1: N Engl J Med. 2007 Feb 8;356(6):593-600. Related Articles, LinkOut 
Religion, conscience, and controversial clinical practices.
Curlin FA, Lawrence RE, Chin MH, Lantos JD.
Department of Medicine, University of Chicago, Chicago, IL 60637, USA. fcurlin@medicine.bsd.uchicago.edu
BACKGROUND: There is a heated debate about whether health professionals may refuse to provide treatments to which they object on moral grounds. It is important to understand how physicians think about their ethical rights and obligations when such conflicts emerge in clinical practice. METHODS: We conducted a cross-sectional survey of a stratified, random sample of 2000 practicing U.S. physicians from all specialties by mail. The primary criterion variables were physicians' judgments about their ethical rights and obligations when patients request a legal medical procedure to which the physician objects for religious or moral reasons. These procedures included administering terminal sedation in dying patients, providing abortion for failed contraception, and prescribing birth control to adolescents without parental approval. RESULTS: A total of 1144 of 1820 physicians (63%) responded to our survey. On the basis of our results, we estimate that most physicians believe that it is ethically permissible for doctors to explain their moral objections to patients (63%). Most also believe that physicians are obligated to present all options (86%) and to refer the patient to another clinician who does not object to the requested procedure (71%). Physicians who were male, those who were religious, and those who had personal objections to morally controversial clinical practices were less likely to report that doctors must disclose information about or refer patients for medical procedures to which the physician objected on moral grounds (multivariate odds ratios, 0.3 to 0.5). CONCLUSIONS: Many physicians do not consider themselves obligated to disclose information about or refer patients for legal but morally controversial medical procedures. Patients who want information about and access to such procedures may need to inquire proactively to determine whether their physicians would accommodate such requests. Copyright 2007 Massachusetts Medical Society.
Publication Types:- Research Support, N.I.H., Extramural
PMID: 17287479 [PubMed - indexed for MEDLINE]
2: Ann Intern Med. 2007 Feb 6;146(3):184-7. Related Articles, Compound via MeSH, LinkOut 
Summary for patients in:
Brief communication: Preoperative anticoagulant activity after bridging low-molecular-weight heparin for temporary interruption of warfarin.
O'Donnell MJ, Kearon C, Johnson J, Robinson M, Zondag M, Turpie I, Turpie AG.
McMaster University and Hamilton Health Sciences Foundation, Hamilton, Ontario, Canada. odonnm@mcmaster.ca
BACKGROUND: Preoperative low-molecular-weight heparin (LMWH) is often used when warfarin therapy is interrupted for surgery. OBJECTIVE: To determine the preoperative anticoagulant activity of LMWH following a standardized "bridging" regimen. DESIGN: Prospective cohort study. SETTING: Single university hospital. PATIENTS: Consecutive patients who had warfarin therapy interrupted before an invasive procedure. INTERVENTION: Enoxaparin, 1 mg/kg of body weight, twice daily. The last dose was administered the evening before surgery. MEASUREMENTS: Blood anti-factor Xa heparin levels measured shortly before surgery. RESULTS: Preoperative anti-Xa heparin levels were obtained in 80 patients at an average of 14 hours after the last dose of enoxaparin was administered. The average anti-Xa heparin level was 0.6 U/mL. The anti-Xa heparin level, measured shortly before surgery, was 0.5 U/mL or greater in 54 (68%) patients and 1.0 U/mL or greater in 13 (16%) patients. A shorter interval since the last dose (P < 0.001) and a higher body mass index (P = 0.001) were associated with higher preoperative anti-Xa heparin levels. LIMITATIONS: The small sample size limits accurate estimates of the frequency of the clinical outcomes. A single regimen of LMWH was evaluated. CONCLUSIONS: Anti-Xa heparin levels often remain high at the time of surgery if a last dose of a twice-daily regimen of LMWH is given the evening before surgery.
Publication Types:- Research Support, Non-U.S. Gov't
PMID: 17283349 [PubMed - indexed for MEDLINE]
3: Ann Intern Med. 2007 Feb 6;146(3):I35. Related Articles, Compound via MeSH, LinkOut 
Original report in:
Summaries for patients. Safety of surgery during bridging anticoagulation therapy with low-molecular-weight heparin.
[No authors listed]
Publication Types:- Patient Education Handout
PMID: 17283344 [PubMed - indexed for MEDLINE]