Survey: Doctors' personal beliefs can hinder care

Do not always expect straight talk from your doctor about treatments he or she disapproves of ? 14 percent of physicians believe it is acceptable to withhold information about medical options they oppose morally, such as teen birth control, abortion and sedating dying patients, according to a survey published Wednesday.

In addition, 29 percent feel no duty to refer patients elsewhere for such treatments.

The survey of 1,144 doctors around the country is the first major look at how physicians? religious or moral beliefs might affect patients? care. Most of the doctors who responded to the poll, conducted by University of Chicago researchers, supported full disclosure and referral to another health care provider if they had moral objections to a treatment or procedure.

According to an American Medical Association policy statement, doctors can decline to give a treatment sought by an individual that is ?incompatible with the physician?s personal, religious or moral beliefs.? But the physician should try to ensure the patient has ?access to adequate health care.?

?If physicians? ideas translate into their practices, then 14 percent of patients ? more than 40 million Americans ? may be cared for by physicians who do not believe they are obligated to disclose information about medically available treatments they consider objectionable,? study author Dr. Farr Curlin of the University of Chicago and colleagues wrote.

?In addition, 29 percent of patients ? or nearly 100 million Americans ? may be cared for by physicians who do not believe they have an obligation to refer the patient to another provider for such treatments.?

The survey did not examine whether these doctors act on their beliefs ? that is, whether they actually withhold information or refuse to refer patients.

?Conscientious objection is fine ... as long as it doesn?t conflict with the rights of the patient,? said David Magnus, director of Stanford University?s Center for Biomedical Ethics. ?You can?t abandon the patient or essentially coerce the patient by saying you won?t do the procedure or refer them to someone else.?

The study was published in Thursday?s New England Journal of Medicine and led by Curlin, an ethicist and internist. The findings were based on a survey mailed to 1,820 practicing U.S. family doctors and specialists, chosen randomly from a national database; more than 60 percent responded.

Doctors describing themselves as very religious, particularly Protestants and Catholics, were much less likely than others to feel obligated to tell patients about controversial treatments or refer them to other doctors, and were far more likely to tell patients if they had moral objections.

Plenty of doctors object to something, the survey found.

Overall, 52 percent said they oppose abortion, 42 percent opposed prescribing birth control to 14- to 16-year-olds without parental approval, and 17 percent objected to sedating patients near death.

Female doctors were much more likely than male ones to feel obligated to refer patients for treatments they personally oppose, far less likely to present their own objections to a patient and slightly more likely to disclose all treatment options.

Dr. Jeffrey Ecker, chairman of the committee on ethics at the American College of Obstetricians and Gynecologists, said he was encouraged that most doctors agreed patients deserve to be told about all appropriate medical options and referred to other doctors when needed.

?There is reason to be concerned about those that don?t do it,? Ecker said. He added that it is possible many doctors in the survey who opposed such disclosures and referrals may be practicing in specialties where they don?t face those issues.

He said doctors must let patients explicitly know if they are opposed to particular services.

Rape victims could be denied help
One big problem area, Magnus said, involves emergency room doctors and emergency contraception for rape victims. He said it is considered standard care to offer the morning-after pill, but t

 

This is the quote that matters:

BTW, what is the source for your article?

Again, freedom isn't a one-way street.

 

Freedom should be a one-way street when doctor's can be irrational 'eh-holes. If your job requires you to treat someone or have them in your care then the right to refuse to give treatment shouldn't be allowed. Then again this is the US we're talking about.

 

Are doctors being upfront in refusing, or are they intentionally and deliberately hiding information from a patient to make sure they rack up a healthy wad of "Afterlife dollars"?

There's a difference between saying "These options exist, but for personal reasons I can't offer treatments in this area" and keeping a patient ignorant.

ES

 

The 1st Amendment isn't a one-way street, FID. It was written to protect individuals from just such sentiments as expressed by certain progressives, that one individual's choice demands that another individual gives up their rights.

This issue has been discussed in the abortion thread thoroughly, with the legal precedents demonstrated quite clearly.

I find it a bit of a paradox that the same liberty that progressives demand for one individual that they are so quick to revoke from another individual, simply because of an ideological difference. You don't want others forcing their religious views on an individual, but you don't mind another forcing an individual to comply against their fundamental rights guaranteed by the Constitution.

You must understand that health care isn't currently a Constitutional right in the United States to begin with. States have discression internally on how to regulate practice, to a certain extent, not to supercede an individual's First Amendment rights.

Certain states have been proactive in protecting the rights of healthcare professionals from such totalitarian sentiments.

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E_S, referrals are usually always made to the proper venue where the patient can get such treatment. Healthcare professionals are usually up-front about the rationales involved.

I already elaborated on a personal situation involving just this scenario: The pharmacy my wife works for does not carry 'Plan B' or 'RU 486'. If asked, they make the proper referrals. However, my wife has never been asked to fill such a script, and they fill over 1,000 scripts a day.

I've never been personally asked to assist in an abortion procedure. If asked, I would refuse and make a proper referral to another RN that would have no objection. I don't work in the OR, so this situation would very rare to come up here. I would care for a patient that already underwent the procedure and needed ICU care. I would not assist in the procedure itself.

 

E_S, referrals are usually always made to the proper venue where the patient can get such treatment.


the survey seems to suggest otherwise. also, "usually" and "always" are not the same thing.

 

But the survey indicates it's a problem that it's not the case, DM

E_S

 

True, but in my experience, I've never run across it. I've been in private healthcare for 6 years. (If my memory serves, we may have had one patient here that had a D&C for an incomplete miscarriage, but never any termination.) My wife has friends that have dispensed the medication, or they have made a referral.

I would agree that a referral should be made (as to location), but no one should be obligated to actually participate in the procedure or dispense the prescriptive agent.

Referrals aren't active participation.

It's like a practicing Muslim telling a non-Muslim where the nearest bar is.

 

Well not exactly, but I see what you're getting at. The problem with that example though is that the non-Muslim has to have some compelling need - not want - for that bar.

E_S

 

Of course it's not. People who have a moral objection to practicing medicine are free to go to law school instead, and I have no objection to them exercising their freedom that way.

It's not the same thing. No one's forcing anyone to become a doctor. If they do agree to become a doctor and go into business or accept employment as such, then they had damn well better be prepared to follow through on that commitment.

If I work at a bond trading firm, and I hire a guy, and then once hired, he says he's a devout Muslim and he's morally opposed to the accumulation of interest, I have every right to demand that he do his job or be fired.

It's like signing a contract, and then trying to back out of your contractual obligations on the grounds that it inhibits your freedom. Yes, it inhibits your freedom, but only in ways that you agreed to deal with when you signed up, and you signed up of your own free will.

If you don't want to distribute the morning after pill, you are not cut out to be a pharmacist. If you don't want to perform certain procedures, either don't become a doctor at all or don't enter a field where those procedures are part of your duties. If you're a devout Hindu, don't flip burgers at McDonald's. If you are devoutly Amish, don't bitch about discrimination and personal freedom when you can't get a job as a NASCAR driver.

You absolutely have the freedom not to take on a job that you can't do because of religious taboos. However, you do not have the freedom to expect to be hired to do a job that you can't or won't do.

 

E_S, Conscience Clause law is clear in many States here, which reinforces the Constitutional rights of individuals not to be compulsed to violate their integrity because of another individual's wishes.

As stated earlier, a referral should be all that is required.

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You don't get to make that call, diz.

The law protects individuals from such totalitarian sentiments.

 

The law does a lot of stupid and unjust things. Hopefully, we can work to change that.

 

isn't this EXACTLY why one gets a second opinion on imporant issues?

I had to have a surgery to correct a problem with my feet. One doctor told us only one procedure, another told us several procedures but most recommended a different procedure. The latter was the easier procedure, i think, and the one I had. Doctors aren't always going to give full info on all if they think one is not the right option. But you can always go to another doctor.

I'll say, though, that emergency rooms are a potentially seperate matter.

 

What about in the case of emergency rooms of Catholic hospitals, though? They are obligated to adhere to the Ethical and Religious Directives for Catholic Health Care Services.

You can't force a doctor to perform a morally objectionable action, diz, as it is tantamount to breaking his Hippocratic Oath. Unlike your other examples, there is room for legitimate debate of the ethics involved in certain aspects of the medical field. It is much more difficult to argue for a burgerless burger joint. If we were talking of someone who rejects medicine wholesale in favor of holistic healing, I might be more inclined to agree.

 

I sure am glad the Constitution and our laws are meant to protect minorities. If you are really pro-choice, that choice should be extended to all involved in the process. Why does the woman get to force any doctor to do things he or she does not want to do? You wouldn't like doctors forcing women to not have abortions. Performing an abortion is not a critical task for medical professionals, and if they do not want to do it they are within their rights to direct the individual to somebody that does.

Don't pretend to be for choice when you would remove that choice from those who make choices you don't like.

 

Can you please cite the source saying employers aren't aware of this?

 

No, it's not. The central ethos of the Hippocratic Oath is the idea of putting the needs of the patient first and foremost. If the patient needs contraception or an abortion, and you can't or won't provide it, you are in violation of the most basic principles of medical ethics.

No, there isn't. Abortion and contraception are totally intertwined with many, many aspects of women's health, and it's absurd to pretend that they are not part of what can reasonably be expected of a professional who wants a license to practice. Having moral objections to either basically puts you in the same camp with Jehovah's Witnesses who have moral objections to blood transfusions. You're absolutely free to believe that, but you have to recognize that those beliefs are fundamentally incompatible with practicing modern medicine. You're welcome to try to find some kind of theological workaround to sort it out in your head to justify doing your job, but if your beliefs conflict with your job requirements, one of them has to give.

I agree. I don't think anyone should be forced to do anything they don't want to do. However, if someone can't or won't perform necessary job functions for a position which requires professional licensing, I don't think they should be licensed to practice. You can believe whatever you want, and I can't force you to act in violation of that, but neither do I have any obligation to license you to do something you can't or won't do.

So yes, you have the choice whether or not to participate in filling a prescription for the morning-after pill, and you make it when you decide to apply for a pharmacist's license and accept a job in the field. Similarly, you have the choice to decide whether or not to participate in performing abortions, and you make it when you decide to practice medicine in any field where it would be a reasonable requirement.

You can back out at any time, but you have to understand that your license to practice is conditional upon compliance with certain standards, and it's fully legitimate for those in question to be among them.

Choice is meaningless without access and availability. The right to control one's own body is a fundamental underpinning of all aspects of personal freedom, and for women, that means access to abortion and contraception, which makes doctors and pharmacists the guarantors of women's freedom in a very real and practical way. As such, it's a position of public trust, like a police officer.

Police officers have to serve and protect the public at large, even people they don't like or the ones who live lifestyles they disapprove of morally. Would you allow a police officer to "opt out" of investigating the gay-bashing death of a homosexual on moral grounds? Or the murder of a doctor at an abortion clinic? The police make a choice to willingly surrender their rights to act on the basis of their personal feelings, including their religious beliefs, because it's necessary for them to do so in order to perform their job functions, and their job functions are necessary for any of us to have real freedom.

Doctors are no different, and the legal recognition of that public trust is the licensing process. When you are applying to be licensed as a physician or a pharmacist, you are agreeing to provide a specific set of services, to abide by a set of regulations, and, crucially, to subordinate your personal feelings, beliefs, and biases to the needs of the patient. This is a necessary comp

 

dizfactor, i recently accompanied a friend to the doctor, and she needed bloodwork done as part of a diagnosis. however, because of how her veins are, there wasn't anyone there that felt as though trying to take blood would be something they would be comfortable doing. How different is that from saying that, say, performing an abortion, which a doctor may not feel comfortable doing because they don't believe its best for the mother, saying they're not comfortable with it and sending them elsewhere?
And if women have choice, what about choice of what doctor to go to? Your police analogy is faulty... I can't pick the police officer investigating a crime. A woman can, however, choose who her doctor is, under normal circumstances.

 

Not always. 87% of all counties within the US lack abortion providers. Women who live in rural areas, especially in the middle of the country, often have to travel great distances at considerable personal expense in order to exercise their rights. For many, many women, they don't have any choice at all of where they can go.

This is not, primarily, for the benefit of women who live in heavily-populated metropolitan areas, especially on the coasts. If you have one doctor who objects, there are others. If one pharmacy won't fill your order, there's one down the street. However, not everyone is so lucky.

Plus, you have women in prisons, you have rape victims who are coming into an ER in a distressed state, you have other circumstances where people have limited options. I mean, let's say that a woman is raped, beaten, and left without her purse or any identification in an alley somewhere. Someone finds her, calls 911, and the hospital the ambulance takes her to happens to be affiliated with the Catholic Church. In most hospitals, the morning-after pill is distributed as a matter of course to rape victims, but that's not the case (as I understand it) in Catholic hospitals. She's badly injured and psychologically traumatized - she's not going to be in a condition where she can just decide to take her business elsewhere, and most medical professionals would agree she needs emergency contraception and she needs it now. How can it possibly be ethical for an institution which is claiming to be a hospital and is accepting rape victims in off the street to then refuse to provide appropriate treatment?

It's worth noting that in both of the cases of emergency contraception and abortion, time is a critical factor. If you don't take emergency contraception within 72 hours, you can't take it at all, and the longer you wait to have an abortion, the greater the risk of medical complications and the greater the expense. If you live in a remote area, and the local pharmacist doesn't fill your prescription, or the local OB/GYN won't perform abortions, you've got serious problems.

 

That statistic is irrelevant for this discussion, because not all doctors are abortion providers. Or would you insist that an ophthalmologist or an anesthesiologist be required to give abortions on demand? Not every county in the US has either of those either.

That's a load of bull. My ex-wife, for example, went to school in a rural town in Virginia, and yet there were still over a dozen pharmacies within the town, ranging from mom-and-pop stores to big corporate branches. The odds of all of them (including the corporate ones) refusing to fill a prescription are stronomical.

If you are going to claim that there are places with so few pharmacies, then why don't you back it up? Where is this mythical town where people have no choice whatsoever about which pharmacy they go to? Can you name just one town that fits your description? Or are you just talking out of your rear?

You, sir, are a tyrant. You complain about the tyranny of someone passively not allowing a woman to exercise her rights, but you would actively infringe the rights of others. I would submit that you cannot passively infringe someone's rights, because infringement itself requires actions. By that measure, your position is by far the worse one.

Once more, where is this mythical rural area? Name one town that fits your description of having only one pharmacy and one OB/GYN. Considering how many major corporate pharmacies there are these days (don't both Walgreens and CVS brag about how many stores they have?), you need to back that one up. Otherwise, it's just your word on it, and why should we accept what you say without proof?

Kimball Kinnison

 

I have to say that I'm with diz 100% on this, and I cannot state his arguments better than he can.

As a physician, I have a sworn duty to put my patients first, regardless of my personal feelings. If I can't, it is my obligation to not only inform, but arrange for alternative treatments for said patient. If the situation is an emergency and I am the only provided with the necessarily skills available, then I am out of luck and I must take care of my patient. To do otherwise is an unconscionable violation of my oath and my duty.

The fact of the matter is that we as a society entrust professionals through the process of training and licensure with specific duties. These duties must adhere to the standards of practice for each individual profession. The issue of freedom here is not one's beliefs, but the choice to not engage in activities that would conflict with said beliefs. Put another way, the definition of freedom that places personal beliefs above professional standards is not controlling, nor is it right or correct.

Most of you have known me for a long time, and I like to think of myself as a fairly reasonable person who accepts and listens to other people's beliefs. However, this is something that I feel very strongly about. A physician's first duty is to their patient, always. To demand that the profession conform to say, individual religious beliefs when placed in direct conflict with what is best for a patient is a violation of the duty to the professional standards of medicine. That is wordy, but it is the truth.

The overwhelming problem here is that people argue against this with soundbites that do very little to solve any problems in the real world. If you are against abortion, that is your position and I accept that. If, however, you are a physician who refuses to provide a rape victim birth control, whatever legal protections you may have, you are violating your duty to your patient and in fact doing her great harm. Your personal beliefs are not the issue, the human being who just attacked is-and denying her an emergency contraceptive sharply increases the likelihood that she would indeed need an abortion at some later date.

Peace,

V-03

 

That statistic is irrelevant for this discussion, because not all doctors are abortion providers. Or would you insist that an ophthalmologist or an anesthesiologist be required to give abortions on demand? Not every county in the US has either of those either.

That comment is even more irrelevant than the one you claim diz made was. He obviously was referring to OB-GYN physicians, and his statistic not only was correct, but very relevant. 87% of all US counties lack Ob-gyn's trained in abortion procedures. It has nothing to do with how many ob-gyn's there are; there are far more gyn physicians in the US who refuse to perform the procedure, not out of religious belief (although of course they do exist) but because they fear for their lives.

That's a load of bull.

The hell it is. When I was an anesthesiology resident in a major US city, I cared for numerous such patients, I saw them all the time on call. For legal reasons, I cannot give any more specifics than that, I have to protect myself. But some ED's send patients who are otherwise stable to other hospitals even if they are having natural miscarriages because the doctors there will not surgically complete a missed spontaneous abortion on religious grounds. It's deplorable.


My ex-wife, for example, went to school in a rural town in Virginia, and yet there were still over a dozen pharmacies within the town, ranging from mom-and-pop stores to big corporate branches. The odds of all of them (including the corporate ones) refusing to fill a prescription are stronomical.

And of course your sample represents all small towns in the US.

Come on Kimball, you know better than that. Her town was most likely the exception, rather than the rule. Even if it is only 50%, that certainly counts more than your blanket implication that all small towns in the US are like that small town.

If you are going to claim that there are places with so few pharmacies, then why don't you back it up? Where is this mythical town where people have no choice whatsoever about which pharmacy they go to? Can you name just one town that fits your description? Or are you just talking out of your rear?

How about one single abortion provider in the state of Nebraska? South Dakota? Does that float your boat? And there are numerous towns in the US that have only one local pharmacy; I've travelled all over this country and I saw many examples. The fact that I can't name them all doesn't mean that they aren't there.


Once more, where is this mythical rural area? Name one town that fits your description of having only one pharmacy and one OB/GYN. Considering how many major corporate pharmacies there are these days (don't both Walgreens and CVS brag about how many stores they have?), you need to back that one up. Otherwise, it's just your word on it, and why should we accept what you say without proof?

Hmm, ever been to Kintnersville, PA? No doctors period. Go drive up Route 611 in PA between Doylestown and Easton and you will find a strip of towns with one or less pharmacies and the same ratio of physicians. Get on Route 322 between Harrisburg PA and State College PA and it is even worse. You can end up at least 60 miles from a second pharmacy if your prescription is refused, and time is of the essence where morning-after pills are concerned.


Kimball, you make arguments very oftentimes on procedural grounds alone. That is an observation and not a criticism, but it would behoove you to look at the larger picture. No-one as intelligent as dizfactor would make a claim about problems with pharmacists without looking it up first. The fact of the matter is that this situation has not only occured in the past, but it has been national news and that is where "he gets it from". It's "out there", and has been for a long time. His failure to give a comprehensive list of one-stoplight towns in the US is not a reasonable counter to the argument. You call him a tyrant and claim he is cherry-pick

 

I'm sorry, but prove it.

I never said that it represented all small towns, but I did use it as one example.

As I said before, if the problem is as common as dizfactor and you claim, then can you name even one town that has only one pharmacy, no other pharmacies within easy reach (say, a half hour drive) and refuses to fill those prescriptions? If it as common as you claim, you should be able to do that. I'll even help you by illustrating my point:

CVS (just one of the major corporate drug stores) is primarily located in the East, but is expanding cross country. Here is their map of locations in th continental US. Notice how thoroughly covered the East is? Walgreens has about as many stores distributed differently throughout the country. Rite Aid has even more stores.

That's not even starting on places like Wal-Mart, K-Mart, Target, or pharmacies in grocery stores.

Let's look at Kintnersville. According to CVS.com, there are 7 CVS pharmacies within the default range of 15 miles from Kintnersville. 3 of those are located in Easton, PA which is only 12.5 miles (according to Google maps), or a drive of about 23 minutes (assuming you follow the speed limit). That's just for one major chain. Do you want me to pull up others?

As for your suggestion of Harrisburg to State College, the drive is 87.7 miles (according to Google). I picked the town of Port Royal, PA, which is about half way between the two. CVS has two pharmacies in Lewistown, about 17 miles (21 minutes) away. Rite Aid has another two pharmacies within 20 miles of Port Royal, if different directions from Lewiston. Walmart also has a store with a pharmacy in Lewiston.

Again, this neglects pharmacies in grocery stores or smaller mom-and-pop type stores.

Do you want me to continue?

I've asked both him and you to present that evidence before, and you have both failed to do so. The closest anyone came is when you actually named towns in your post there, but as I've just shown, that is easily demolished

 

Is there some medical reason that she needs the contraceptive or abortion, or is it just so that, as the victim, she doesn't have to go through the trials of pregnacy and childbirth? I sympathize with her situation, but understand that from the perspective of one who believes abortion to be murder, the life of the child is of higher priority than the hardship of the victim.

Also, I may be reading into what you said diz, but are you suggesting that if one were to come into the ER psychologically fragile as a rape victim, that those treating her should give her the morning after pill, regardless of what her beliefs are? Is so, I find that troubling and hypocritical.

 

I would argue that there are ideological tests on the president. The test for the presidency is whether they support the interests of the average citizen and how they feel about certain topics. You seriously wouldn't suggest that someone like GWB could get elected anywhere but in the US are you? So ideological tests for the president do exist, they're just not spelled out.

Similarly if someone's chosen profession conflicts with their beliefs why did they choose it? Probably money. So, they're okay with taking your money but if you ask for contraceptives then that goes too far! "No, you can't have birth control!" They proclaim. All the while taking your money. Something doesn't jive there. I think it's totally fair to force an employee to choose between their ideology and their job. After all, they chose it. No one came up to them and asked them to be a doctor or pharmacist. If they wanted to moralize they should have chosen another profession that doesn't involve making those icky choices like helping people--like a priest or a nun or maybe even a philosopher.