, that it certainly would be wise, before selecting a physician, to ask them about how they would respond to these requests by a patient. If the patient was unsatisfied with the physician’s response, another physician should be sought.

Have any of my visitors interviewed a physician with regard to their moral opinions and practices before selecting that physician as ones personal doctor? ..Maurice.