Some Doctors Still Think They Know Best—They Are Wrong

The Washington Post is reporting the results of a physician survey published in the New England Journal of Medicine that finds that a small, but significant portion of doctors "believe that they have the right not to tell patients about treatments that they object to on moral or religious grounds and to refuse to refer patients elsewhere for the care."

The survey asked them about three controversial practices: (1) sedating dying patients to the point of unconsciousess; (2) prescribing birth control to teenagers without parental notification; and (3) performing abortions after failed contraception. Of those who responded 17 percent objected to terminal sedation, 42 percent object to providing birth control to teens without parental consent, and 52 percent objected to abortion after failed contraception.

The good news is that 86 percent agreed that they had an obligation to present all possible medical options to their patients. Yet 8 percent do not believe that they must tell patients about legal medical options to which they object. In addition, 18 percent felt no duty to refer patients to other doctors who do not have moral or religious objections to these controversial practices.

The Post reports:

R. Alta Charo, a bioethicist at the University of Wisconsin at Madison, said the results were disturbing, particularly the belief by a significant proportion of doctors that they do not have an obligation to inform patients about all options.

"How are patients supposed to make choices when they don't even know the range of choices that they have?" Charo asked. "Failure to inform completely disables a patient. It makes it impossible for them to even know what to ask or whom to ask or where to go to ask."

But Al Weir, director of Campus and Community Ministries for the Christian Medical & Dental Associations, defended doctors' rights to adhere to their personal beliefs.

"The doctor has the right to follow their own moral compass and their own moral integrity," Weir said.

The question here is, Whose values are to triumph in the therapeutic encounter? In the bad old days of a couple of generations ago, the doctors' values generally did. But in a significant moral advance, we have come to recognize that respect for the autonomy of patients is a (if not the) primary value in medical care.

It would be morally odious to force physicians to participate in treatments that they believe are evil. Thus, we do not require that Catholic hospitals offer contraception or abortions.

However, Oxford University bioethicist Julian Savulescu argues that "a doctor's conscience has little place in the delivery of modern medical care " and that "if people are not prepared to offer legally permitted, efficient, and beneficial care to a patient because it conflicts with their values, they should not be doctors."

I have considerable sympathy with Savulescu's argument. Nevertheless, I think that if a doctor is willing to tell his or her patients about all options and refer them to other physicians who are willing to offer the requested treatment, then he or she has fulfilled his or her moral duty. On the other hand, keeping information about patient options secret is medical malpractice and should be treated as such.

Whole Post article here. Whole NEJM article here.

My Reason colleagues weigh in on conscience clauses in medical care here and here.