Physician Refusal to Provide Information or Treatment on the Basis of Claims of Conscience

Abstract

Health care professionals may have moral objections to particular medical interventions. They may refuse to provide or cooperate in the provision of these interventions. Such objections are referred to as conscientious objections. Although it may be difficult to characterize or validate claims of conscience, respecting the individual physician's moral integrity is important. Conflicts arise when claims of conscience impede a patient's access to medical information or care. A physician's conscientious objection to certain interventions or treatments may be constrained in some situations. Physicians have a duty to disclose to prospective patients treatments they refuse to perform. As part of informed consent, physicians also have a duty to inform their patients of all relevant and legally available treatment options, including options to which they object. They have a moral obligation to refer patients to other health care professionals who are willing to provide those services when failing to do so would cause harm to the patient, and they have a duty to treat patients in emergencies when referral would significantly increase the probability of mortality or serious morbidity. Conversely, the health care system should make reasonable accommodations for physicians with conscientious objections.

Ensuring privacy in telemedicine: Ethical and clinical challenges

“…In this scenario, the physician's attempt at deferring the discussion may ultimately limit the patient's access to medical information or care. 34 We are particularly concerned that refusing to continue suboptimal telemedicine appointments may result in furthering existing disparities in care. If, when the content of the interaction has potential to be communicated over telemedicine platforms, physicians still insist on in-person exams, this will have variable effects depending on the patient's situation.…”

Obstetrician–Gynecologistsʼ Objections to and Willingness to Help Patients Obtain an Abortion

“…Some bioethicists argue that physicians who refuse to provide legal and professionally permitted services should leave the profession (5); others argue that physicians have a basic obligation and right to act in accordance with their moral convictions (6). Most professional medical organizations endorse a limited right of refusal, balanced against patients’ interests and professional obligations (7)(8). Previous studies suggest that the majority of physicians agree that doctors may not be obligated to provide an intervention to which they have a moral objection (9), but that they are obligated to refer patients for interventions they are unwilling to provide themselves (10)(11).…”

Are conscientious objectors morally obligated to refer?

“…Almost all compromise approaches to conscientious objection require refusing providers to refer their patients or facilitate transfers to willing providers. [1][2][3][4][5][6] The referral requirement reflects acceptance of the slogan that a provider may 'step away from, but not in between' patients and professionally accepted medical interventions; it is part of an attempt to ensure that all patients have access to care while allowing providers to maintain their integrity. ii The referral requirement also expresses a belief in the value of tolerance in a morally diverse liberal society: patients get the care they require and demand; providers are not forced to forsake their ethical commitments.…”