AMA meeting: CEJA forum debates limits of personal beliefs
■ A doctor's right to withhold services that conflict with his or her moral beliefs is a source of long-standing debate.
By Carolyne Krupa — Posted Nov. 22, 2010
San Diego -- A physician's duty is to his or her patients, but occasionally a situation arises in which care the patient needs or wants goes against the physician's personal beliefs.
The question of a doctor's right to withhold services in such cases is a source of long-running debate. Many states have enacted laws that give physicians and other health professionals the right to refuse to provide services, such as performing abortions, on the grounds of conscience.
Delegates at the AMA Interim Meeting explored the question of withholding care in certain cases at an open forum hosted by the Council on Ethical and Judicial Affairs. They agreed that physicians shouldn't be forced to provide care that violates their beliefs, but said doctors should have honest conversations with patients upfront to avoid such conflicts.
"The rest of the nation has to understand that we are standing for a person's autonomy and human dignity," said Maria Lymberis, MD, a psychiatrist from Santa Monica, Calif., and an alternate delegate for the California Medical Assn.
Daniel Edney, MD, an internist from Vicksburg, Miss., said a physician's religious beliefs should be respected.
"My faith principles go to the core of my existence, and if you force me to do something that goes against that, you change who I am as a person and definitely as a physician," said Dr. Edney, an alternate delegate for the Mississippi State Medical Assn.
Likewise, physicians must respect a patient's faith. For example, doctors treating Jehovah's Witnesses must honor beliefs against blood transfusions, even though it's difficult to watch a patient succumb to a condition that otherwise could be treated, Dr. Edney said.
Physicians should let their patients know their moral beliefs early on. "We need to disclose that information upfront," said Robert Phillips, MD, PhD, a delegate for the American Academy of Psychiatry and the Law and a psychiatrist in Annapolis, Md.
Delegates also discussed substance abuse policies for physicians that many said are outdated, don't acknowledge addiction as a disease and need revision.
Too often physicians with addictions are ostracized and have trouble returning to practice after treatment, delegates said.
"The AMA should advocate more for those people," said Michael Miller, MD, an addiction medicine specialist from Madison, Wis., and a delegate for the Wisconsin Medical Society.