AMA House of Delegates

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.

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Delegates discussed substance abuse policies for physicians at an open forum hosted by the Council on Ethical and Judicial Affairs. Addiction medicine specialist Michael Miller, MD, was among those who felt that current AMA policy is outdated. Photo by Ted Grudzinski / AMA

"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.

ADDITIONAL INFORMATION

Meeting notes: Other actions

Issue: Excessive medical school debts place a large burden on physicians, affect choices and narrow the pool of medical school applicants. Some cities have considered imposing tuition taxes.

Proposed action: Oppose medical school tuition taxes and any other attendance-based taxes imposed on medical students by government. [Adopted]

Issue: Physicians and other health care workers have a professional obligation to safeguard colleagues, the public and themselves against preventable communicable diseases.

Proposed action: Promote physician immunization against vaccine-preventable diseases, as well as immunization of health care workers against seasonal and pandemic influenza. [Adopted]

Issue: Medical students are often restricted from accessing patients' electronic medical records, limiting educational and patient care opportunities.

Proposed action: Encourage teaching hospitals and other clinical clerkship sites to allow medical students access to patient electronic medical records. [Adopted]

Issue: Existing physician licensure procedures make it difficult for doctors who want to volunteer short term in other states.

Proposed action: Encourage the Federation of State Medical Boards to develop a process by which licensing boards would allow licensed physicians to volunteer for less than 90 days in another area. [Adopted]