Doctors' Moral Views Influence Their Advice to Patients

A large majority of doctors (71 percent) also felt obligated to refer a patient who wanted a particular procedure to another physician -- one who had no moral qualms about the treatment.

Demographic patterns emerged during the study. Older doctors were more likely than younger practitioners to support full disclosure of personal moral views to patients, and female physicians were nearly twice as likely as males to support full disclosure of treatment options and to refer patients to other doctors.

"We don't know for sure, but we speculate that women are bringing to mind issues of sexual and reproductive health care -- which disproportionately affect them -- and that may explain the [gender] difference," Curlin said.

Not surprisingly, religion played a key role in the doctors' responses. Highly religious physicians were much less likely to disclose a morally objectionable treatment option to a patient, for example, than doctors who were less devout.

Curlin said he was disturbed by the notion that 14 percent of U.S. doctors -- who together care for about 40 million Americans -- might intentionally withhold important treatment information from patients because of personal moral objections.

The Chicago researcher believes that it's perfectly fine -- even beneficial -- that doctors make their personal beliefs known to patients. Then, at least, patients can understand why doctors might advise them in the way that they do, and act accordingly.

But to withhold valuable information from patients is wrong, Curlin said.

"It's the difference between saying, 'Ms. Smith, there are only these three options for you,' versus saying, 'Ms. Smith, let me be clear -- I think that there are only threegoodoptions for you, and I'm not going to give you information on obtaining this other option, because I really hope that you won't get it,' " Curlin said. "At least then, patients can understandwhythey are getting that counsel."

Patients can then, if they so choose, seek out a doctor on their own who would perform the requested procedure, Curlin said.

But another expert said physician referral is another obligatory part of standard medical care.

"I really think that's part of a physician's duty, and that's what the leading professional associations say, also," said Dr. Peter Ubel, director of the Center for Behavioral and Decision Sciences in Medicine at the University of Michigan.

"Yes, it may seem weird to say, 'I think this procedure is wrong, but here's a guy who can do it for you,' " Ubel said. "I understand why that might make someone morally uncomfortable. But that is part of what your job as a physician is."

So, where does all of this leave patients, many of whom have little insight into their doctor's personal moral views?

"I think people need to educate themselves," said Ubel, who is also a professor of medicine at the University of Michigan. "When your doctor says, 'Here's how I think that you should be treated,' I say -- do your homework. I am not saying that you shouldn't trust your physician, because I think most of us are really trying to help patients out. But nobody knows everything, and we all come with our biases. Patients should empower themselves with knowledge."

More information

For more on medical ethics, visit the American Medical Association.

SOURCES: Peter Ubel, M.D., professor, medicine, and director of the Center for Behavioral and Decision Sciences in Medicine, and David Stern, M.D., associate professor, medicine and medical education; both of the University of Michigan, Ann Arbor; Farr Curlin, M.D., associate professor, medicine, MacLean Center for Clinical Medical Ethics, University of Chicago; Feb. 8, 2007,New England Journal of Medicine