At the core of the debate is this question: Does a doctor's right to follow his or her conscience trump a patient's right to a full range of medical treatment? In a position paper released last November, ACOG said gynecologists must provide "accurate and unbiased information" so that patients can make informed decisions, and "have the duty to refer patients in a timely manner to other providers" if they don't feel comfortable performing an abortion, say, or prescribing contraception. HHS Secretary Michael Leavitt, however, said ACOG overstepped its bounds by "forcing providers to choose between their personal beliefs and facing economic and professional sanctions."
In the real world, the vast majority of doctors who object to a particular practice feel an obligation to present all the options and refer patients to other physicians, according to a survey of 1,144 doctors published last year in the New England Journal of Medicine. On the other hand, a full 14 percent of doctors surveyed didn't think they needed to fully inform patients and nearly 30 percent didn't think they had to make referrals. "For many doctors, referring for a practice that one would not be willing to do oneself is still participating in that same practice," explains McQuade. At the very least, critics argue, shouldn't doctors be obligated to inform patients of their ethical objections rather than just keep mum about a woman's alternatives? "No one's advocating on keeping these views hidden," says McQuade. This sort of requirement, however, isn't included in the draft regulation.