Protection of Conscience Project Library
Service, not Servitude
Abstract
This appendix has been provided by the authors to give readers additional information about their work.
Curlin FA, Lawrence RE, Chin MH, Lantos JD. Religion, Conscience and Controversial Clinical Practices (Supplement). N. Engl. J. Med.. 2007;356(593-600.
Abstract
Background
There is a heated debate about whether health professionals may refuse to provide treatments to which they object on moral grounds. It is important to understand how physicians think about their ethical rights and obligations when such conflicts emerge in clinical practice.
Methods
We conducted a cross-sectional survey of a stratified, random sample of 2000 practicing U.S. physicians from all specialties by mail. The primary criterion variables were physicians’ judgments about their ethical rights and obligations when patients request a legal medical procedure to which the physician objects for religious or moral reasons. These procedures included administering terminal sedation in dying patients, providing abortion for failed contraception, and prescribing birth control to adolescents without parental approval.
Results
A total of 1144 of 1820 physicians (63%) responded to our survey. On the basis of our results, we estimate that most physicians believe that it is ethically permissible for doctors to explain their moral objections to patients (63%). Most also believe that physicians are obligated to present all options (86%) and to refer the patient to another clinician who does not object to the requested procedure (71%). Physicians who were male, those who were religious, and those who had personal objections to morally controversial clinical practices were less likely to report that doctors must disclose information about or refer patients for medical procedures to which the physician objected on moral grounds (multivariate odds ratios, 0.3 to 0.5).
Conclusions
Many physicians do not consider themselves obligated to disclose information about or refer patients for legal but morally controversial medical procedures. Patients who want information about and access to such procedures may need to inquire proactively to determine whether their physicians would accommodate such requests.
Curlin FA, Lawrence RE, Chin MH, Lantos JD. Religion, Conscience, and Controversial Clinical Practices. N. Engl. J. Med.. 2007;356(6):593-600.
Abstract
Context: Controversy exists regarding whether and how physicians should address religion/spirituality (R/S) with patients.
Objective: This study examines the relationship between physicians’ religious characteristics and their attitudes and self-reported behaviors regarding R/S in the clinical encounter.
Methods: A cross-sectional mailed survey of a stratified random sample of 2000 practicing U.S. physicians from all specialties. Main criterion variables were self-reported practices of R/S inquiry, dialogue regarding R/S issues, and prayer with patients. Main predictor variables were intrinsic religiosity, spirituality, and religious affiliation.
Results: Response rate was 63%. Almost all physicians (91%) say it is appropriate to discuss R/S issues if the patient brings them up, and 73% say that when R/S issues comes up they often or always encourage patients’ own R/S beliefs and practices. Doctors are more divided about when it is appropriate for physicians to inquire regarding R/S (45% believe it is usually or always inappropriate), talk about their own religious beliefs or experiences (14% say never, 43% say only when the patient asks), and pray with patients (17% say never, 53% say only when the patient asks). Physicians who identify themselves as more religious and more spiritual, particularly those who are Protestants, are significantly more likely to endorse and report each of the different ways of addressing R/S in the clinical encounter.
Conclusions: Differences in physicians’ religious and spiritual characteristics are associated with differing attitudes and behaviors regarding R/S in the clinical encounter. Discussions of the appropriateness of addressing R/S matters in the clinical encounter will need to grapple with these deeply rooted differences among physicians..
Curlin FA, Chin MH, Sellergen SA, Roach CJ, Lantos JD. The association of physician’s religious characteristics with their attitudes and self-reported behaviours regarding religion and spirituality in the clinical encounter,’. Med Care. 2006;44(446-453.