Medical morality
Doctors are letting their conscience dictate your treatment
It's one of the thorniest questions in medicine today:
Is it OK for health care workers to opt out of medical procedures they oppose on moral or religious grounds?
Consider these cases from recent headlines:
• A California fertility clinic refuses to help a gay woman get pregnant.
• A Chicago ambulance company fires an emergency medical technician for refusing to help drive a woman to an abortion clinic.
And now a University of Chicago study has found that large numbers of doctors would allow their moral beliefs to affect how they practice medicine.
Researchers surveyed 1,820 doctors, and 63 percent responded. Doctors were asked how they would respond if a patient requested a legal medical procedure the doctors opposed on ethical grounds.
Sixty-three percent said it would be OK to explain their objections to the patient. Eighteen percent said they're not obligated to refer the patient to another physician who does the procedure.
And 14 percent were either undecided or felt no obligation to present all possible options, including information about the requested procedure. This implies that more than 40 million Americans have doctors who "do not believe they are obligated to disclose information about medically available treatments they consider objectionable," Dr. Farr Curlin and colleagues wrote.
The study is published in the New England Journal of Medicine.
Male doctors and highly religious doctors were more likely to express moral objections and less likely to refer patients to other doctors.
Dr. Wayne Detmer, an internist at Lawndale Christian Health Center, is morally opposed to abortion. If a pregnant patient asked him about an abortion, he would say, "I'm a Christian. From my perspective, life is sacred."
Detmer, who was not among those surveyed, said he would express this opinion only if the patient appeared eager to hear his views. Under no circumstances would Detmer refer a patient to another doctor who performs abortions.
"The foundation of western medicine supports the right of doctors to abstain from practices that violate their conscience," Detmer said.
Loyola University Medical Center in Maywood and other Catholic hospitals in the Archdiocese of Chicago refuse to do procedures that go against church teachings, including elective abortions, birth control pills and in vitro fertilization.
That's OK with the American Medical Association. The AMA says it's ethical for a doctor to decline to treat a patient if the patient seeks a treatment that is "incompatible with the physician's personal, religious or moral beliefs."
Not all doctors agree. In a provocative essay in the British Medical Journal, University of Oxford ethicist Julian Savulescu wrote there should be no place in modern medicine for a doctor's conscience.
When a doctor refuses to offer a treatment, it forces the patient to shop around for a physician who does. This is inefficient and a waste of resources. Worse, patients who aren't savvy enough to find willing doctors "will fail to receive a service they should have received. This inequity is unjustifiable."
Savulescu states flatly that if doctors are unwilling to offer "legally permitted, efficient and beneficial care to a patient because it conflicts with their values, they should not be doctors."
However, most states have enacted "conscience clauses." In Illinois, for example, a health professional cannot be held liable for refusing to "perform, assist, counsel, suggest, recommend, refer or participate in any . . . health care service which is contrary to the conscience of such physician or health care personnel."
The Illinois Pharmacists Association believes pharmacists are covered by this act. But Gov. Blagojevich has ordered pharmacies to dispense Plan B. This could put a pharmacist in a bind if he or she objects to the morning-after pill, and there are no other pharmacists on duty to dispense it.
Pharmacists have been fined or otherwise disciplined for refusing to dispense Plan B. Several lawsuits are challenging the governor's order.
