Nearly 100 million Americans are at risk of being denied "legal medical interventions" by religious doctors, according to a feature article in the New England Journal of Medicine. In the light of numerous news stories about health care workers who have refused to dispense contraceptives and editorials in leading clinical journals, doctors from the University of Chicago polled about 2,000 of their colleagues to assess the scale of the problem.

They found that it was big — and implied that it was quite scary. About 14% of patients, more than 40 million Americans, may be cared for by doctors who do not feel obliged to disclose information about treatments which they object to. And 29%, or nearly 100 million, may be cared for by doctors who will not refer to other doctors for morally controversial practices such as "terminal sedation" (sometimes described as euthanasia), abortion and providing teenagers with contraceptives without parental consent. Since 52% of doctors objected to abortion for failed contraception and 42% to contraception without parental consent, the authors feel that patients should be worried.

The study also found that male doctors with religious convictions are the least likely to endorse full disclosure of their prejudices and referral to more compliant colleagues. "Thus, those physicians who are most likely to be asked to act against their consciences are the ones who are most likely to say that physicians should not have to do so," say the authors.

The study shows that "a lot of physicians out there… are not, in fact, doing the right thing," commented David Magnus, a Stanford bioethicist. He said that since emergency contraception is considered standard care in ER, doctors who are opposed should avoid working there. Many doctors may have solved the dilemma by acting against their conscience. The lead author of the study, Farr Curlin, says that although doctors tend to be slightly more religious than the public, they are much less likely to carry their beliefs into their workplace, with 58% saying that they do, compared with 78% of the public.

The issue of conscientious objection for health care workers also troubles the Vatican. The Pontifical Academy for Life will host a conference on the topic later this week in Rome, with speakers from the US, Australia, England and France, amongst others.

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Michael Cook

Michael Cook edits BioEdge, a bioethics newsletter, and MercatorNet, an on-line magazine whose focus is human dignity. He writes from Sydney, Australia.

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