The Values of Doctors and the Nontreatment of Patients

The media are making a pretty big splash about a New England Journal of Medicine study, which measured doctors’ willingness to refuse desired services if it violated their personal moral codes. From the story: “Based on the findings, the researchers estimate that more than 40 million Americans may be seeing physicians who do not believe that they are obligated to disclose information about legal treatments the doctor objects to, and 100 million have doctors who do not feel the need to refer patients to another provider.”

The focus, of course, was on doctors who hold what are labeled conservative beliefs, e.g., abortion, contraception, etc. And there is a pretty strong move underway to compel medical professionals (including pharmacists) to perform these services at the risk of losing their jobs or licenses to practice.

But this is a two-edged sword. Futile care theory, which would authorize doctors to refuse wanted life-sustaining treatment based on their own moral code, also would authorize physicians and other professionals to refuse wanted services. Yet, many bioethicists who are the most adamantly against, say, a Catholic pharmacist being allowed to refuse to distribute contraception, are all for futile care theory. Similarly, when I warn pro lifers that creating so-called “conscience clauses” allowing the refusal of some services could also legitimize medical futility, they will often nod their heads and keep on trucking.

I think there are solutions to these moral dilemmas. And I offer a few here: First, if denying the wanted medical service would likely result in death or significant harm to the health of the patient, it should not be allowed to be refused. Example: No doctor should be allowed to refuse to end an ectopic pregnancy, nor provide food and fluids to a patient diagnosed with permanent unconsciousness when that is what the patient/surrogate decision makers want.

For less pressing issues, surely panels of willing professionals can be found to take over a patient’s care or provide contraceptive services. And whenever there is a bona fide conscience issue, all should work together to transfer care to a willing professional.

Finally, doctors and health care institutions should disclose their policies before receiving patients into their care. In this regard, for example, I have urged doctors in Oregon to hang plaques in their waiting rooms declaring the office to be an “assisted suicide free zone.”

The genius of our system is our ability to accommodate the beliefs of people holding widely divergent moral and political views. Surely, we can work together to generally respect the moral views of medical professionals, without deleteriously impacting pateients’ health.