Purpose: 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.
Method: 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.
Conclusion: A substantial minority of physicians do not believe there is ever a professional obligation to do something they personally believe is wrong.
Mr. Lawrence is a fourth-year medical student, Pritzker School of Medicine, University of Chicago, Chicago, Illinois.
Dr. Curlin is assistant professor, Section of General Internal Medicine, and associate faculty, MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois.
Correspondence should be addressed to Mr. Lawrence, Pritzker School of Medicine, 924 East 57th Street, Suite 104, Chicago, IL 60637-5415; e-mail: (firstname.lastname@example.org).