Doctors' Moral Views Influence Their Advice to Patients

By E.J. Mundell
HealthDay Reporter

(HealthDay News) -- Your physician's moral outlook may play a larger role in your medical care than you realize, according to the first-ever survey of doctors' views on controversial procedures.

For example, more than half (52 percent) of doctors surveyed objected to the use of abortion due to failed contraception, and about 40 percent said they wouldn't give a 16-year-old a contraceptive without parental consent.

What's more, nearly one-third (29 percent) of physicians interviewed said they would balk at referring a patient to another doctor for a procedure or drug they felt qualms about recommending themselves.

And 14 percent -- one in seven -- said they would not mention a procedure they believed to be morally wrong as a viable treatment option.

However, that stance is itself "morally questionable," contends one medical ethicist, Dr. David Stern, an associate professor of medicine and medical education at the University of Michigan.

No one is advocating that doctors perform procedures they object to, Stern said. However, "because we are in a position of power over patients who walk through the door, I think we have a professional responsibility to at least disclose treatments," said Stern, who was not involved in the study.

The findings, by a team from the University of Chicago, are published in the Feb. 8 issue of the New England Journal of Medicine.

The physician's office has always been "ground zero" for controversial medical issues such as euthanasia, abortion, and contraceptives such as the "morning-after pill."
However, up until this survey, experts have known little about what U.S. doctors think about sensitive issues like these, and how those views might impact medical practice.

The new study was led by Dr. Farr Curlin, an associate professor of medicine at the University of Chicago's MacLean Center for Clinical Medical Ethics. His team surveyed 1,144 physicians from varying specialities on their views on issues such as abortion, giving terminal sedation to dying patients, and prescribing birth control to teens without their parents' consent.

The doctors were also quizzed about their level of religious belief and its importance in their lives.

The results: 83 percent of physicians said they had no objection to terminal sedation of the dying, and 48 percent said they had no moral objection to abortion in the case of failed contraception. Fifty-eight percent of doctors had no problem prescribing contraception to a minor without parental consent.

Most doctors (63 percent) also felt that it was "ethically permissible" to express a personal moral bias to a patient. The large majority -- 86 percent -- agreed that, even if a doctor objected to a particular legal medical procedure, he or she was still obligated to list it as an available treatment option when advising patients.

A large majority of doctors (71 percent) also felt obligated to refer a patient who wanted a particular procedure to another physician -- one who had no moral qualms about the treatment.

Demographic patterns emerged during the study. Older doctors were more likely than younger practitioners to support full disclosure of personal moral views to patients, and female physicians were nearly twice as likely as males to support full disclosure of treatment options and to refer patients to other doctors.

"We don't know for sure, but we speculate that women are bringing to mind issues of sexual and reproductive health care -- which disproportionately affect them -- and that may explain the [gender] difference," Curlin said.

Not surprisingly, religion played a key role in the doctors' responses. Highly religious physicians were much less likely to disclose a morally objectionable treatment option to a patient, for example, than doctors who were less devout.

Curlin said he was disturbed by the notion that 14 percent of U.S. doctors -- who together care for about 40 million Americans -- might intentionally withhold important treatment information from patients because of personal moral objections.

The Chicago researcher believes that it's perfectly fine -- even beneficial -- that doctors make their personal beliefs known to patients. Then, at least, patients can understand why doctors might advise them in the way that they do, and act accordingly.
But to withhold valuable information from patients is wrong, Curlin said.
"It's the difference between saying, 'Ms. Smith, there are only these three options for you,' versus saying, 'Ms. Smith, let me be clear -- I think that there are only three good options for you, and I'm not going to give you information on obtaining this other option, because I really hope that you won't get it,' " Curlin said. "At least then, patients can understand why they are getting that counsel."

Patients can then, if they so choose, seek out a doctor on their own who would perform the requested procedure, Curlin said.

But another expert said physician referral is another obligatory part of standard medical care.

"I really think that's part of a physician's duty, and that's what the leading professional associations say, also," said Dr. Peter Ubel, director of the Center for Behavioral and Decision Sciences in Medicine at the University of Michigan.

"Yes, it may seem weird to say, 'I think this procedure is wrong, but here's a guy who can do it for you,' " Ubel said. "I understand why that might make someone morally uncomfortable. But that is part of what your job as a physician is."

So, where does all of this leave patients, many of whom have little insight into their doctor's personal moral views?

"I think people need to educate themselves," said Ubel, who is also a professor of medicine at the University of Michigan. "When your doctor says, 'Here's how I think that you should be treated,' I say -- do your homework. I am not saying that you shouldn't trust your physician, because I think most of us are really trying to help patients out. But nobody knows everything, and we all come with our biases. Patients should empower themselves with knowledge."