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Excerpt:
The following is from the Feb. 8, 2007, edition of The Dallas Morning News.


Silent treatment: Doctors' morals can limit options

By JEFFREY WEISS
The Dallas Morning News

Millions of Americans have doctors who may not tell them about morally controversial medical procedures, according to a study published in Wednesday's New England Journal of Medicine.

A significant minority of physicians who responded to a survey conducted by researchers at the University of Chicago said that doctors are not obligated to tell patients about procedures that the doctors object to, or to refer the patients to other doctors.

Doctors who consider themselves more religious were more likely to approve of restricting information than doctors who said they were not religious. Female doctors were more likely than their male counterparts to say a doctor is obligated to disclose all information.

"The general teaching is that doctors need to be candid and open with their patients," said Dr. Farr Curlin, lead researcher on the study. "I think doctors are ethically obligated to be candid."

He said he hoped the study would prod patients and their doctors into discussing these ethical questions, so that patients will know where their physicians stand.

The study asked about three morally controversial procedures: sedating dying patients to the point of unconsciousness, providing abortion for failed contraception, and prescribing birth control to adolescents without parental approval.

Doctors who said they had moral objections to one or more of the procedures also were more likely to say they did not feel obligated to tell their patients about them or refer patients to doctors willing to perform the procedures.

For the representative sample of American doctors, 86 percent said that doctors were obligated to tell their patients about all medically available procedures, and 71 percent said doctors were obligated to refer patients to colleagues who did not object to a medical procedure. And 63 percent said they believed it was ethical for doctors to explain their moral objections to their patients.

Doctor knows best?

While patients have the legal right to determine their treatments, as a practical matter, many don't contradict their doctors, said Dr. Tom Mayo, a medical ethicist and professor at the Southern Methodist University law school and UT Southwestern Medical School.

"You see it in end-of-life care, people who are reluctant to raise an issue that bothers them because they don't want to get the doctor mad at them," he said.

That means a doctor who isn't careful can coerce a patient into a treatment the patient might not want, he said.

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