In a recent mail survey of 1,820 U.S. physicians conducted by the University of Chicago, 86 percent of the responders believe that doctors are obligated to mention all treatment options, but only 71 percent believe they must refer a patient to another doctor for treatments they oppose.

Male physicians who described themselves as very religious, especially Protestants and Catholics, were much less likely than female physicians or others to feel obligated to tell their patients about controversial treatments or to refer them to other physicians.

In other words, about one-seventh of patients may be taken care of by doctors who may not disclose information about available and legal treatments they (the doctors) object to, and nearly a third of patients may be cared for by doctors who feel no obligation to refer patients to another physician for such treatments. 

Another problem is that many physicians assume that they know what is best for their patients and then go on to make decisions without letting them know all the facts, alternatives, and risks.

In a February 4, 2006, article in the British Medical Journal, Julian Savulescu, director of the Center for Practical Ethics at the University of Oxford in Great Britain, argued that "a doctor's conscience has little place in the delivery of modern medical care." Savulescu also made the following strong statement: "If people are not prepared to offer legally permitted, efficient, and beneficial care to a patient because it conflicts with their values, they should not be doctors."

Further, Stanford biomedical ethicist David Magnus stated that the results of the Chicago survey "[mean] that there are a lot of physicians out there who are not, in fact, doing the right thing."

The policy statement of the American Medical Association (AMA) says that doctors may refuse to give a requested treatment that is "incompatible with the physician's personal, religious, or moral beliefs," but that the physician should try to be sure that the patient has "access to adequate health care." Failure to follow these policy statements may be particularly troublesome for patients who live in rural areas where access to physicians is limited.

The controversial nature of this issue is evident, for example, in the Illinois Health Care Right of Conscience Act, which protects physicians from liability resulting from "refusal to perform, assist, counsel, suggest, recommend, refer, or participate in any ... form of health care service which is contrary to the conscience of such a physician."

I personally believe it is ethical for doctors to explain their moral objections to patients and to refuse to carry out procedures they find unacceptable. However, I also believe it is improper for physicians to withhold important information from their patients or to fail to provide requested referrals.

With this new evidence that many physicians allow their values to limit the treatment options they prescribe, patients should now consider determining ahead of time whether a prospective physician's religious or moral views might adversely narrow the range of suggested treatments.