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Moral Controversy, Directive Counsel, and the Doctor's Role: Findings From a National Survey of ObstetricianGynecologists

Yoon, John D. MD; Rasinski, Kenneth A. PhD; Curlin, Farr A. MD

Academic Medicine:
doi: 10.1097/ACM.0b013e3181eabacc
Ethics Issues
Abstract

Purpose: To explore physicians' attitudes toward providing directive counsel when dealing with morally controversial medical decisions, and to examine associations between physicians' opinions and their demographic and religious characteristics.

Method: In 2008–2009, the authors mailed a survey to a stratified, random sample of 1,800 U.S. obstetrician–gynecologists. They asked participants whether, when dealing with either typical or morally controversial medical decisions, “a physician should encourage patients to make the decision that the physician believes is best.”

Results: Among eligible physicians, the response rate was 66%. Fifty-four percent of respondents rejected the use of directive counsel for typical medical decisions; 78% did so for morally controversial medical decisions. Physicians were less likely to refrain from directive counsel for typical medical decisions if they were older and foreign-born but more likely to refrain from directive counsel if they were more theologically pluralistic. Theological pluralism was the only characteristic significantly associated with refraining from directive counsel for morally controversial medical decisions.

Conclusions: Providing nondirective counsel to their patients appears to have become the norm among certain obstetrician–gynecologists in the United States, particularly when dealing with morally controversial medical decisions. These physicians tend to be female, younger, U.S.-born, and more theologically pluralistic. Shifts toward refraining from directive counsel seem to relate to shifts in physicians' demographic, cultural, and religious characteristics.

Author Information

Dr. Yoon is assistant professor, Section of Hospital Medicine, and ethics fellow, Maclean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois.

Dr. Rasinski is research associate, Section of General Internal Medicine, University of Chicago, Chicago, Illinois.

Dr. Curlin is associate 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 Dr. Yoon, Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 5000, Chicago, IL 60637; telephone: (773) 702-5197; fax: (773) 795-7398; e-mail: jdyoon@uchicago.edu.

© 2010 Association of American Medical Colleges