Doctors’ Values Influence Treatment and Access to Information

By Christine Cupaiuolo |

Here’s some shocking medical news. Rob Stein of the Washington Post of 1,144 doctors nationwide that found “8 percent said they had no obligation to present all possible options to patients, and 18 percent said they did not have to tell patients about other doctors who provide care they found objectionable.”

Based on the findings, the researchers estimate that read than 40 million Americans may be seeing physicians who do not believe that they are obligated to disclose information about legal treatments the doctor objects to, and 100 million have doctors who do not feel the need to refer patients to another provider.

“They are a minority of doctors, but it’s fairly substantial minority,” said Farr A. Curlin, a bioethicist at the University of Chicago who led the study, published in today’s issue of the New England Journal of Medicine.

The survey was prompted by an intense debate over medical workers who refuse to deliver care that runs contrary to their moral or religious beliefs, asserting a “right of conscience” or “right of refusal.” Some pharmacists, for example, refuse to fill prescriptions for birth control and emergency contraceptive “morning-after” pills. Some doctors and nurses refuse to participate in abortions, prescribe birth control pills or withdraw or withhold care from dying patients.

Here are the details of the survey:

Curlin and his colleagues mailed 12-page questionnaires to 2,000 physicians from all specialties in 2003 asking them if they had objections to three controversial practices — sedating dying patients to the point of unconsciousness; prescribing birth control to teenagers without parental consent; and performing abortions after failed contraception.

Of the 1,144 who responded, 17 percent objected to “terminal sedation,” 42 percent objected to providing birth control to teens without parents’ consent and 52 percent objected to abortion after failed contraception.

When the researchers asked the doctors about their sense of obligation when patients request such procedures, they found that 86 percent felt obliged to present all possible options. But 6 percent were undecided and 8 percent felt no such responsibility. Sixty-three percent felt it was ethical to tell patients about their objections, and 18 percent felt no duty to refer patients to another doctor. Eleven percent were undecided.

Male doctors and those who described themselves as religious were the most likely to feel that doctors could tell patients about their objections and less likely to believe doctors must present all options or offer a referral.

This is problematic on multiple levels. My first thought is that any doctor who admittedly will not provide all medical options should post a public notice stating that information will be limited and restricted based on personal and religious beliefs. So much trust is put into the hands of medical professionals. Is it too much to ask of doctors that they provide their patients with the facts?

After all, the first principle of the Patient’s Bill of Rights addresses information disclosure and states: “You have the right to receive accurate and easily understood information about your health plan, health care professionals, and health care facilities. If you speak another language, have a physical or mental disability, or just don’t understand something, assistance will be provided so you can make informed health care decisions.”

Even if public disclosure were customary (I know — stretch of the imagination), many Americans are limited by their healthcare plans to certain doctors (assuming they have health insurance). And even when choice is permitted, selecting a doctor can take a great deal of time and effort.

Ultimately, it’s a matter of trust.

In the comments on a previous post, Roni pointed to NOW’s letter to the writers of a recent “Desperate Housewives” episode that was built around the false premises that teenagers need parental permission to obtain contraception, and parents could obtain confidential sexual health information about their teenager from the teenager’s healthcare provider.

The same mistrust that that episode fomented is further promoted by this recent survey. It’s bad enough when pop culture messes with the facts. Patients should never have to wonder if their doctors are, too.

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