Most Docs Voice Objections But Offer Referrals, Survey Finds

Although most physicians consider themselves obligated to disclose information about legal but morally controversial medical procedures to patients or to refer them to another physician willing to accommodate their needs, a significant portion do not profess that same obligation, say the authors of a study published in the Feb. 8 New England Journal of Medicine. View the study abstract online for free.

According to "Religion, Conscience and Controversial Clinical Practices," 63 percent of all physicians surveyed said they think it is ethical for doctors to express their moral objections to patients regarding a course of treatment or a procedure. Eighty-six percent of physicians said they were obligated to present all options for treatment regardless of their personal moral objections, and 71 percent agreed that they should refer the patient to another clinician who does not object to the requested procedure.

Although these percentages represent a majority, the study researchers found that 14 percent of patients, or more than 40 million Americans, may be treated by physicians who do not consider themselves obligated to disclose medical information about procedures to which they object. Additionally, physicians who do not think they are obligated to refer patients to other providers for treatment may care for as many as 29 percent of all patients, or nearly 100 million Americans.

The extent to which a physician was determined to be religious was measured by his or her agreement or disagreement with two statements from Hoge's Intrinsic Religious Motivation Scale: "I try hard to carry my religious beliefs over into all my other dealings in life," and "My whole approach to life is based on my religion."

Data for the study were collected via a 12-page, self-reported questionnaire mailed in 2003 to a random sample of 2,000 practicing U.S. physicians age 65 or younger. The researchers received 1,144 responses, for a 57 percent response rate.

Overall, female physicians in the study were more supportive of disclosure and referral than were male physicians, say the authors. In addition, physicians who self-identified as "religious" were "less likely to endorse full disclosure and referral than are nonreligious physicians, perhaps because … religious physicians are more likely to have personal objections to many controversial medical interventions," the authors note/

The two services most often deemed objectionable by physicians responding to the questionnaire were abortion for failed contraception -- 52 percent of respondents objected to this procedure -- and contraception for adolescents without parental consent -- 42 percent of respondents objected to this practice.

This study, although preliminary, has implications for patients, say the authors, and it is important for patients to be aware of their physicians' beliefs about certain clinical interventions before the matter arises. "Physicians and patients might engage in a respectful dialogue to anticipate areas of moral disagreement and to negotiate acceptable accommodations before crises develop," say the authors.

The study was supported by grants from the Greenwall Foundation, the Robert Wood Johnson Clinical Scholars Program, and NIH's National Center for Complementary and Alternative Medicine.