Moral controversy, directive counsel, and the doctor's role: findings from a national survey of obstetrician-gynecologists.

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.