An alarming number of physicians do not feel obligated to tell their patients about certain medical procedures they morally oppose. Often falling into this category are teen birth control and abortion. A recently published study in the New England Journal of Medicine, led by Dr. Farr Curlin, a bioethicist at the University of Chicago has brought forth new information. The researchers surveyed 1,144 doctors from all around the US and found some truly disturbing facts about medical care in this country. Many doctors who morally oppose certain treatments do not feel obligated to refer people elsewhere for care they do not wish to provide.

According to the study, 86 percent of physicians believed they should present all options to patients, eight percent felt no obligation to present all options and six percent were undecided on the issue. In addition, the study found that 63 percent of doctors believed it was ethical to tell patients they had objections about certain treatments and that 18 percent felt no obligation to refer patients to another physician, while 11 percent were undecided (Kaiser Daily Women's Health Policy Report).

"They are a minority of doctors, but it's fairly substantial minority," said Dr. Curlin.

Overall, 52 percent of physicians surveyed said they oppose abortion, 42 percent opposed prescribing birth control to 14- to 16-year-olds without parental approval, and 17 percent objected to sedating patients near death.

Researchers claim that, based on their findings, 40 million Americans may be seeing physicians who do not believe that they are obligated to disclose information about legal treatments they oppose, and 100 million have doctors who do not feel the need to refer patients to another provider.

Those doctors who describe themselves as very religious, particularly Protestants and Catholics, were much less likely than others to feel obligated to tell patients about controversial treatments or refer them to other doctors, and were far more likely to tell patients if they had moral objections.

This is outrageous.

Imagine the scenario: A woman goes to see her doctor, someone whom she trusts, and she is either refused the care she needs or is simply denied it. Consider the implications for women who have been sexually assaulted or young women who need care and cannot get the support of a parent. A study of sexual assault survivors who were treated in emergency rooms found that fewer than half of the women who were at risk of pregnancy received EC (Amey & Bishai, 2002). Now add to this the chance that a woman isn't even told that EC is an option for her, or the young woman is not told how and where she can find a doctor who will treat her. Condoning the behavior of doctors who refuse to offer treatment and information clearly places an inordinate burden on patients to find care they need. Add to that the emergency and time-sensitive nature of some reproductive rights care and we've got some serious infringements on patient's rights.

The central questions remain: what kinds of obligations do professionals in various industries have to their clients? And who shall decide and regulate these obligations?

According to an American Medical Association policy statement, doctors can decline to give a treatment sought by an individual that is "incompatible with the physician's personal, religious or moral beliefs." However, the doctor should also try to ensure that their patient has "access to adequate health care." A New York Times editorial, rightly points out that while these doctors claim to be following their consciences, they have all too easily forgotten their oath to "do no harm."

According to the Washington Post, the study was prompted by the issue of health care providers who refuse to provide care that counters their moral and religious beliefs, such as pharmacists who refuse to fill prescriptions for emergency contraception or birth control pills, and physicians and nurses who refuse to participate in providing an abortion or to prescribe contraception. Study co-author John Lantos, professor of pediatrics and associate director of the University of Chicago MacLean Center for Clinical Medical Ethics, said the study is part of a larger effort to determine how physicians' values and religious beliefs shape their practice of medicine. The debate will undoubtedly continue seeing that many states have considered legislation that would require doctors to provide patients with all legal treatments or conversely would protect health care providers who refuse to provide certain treatments.

Given all this information, it seems that some folks do think that your conscience can suspend your obligation to uphold the ethical requirements of your profession and your obligations to society. Unless, of course, you object to war.

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For more: NPR's "Day to Day" conducted an interview with Dr. Curlin. In the interview, Curlin said, "Hopefully, doctors will be forthright with patients and candid. When they draw boundaries, they will make clear to patients that that's what they're doing." Listen online.