January 6, 2012
Are there significant consequences when doctors and nurses provide health care that violates their moral or professional principles? The APPROPRICUS study, results of which were reported in the December 28 issue of the Journal of the American Medical Association (JAMA), suggests that the inability of physicians to practice medicine in accord with their personal ethical standards leaves them professionally dissatisfied and clinically less effective. Specifically, the authors conclude:
Among a group of European and Israeli ICU clinicians, perceptions of inappropriate care were frequently reported and were inversely associated with factors indicating good teamwork.
Researchers across Europe and Israel surveyed doctors and nurses working in intensive care units. If the physician or the nurse perceived he or she was providing inappropriate care to a patient, they completed a detailed questionnaire. Inappropriate care was defined as care that did not meet the professional, ethical, or moral standards of the medical personnel. The results assessed the impressions of 1651 clinicians.
Overall, 27% of those surveyed indicated they had participated in care that was contrary to their moral or professional principles. Those who reported such incidents also indicated that such occurrences were commonplace rather than isolated. Nurses who perceived care as inappropriate were more likely to work in an environment with poor communication between doctors and nurses and where input from nurses was not considered in care decisions. Both physicians and nurses who perceived care was inappropriate were more likely to suffer “burnout.” They were often looking to leave their current job and were also more likely to consider leaving medicine for an alternate career field.
This study has its limitations. There was no attempt to assess whether or not patients actually suffered from the care given by study participants. There was a great deal of discordance as to the perceived appropriateness of care among providers caring for the same patient, highlighting the subjective nature of defining appropriate care.
Increasingly, those in power share the opinion of Julian Savulescu, who wrote in the British Medical Journal, “A doctors’ conscience has little place in the delivery of modern medical care.” The study described above, however, should serve as a warning to the department of Health and Human Services (HHS) and others who disregard the importance of safeguarding the right of health care providers to adhere to their consciences. Forcing doctors and nurses to provide care that violates fundamental professional standards or religious beliefs may result in the exodus of highly qualified clinicians from the medical profession. More to the point: even those who stay will conduct their practice in a demonstrably less healthy mental state, which, it seems, would be dangerous to the health of those whom they treat.
Another significant finding in the study is that nurses were far more likely to feel they were providing inappropriate care when they were not included in the treatment decision process for a patient. Understandably, they felt frustrated and powerless when they spent so much time at the bedside yet their professional opinions were ignored.
This does not bode well for the plan to even further remove patient care decisions from physicians and nurses, handing them to distant case managers and bureaucrats. The current implementation of the Patient Protection and Affordable Care Act threatens medical provider autonomy by transferring health care treatment decisions to committees within HHS. The American Recovery and Reinvestment Act of 2009 set up the Federal Coordinating Council Comparative Effectiveness Research to provide information for patient treatment decisions to the HHS. This significant reduction of physician input into patient care sets doctors up for the same frustrations experienced by the nurses in the APPROPRICUS study.
Clearly, failure to respect the conscience of health care providers is a threat to religious liberty. That alone is reason enough to justify opposition to any policy that jeopardizes the ability of health care providers to stay true to their moral compass. This newly published data suggests that policies that force health care providers to participate in abortions, to provide contraception or to limit care to the elderly or disabled, or any other practice they find morally objectionable, is, in addition to being an assault on freedom, a threat to the quality of our health care system.
Denise Hunnell, MD, is a Fellow of HLI America, an educational initiative of Human Life International. She writes for HLI America’s Truth and Charity Forum.
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