Literature DB >> 21335574

Conscientious refusals to refer: findings from a national physician survey.

Michael P Combs1, Ryan M Antiel, Jon C Tilburt, Paul S Mueller, Farr A Curlin.   

Abstract

BACKGROUND: Regarding controversial medical services, many have argued that if physicians cannot in good conscience provide a legal medical intervention for which a patient is a candidate, they should refer the requesting patient to an accommodating provider. This study examines what US physicians think a doctor is obligated to do when the doctor thinks it would be immoral to provide a referral.
METHOD: The authors conducted a cross-sectional survey of a random sample of 2000 US physicians from all specialties. The primary criterion variable was agreement that physicians have a professional obligation to refer patients for all legal medical services for which the patients are candidates, even if the physician believes that such a referral is immoral.
RESULTS: Of 1895 eligible physicians, 1032 (55%) responded. 57% of physicians agreed that doctors must refer patients regardless of whether or not the doctor believes the referral itself is immoral. Holding this opinion was independently associated with being more theologically pluralistic, describing oneself as sociopolitically liberal, and indicating that respect for patient autonomy is the most important bioethical principle in one's practice (multivariable ORs, 1.6-2.4).
CONCLUSIONS: Physicians are divided about a professional obligation to refer when the physician believes that referral itself is immoral. These data suggest there is no uncontroversial way to resolve conflicts posed when patients request interventions that their physicians cannot in good conscience provide.

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Year:  2011        PMID: 21335574      PMCID: PMC4019379          DOI: 10.1136/jme.2010.041194

Source DB:  PubMed          Journal:  J Med Ethics        ISSN: 0306-6800            Impact factor:   2.903


  32 in total

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Authors:  E C Winkler
Journal:  J Med Ethics       Date:  2005-10       Impact factor: 2.903

2.  The celestial fire of conscience -- refusing to deliver medical care.

Authors:  R Alta Charo
Journal:  N Engl J Med       Date:  2005-06-16       Impact factor: 91.245

3.  The ethical standard of care.

Authors:  Rosamond Rhodes
Journal:  Am J Bioeth       Date:  2006 Mar-Apr       Impact factor: 11.229

Review 4.  "Conscience clauses" or "unconscionable clauses": personal beliefs versus professional responsibilities.

Authors:  Martha S Swartz
Journal:  Yale J Health Policy Law Ethics       Date:  2006

Review 5.  Conscientious objection in medicine.

Authors:  Julian Savulescu
Journal:  BMJ       Date:  2006-02-04

6.  Two cheers for conscience exceptions.

Authors:  Adrienne Asch
Journal:  Hastings Cent Rep       Date:  2006 Nov-Dec       Impact factor: 2.683

7.  Rational non-interventional paternalism: why doctors ought to make judgments of what is best for their patients.

Authors:  J Savulescu
Journal:  J Med Ethics       Date:  1995-12       Impact factor: 2.903

8.  Toward a reconstruction of medical morality.

Authors:  Edmund D Pellegrino
Journal:  Am J Bioeth       Date:  2006 Mar-Apr       Impact factor: 11.229

9.  Response rates to mail surveys published in medical journals.

Authors:  D A Asch; M K Jedrziewski; N A Christakis
Journal:  J Clin Epidemiol       Date:  1997-10       Impact factor: 6.437

10.  Crisis of conscience: reconciling religious health care providers' beliefs and patients' rights.

Authors:  K A White
Journal:  Stanford Law Rev       Date:  1999-07
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  5 in total

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Authors:  Lisa H Harris; Alexandra Cooper; Kenneth A Rasinski; Farr A Curlin; Anne Drapkin Lyerly
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2.  International survey of nephrologists' perceptions and attitudes about rewards and compensations for kidney donation.

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3.  The NERSH Questionnaire and Pool of Data from 12 Countries: Development and Description.

Authors:  Niels Christian Hvidt; Farr Curlin; Arndt Büssing; Klaus Baumann; Eckhard Frick; Jens Søndergaard; Jesper Bo Nielsen; Ryan Lawrence; Giancarlo Lucchetti; Parameshwaran Ramakrishnan; Inga Wermuth; René Hefti; Eunmi Lee; Alex Kappel Kørup
Journal:  J Relig Health       Date:  2021-10-01

4.  "Righteous minds" in health care: measurement and explanatory value of social intuitionism in accounting for the moral judgments in a sample of U.S. physicians.

Authors:  Jon C Tilburt; Katherine M James; Sarah M Jenkins; Ryan M Antiel; Farr A Curlin; Kenneth A Rasinski
Journal:  PLoS One       Date:  2013-09-04       Impact factor: 3.240

Review 5.  Ethical diversity and the role of conscience in clinical medicine.

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  5 in total

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