Medicine and Democracy

If I told you that “doctors’ personal beliefs can hinder care,” you might guess that I was talking about physicians who would use leeches instead of antibiotics—or, maybe, Jehovah’s Witnesses who refused to give their patients blood transfusions. If so, you probably have not read the Associated Press. “Doctors’ Personal Beliefs Can Hinder Care” was the headline of an AP story about a just-released University of Chicago study. The study, published in the prestigious New England Journal of Medicine, surveyed physicians’ handling of “legal but morally controversial medical treatments”: abortion, birth control for minors, and terminal sedation. Based on physician questionnaires, the study found that “86 percent of doctors did feel obliged to present all options in such cases.” However, “only” 71 percent felt obligated to “refer the patient to a doctor who did not object to the requested procedure”—like abortion, for example. And 63 percent of the respondents said that sharing their moral objections—like, to abortion—with their patients was ethical. The report’s authors were alarmed that “40 million Americans” are being treated by physicians who do not feel obligated “to disclose information” about certain “treatments.” Even worse, as many as “100 million Americans,” so the study said, are being treated by doctors who do not feel obligated to refer patients to doctors who will provide those treatments. The authors wrote that this points to a “basic dilemma facing patients and physicians in our plural democracy”: Physicians and their patients might not share the same moral objections. This “dilemma” was summed up by the study’s co-author John Lantos. He asked whether there was “room within [medicine] . . . for radically different approaches to care based on moral or religious opinions?” He asked whether “doctors [should] leave their personal religious beliefs at the door?” Sounds like the thought police at work to me. According to the study, most doctors believe that caring for patients doesn’t require leaving your religious or moral convictions at the door. While patients have a “right to legal, medically approved treatment,” doctors also have the right to “follow their conscience.” It is important to keep in mind what “treatments” we are talking about here. Nobody is being denied access to the latest treatments for cancer or any other disease, at least not on moral grounds. Instead, the “illness” in question is pregnancy, or the possibility of becoming pregnant. Even if you are willing to regard pregnancy as an illness, you are still left with the fact that nobody is being “denied” anything. In the age of managed care, most Americans have to jump through hoops to see any kind of specialist. If anything, getting an abortion is sadly easier. A woman does not need a referral from her physician—in much of the country, all she needs are the Yellow Pages or Google. Likewise, Planned Parenthood and similar organizations are ready, willing, and able to accommodate a minor who wants contraceptives without her parents’ consent. Saying that a doctor’s following his convictions somehow “hinders” his patients’ care says more about the centrality of abortion in the elite imagination than about medicine. The real “concern” is that, thirty-four years after Roe v. Wade, abortion is still “morally controversial,” even if some insist on calling it a “treatment.”

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For Further Reading and Information

“Conscience, Religion Alter How Doctors Tell Patients about Options,” University of Chicago press release, 7 February 2007. “Doctors’ Personal Beliefs Can Hinder Care,” MSNBC, 9 February 2007. BreakPoint Commentary No. 060320, “Outlawing Conscience: Why We Need a Conscience Clause.”

02/13/07