Physicians' beliefs about conscience in medicine: a national survey.
OBJECTIVE
To explore physicians' beliefs about whether physicians sometimes have a professional obligation to provide medical services even if doing so goes against their conscience, and to examine associations between physicians' opinions and their religious and ethical commitments.


METHODS
A survey was mailed in 2007 to a stratified random sample of 1,000 U.S. primary care physicians, selected from the American Medical Association Physician Masterfile. Participants were classified into three groups according to agreement or disagreement with two statements: "A physician should never do what he or she believes is morally wrong, no matter what experts say," and "Sometimes physicians have a professional ethical obligation to provide medical services even if they personally believe it would be morally wrong to do so."


RESULTS
The response rate was 51% (446/879 delivered questionnaires). Forty-two percent and 22% believed they are never and sometimes, respectively, obligated to do what they personally believe is wrong, and 36% agreed with both statements. Physicians who are more religious are more likely to believe that physicians are never obligated to do what they believe is wrong (58% and 31% of those with high and low intrinsic religiosity, respectively; multivariate odds ratio, 2.9; 95% CI, 1.2-7.2). Those with moral objections to any of three controversial practices were more likely to hold that physicians should never do what they believe is wrong.


CONCLUSIONS
A substantial minority of physicians do not believe there is ever a professional obligation to do something they personally believe is wrong.
Lawrence
Ryan E
RE
Pritzker School of Medicine, University of Chicago, Chicago, Illinois 60637-5415, USA. rlawrence@uchicago.edu
Curlin
Farr A
FA
D000029:Abortion, Legal / Q000941:ethics; D000328:Adult; D003242:Conscience; D003469:Culture; D003625:Data Collection; D004992:Ethics, Medical; D005006:Ethnicity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians; D010821:Physicians, Family; D016079:Refusal to Treat / Q000941:ethics; D012068:Religion and Medicine; D017236:Suicide, Assisted / Q000941:ethics
Acad Med. 2000 Aug;75(8):834-9
10965863
Postgrad Med J. 2006 Apr;82(966):233-8
16597808
N Engl J Med. 2005 Jun 16;352(24):2471-3
15958802
Hastings Cent Rep. 1995 Jan-Feb;25(1):22-6
7730046
J Med Philos. 2004 Feb;29(1):3-9
15449810
Theor Med Bioeth. 2008;29(3):187-200
18756375
J Pers Soc Psychol. 1967 Apr;5(4):432-43
6051769
J Med Philos. 2004 Feb;29(1):61-74
15449813
J Clin Epidemiol. 1997 Oct;50(10):1129-36
9368521
J Med Ethics. 2005 Oct;31(10):612-8
16199607
Demography. 2006 Feb;43(1):185-201
16579214
J Med Ethics. 2007 May;33(5):249-54
17470498
J Law Med Ethics. 2000 Spring;28(1):78-80, 3
11067636
Arch Intern Med. 2001 Apr 9;161(7):925-8
11295954
Acad Med. 2005 Sep;80(9):866-73
16123470
J Med Ethics. 2000 Oct;26(5):363-9
11055040
Obstet Gynecol. 2007 Nov;110(5):1203-8
17978145
Hastings Cent Rep. 1995 Jan-Feb;25(1):27-8
7730047
N Engl J Med. 2007 Feb 8;356(6):593-600
17287479
J Med Philos. 2004 Feb;29(1):75-91
15449814
Bioethics. 2000 Jul;14(3):205-27
11658133
BMJ. 2006 Feb 4;332(7536):294-7
16455733
Am J Bioeth. 2007 Dec;7(12):10-4
18098008
N Engl J Med. 2005 Apr 14;352(15):1511-3
15829530
N Engl J Med. 2004 Nov 4;351(19):2008-12
15525728
Am J Bioeth. 2007 Jun;7(6):8-14
17558978
J Gen Intern Med. 2001 Aug;16(8):559-63
11556934
Healthc Manage Forum. 2002 Fall;15(3):32-8
12389535
Hastings Cent Rep. 2006 Nov-Dec;36(6):11-2
17278865
Arch Intern Med. 1996 Apr 22;156(8):825-9
8774200