Academic journal article The Hastings Center Report

Martin Luther at the Bedside

Academic journal article The Hastings Center Report

Martin Luther at the Bedside

Article excerpt

The New England Journal of Medicine recently published a study that included data on physicians' personal beliefs about three controversial medical practices: "terminal sedation" (palliative sedation of a dying patient), abortion after failed contraception, and prescribing birth control to an adolescent without parental permission. Of the 1,144 respondents, 17 percent objected to "terminal sedation"; 52 percent objected to the abortion scenario presented; and 42 percent objected to the birth control scenario presented.

Respondents were also asked about the ethical obligations of physicians who object to any unspecified "legal medical procedure requested by a patient": 63 percent said it would be ethical for physicians to "plainly describe" their objections to the patient, 86 percent believed that the physician should provide complete information to the patient, "including information about obtaining the requested procedure," and 71 percent believed the physician should refer the patient to another provider. Then the researchers did the math: "If physicians' ideas translate into their practices ... more than 40 million Americans ... may be cared for by physicians who do not believe they are obligated to disclose information" about procedures they object to, and "nearly 100 million Americans ... may be cared for by physicians who do not believe they have an obligation to refer" such patients.

The researchers concluded that "physicians and patients might engage in a respectful dialogue to anticipate areas of moral disagreement and to negotiate acceptable accommodations before crises develop"--a conclusion that a New York Times editorial said "lets doctors off the hook." Indeed, it is hard to imagine how a dying person, a woman with an unplanned pregnancy, or a teenager who fears pregnancy and, perhaps, her parents, would be in a good place, strategically, "to negotiate acceptable accommodations before crises develop." All three of these people may already be in crisis.

The NEJM study has other limitations, acknowledged by its authors. The physicians surveyed may have expressed objections to practices they never, in fact, are asked to perform. Their answers do not tell us what they have done, or may do, in practice. …

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