October 4, 2022

No easy answer to conscientious refusal to refer, says ethicist

Doctors who are unwilling either to supply a legal service or refer to a willing doctor should be disciplined or get out of medicine altogether, a number of leading bioethicists have argued. But it’s not as simple as that, according to an article in the latest Journal of Medical Ethics.

Doctors who are
unwilling either to supply a legal service or refer to a willing doctor should be
disciplined or get out of medicine altogether, a number of leading bioethicists
have argued. But it’s not as simple as that, according to an article in the latest
Journal of Medical Ethics. A team led by Farr Curlin, of the University of Chicago,
surveyed 1000 American doctors and found that on ly 57% of them agreed that doctors must refer patients regardless
of whether or not the doctor believes the referral itself is immoral. But nearly
half — 43% — did not agree with this.

The slim majority,
say the researchers, tended to be theologically pluralistic and sociopolitically liberal. They also believe
that respect for patient autonomy is the most important bioethical principle.

Dr Curlin is pessimistic
about reconciling the two approaches: “there remains no uncontroversial way to resolve conflicts posed when patients
request interventions that their physicians cannot in good conscience provide.”

Nor does he think
that retiring into an uncontroversial corner of the profession or out of medicine
altogether will solve the conflict.

Given the rapid evolution
of medical practice, not to mention its segmentation and subspecialisation, those
entering medical practice cannot fully anticipate whether a certain specialty will
or will not coincide with their values in the future. Furthermore, this proposed
resolution does not adequately address what is to be done with individuals who have
a passionate interest in and aptitude for a particular clinical specialty, but who
have misgivings about a small segment of that specialty’s practice. Journal of Medical Ethics, July

Michael Cook
conscientious objection