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The Nation

Medical options withheld, study finds

February 08, 2007|Jeremy Manier | Chicago Tribune

CHICAGO — Patients who consult with doctors about controversial medical procedures might not be getting the whole story, according to a study that suggests some physicians won't even discuss options they deem to be morally wrong.

The study, by ethics researchers at the University of Chicago, found that 29% of physicians surveyed would have problems referring a patient to another doctor for procedures that are legal but controversial, including abortion.

Most of the 1,144 doctors who took part said professional duty required that patients at least be informed of their options, even those the doctor finds immoral. But 14% saw no obligation to detail such choices.

"That approach doesn't even give a patient the option to access other physicians," said R. Alta Charo, a professor of law and bioethics at the University of Wisconsin at Madison who was not involved in the study. "It's a raw imposition of your personal beliefs on all those who come to you for professional services."

The authors of the study, which appears in today's edition of the New England Journal of Medicine, did not recommend regulatory action that would compel doctors to tell patients all the options. Instead, coauthor Dr. John Lantos of the University of Chicago said the medical marketplace could resolve potential conflicts.

"Patients have to be aware that they may not get all the information or treatments they're legally due," said Lantos.

Lantos said his advice to patients would be, "Take our article in and show it to your doctor, talk about values, and say, 'I need to know if your beliefs match mine.' "

Male doctors were significantly less likely than female doctors to say a physician was obligated to give a patient a referral, said study coauthor Dr. Farr A. Curlin.

"Even after we controlled for religious characteristics, women physicians were substantially more likely to say doctors must give all the information and refer patients," Curlin said.

The three controversial procedures examined in the study involved having an abortion because of failed contraception; prescribing birth control to adolescents without parental consent; and "terminal sedation," a legal method of pain relief for dying patients that falls short of euthanasia, though in the process of relieving pain it may also bring death more quickly.

For many doctors, opting out of facilitating such procedures may be the only viable moral option, said Dr. Al Weir, a former oncologist who is national director of campus ministries for the Tennessee-based Christian Medical Assn. In particular, he said, doctors who oppose abortion believe it harms one of their patients -- the fetus.

"To knowingly send a patient to someone I knew was going to cause them harm, to me that would be the wrong thing to do," Weir said. But he said he also believed it was acceptable to inform a patient of all options and explain the possible objections.

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