February 20, 2007

U of C study examines doctors’ ethics

Millions of American patients may not be getting the full scoop from their doctors, according to a survey conducted by a group of University researchers published recently in the New England Journal of Medicine.

The 12-page survey was completed by 1,144 doctors. Eighty-six percent said they felt obligated to tell patients about every available treatment in cases involving controversial practices. However, eight percent of doctors said they felt no such requirement, and six percent were undecided. Seventy-one percent said they felt obligated to refer patients to other doctors who would perform controversial procedures.

The survey asked physicians about three morally controversial treatments: sedating dying patients to the point of unconsciousness, to which 17 percent of doctors objected; prescribing birth control to teenagers without parental consent, to which 42 percent objected; and abortion after failed contraception, to which 52 percent objected.

“We know that at the heart of ethics is a commitment to not do what one judges to be unethical,” said Farr Curlin, an assistant professor of medicine at the U of C and the lead author of the study. “We know that there are practices in medicine that many doctors believe are unethical. So I’m not surprised that some proportion of those find it ethically problematic even to tell patients how to obtain those practices.”

The authors note that if doctors are putting their ideas into practice, 14 percent of patients—more than 40 million Americans—may be seeing physicians who do not feel obligated to tell them about treatments to which the doctors object. And 29 percent of patients, about 100 million Americans, have doctors who do not feel forced to refer them to other health care providers who would perform these objectionable treatments.

The study also found that male doctors, more religious physicians, and doctors who objected to some or all of the controversial treatments were most likely to believe that physicians are not obligated to tell patients about treatments they find objectionable.

Sixty-three percent of doctors thought it was ethical to “plainly describe” their objections to a given procedure, according to the study.

“Doctors absolutely have an obligation to be candid and forthcoming about why they’re making the recommendations they’re making or refusing to provide further information,” Curlin said. “But there are certain practices, like abortion, that push on the edge of that, because doctors must decide whether the information they’re giving patients is just candor or helping them obtain the requested practice.”

Curlin said patients should talk with their doctors and ask about all available treatment options. “They should ask their doctors how they feel about those practices so they know how they will handle that,” he said.

The study was coauthored by John Lantos, a professor of Pediatrics and Medicine at the U of C; Marshall Chin, an associate professor of Medicine at the University; and Ryan Lawrence, a medical student at the Pritzker School of Medicine.