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Shortchanging patients.

Byline: The Register-Guard

Many people may be surprised to learn that some doctors would not be willing to provide them with medical information about emergency contraception, stem cell therapy or abortion. These doctors - admittedly a minority of practicing physicians - believe it's their right to withhold information or treatment from their patients based on religious or moral objections.

What's more, many of these doctors, if they had such objections, also would refuse to refer their patients to physicians who would provide the treatment.

It should be noted that the vast majority of doctors are guided by a bedrock commitment to present all medical options to their patients. In a survey conducted by Dr. Farr Curlin of the University of Chicago's MacLean Center for Clinical Medical Ethics, 86 percent of doctors agreed that physicians have an obligation to present all options to their patients, including information about obtaining requested procedures.

But the 8 percent of physicians who do not believe they are obligated to disclose information about treatments they consider objectionable are caring for more than 40 million Americans, Curlin noted in his report in the New England Journal of Medicine. Even more patients - nearly 100 million - may have physicians who wouldn't offer referrals to other doctors who would provide the treatment.

Physicians have every right not to perform medical procedures that conflict with their values. However, withholding information or refusing referrals for appropriate and legal treatment options are much more troubling ethical decisions that deserve to be addressed by medical education programs and national medical associations.

Without a second thought, most patients place enormous trust in their physicians. They see their doctors as more than just professional experts. The special relationship that develops between doctors and patients is characterized by a level of candor and confidentiality that is rarely found anywhere else.

Unfortunately, Curlin's study reveals that an alarming number of patients may not be hearing the kind of candor they deserve from their physicians when it comes to the complete range of treatment options. That's unacceptable. Doctors have an obligation to inform their patients from the very first visit if there may be instances in which a moral issue will restrict the doctor's treatment options for the patient.

Two-thirds of the physicians in Curlin's study believe it's ethically acceptable to explain their moral objections to abortion, adolescent contraception or other treatments to their patients. But that's not enough. Once those objections are shared - as they should be in every case - the physician must indicate to the patient all treatment options.

At that point, patients can ask for referrals. If the physician is unwilling to provide them, the patient should get another doctor.

As things now stand, the onus is on patients to ascertain whether their physicians are among the ones who might have moral objections to certain treatments. But the doctor-patient relationship can't succeed unless it is a two-way street. Patients shouldn't have to quiz their doctors about something as fundamental to ethical, professional care as honest communication.
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Title Annotation:Editorials; Some doctors withhold treatment information
Publication:The Register-Guard (Eugene, OR)
Article Type:Editorial
Date:Feb 22, 2007
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