Books and Essays by Doctor Frank Boehm

(March 10, 2007)

      There is an old joke that goes something like this. A man is standing in a long line waiting to enter the Pearly Gates when he sees a man with white hair, wearing a long white coat and a stethoscope around his neck, walk past him and enter the Pearly Gates without anyone objecting. The man asks, "Who is that?' to which someone replied, "Oh, that's God, every now and then he likes to play Doctor". A recent study in the New England Journal of Medicine provides new evidence that every now and then some doctors also like to play God.

      Recently a survey was sent to over 1800 physicians to determine how they felt about certain controversial issues concerning their ethical rights and obligations when patients requested medical procedures that were legal but which the physician might object to based on ethical, moral or religious reasoning. The issues included administrating terminal sedation to dying patients, providing abortions for failed contraception and prescribing birth control to adolescents without parental approval.

      Seventeen percent of the 1144 physicians who responded to the survey indicated that they objected to terminal sedation for a dying patient; 42% objected to prescribing contraception to adolescents without parental approval, and 52% opposed abortion for a patient who got pregnant because of failed contraception

      In addition, 63% stated that it would be ethical for doctors to tell patients who made such requests that they objected to the request because it violated their own moral or religious code of behavior. Fifteen percent of doctors were undecided on this issue, while 22% said that they felt no obligation to explain why they would not grant the patient their request.

      Essentially, this means that at a minimum one in five doctors feel no obligation to explain to patients why they would not grant their requests on these three sensitive and controversial procedures.

      Another question on the survey questioned whether a doctor has a duty to present all possible options to patients including information on how to obtain the requested procedure if the doctor refused. The answer to this question was also disturbing. While 86% said yes, 8% (or one in twelve physicians) answered no. Even more disturbing was the response to the question of whether a doctor has an obligation to refer a patient to another doctor who would provide the requested procedure. Eighteen percent, or approximately one in five doctors, responded no as well.

      The survey indicates that there are many doctors in this country who do not feel obligated to give information to or refer their patients for certain legal, yet morally controversial, procedures. The authors concluded that patients needed, therefore, to take responsibility in actively questioning the doctor if their requests were denied without proper information as to the reason for the denial and ask to be referred to another doctor who would comply. In other words, it is the patient's responsibility to seek more information when the doctor refuses to comply with basic ethical medical principles of justice and patient welfare. That is quite a turn around in responsibility and in my opinion troubling.

      Doctors have a right to refuse to provide certain medical procedures such as abortion or the dispensing of contraception based on religious or moral reasoning. I don't believe, however, that they have the right to withhold information that would explain why they are refusing to comply with a patient's request or to refuse referral to a provider who would comply.

      While it was comforting to read that the majority of doctors are in agreement that they have an obligation to inform and refer under these circumstances, it is equally troubling that so many did not. These relatively small numbers of doctors take care of millions of patients who are then at risk to be denied certain basic fundamental rights of patient care.

      The public wants to be able to trust their doctor. The doctor in turn has to earn that trust. By being upfront about their beliefs and being willing to refer patients to doctors who would grant a patient's legal yet controversial request, they will be perceived as compassionate and trustworthy doctors….not God.