Navigating Clinicians’ Conscience-Based Refusals to Provide Lawful Medical Care

This article examines the ethical tensions and policy challenges posed by clinicians’ conscience-based refusals (CBRs) to provide, refer for, or inform patients about lawful medical services such as abortion, contraception, medical aid in dying, and aspects of end-of-life care. It differentiates CBRs from refusals grounded in legal or clinical scope limitations and emphasizes their moral foundations in both religious and secular convictions. The authors explore the risks CBRs pose to patient autonomy, timely access to care, and health equity especially for marginalized populations. In response, they advocate a “middle path” approach grounded in four principles: (1) prohibit refusals based on invidious discrimination; (2) require advance disclosure of objectionable services; (3) mandate that patients be fully informed of all legal, medically reasonable care options; and (4) encourage institutions to implement ethical management protocols for CBRs, including referral mechanisms. The piece also highlights the ethical tension surrounding conscientious provision of care that may be legally restricted (e.g., post-Dobbs abortion services), emphasizing the moral distress and legal risks faced by clinicians. The article concludes by urging legal safeguards that balance conscience rights with fiduciary obligations and patient-centered access

This article examines the ethical tensions and policy challenges posed by clinicians’ conscience-based refusals (CBRs) to provide, refer for, or inform patients about lawful medical services such as abortion, contraception, medical aid in dying, and aspects of end-of-life care. It differentiates CBRs from refusals grounded in legal or clinical scope limitations and emphasizes their moral foundations in both religious and secular convictions. The authors explore the risks CBRs pose to patient autonomy, timely access to care, and health equity especially for marginalized populations. In response, they advocate a “middle path” approach grounded in four principles: (1) prohibit refusals based on invidious discrimination; (2) require advance disclosure of objectionable services; (3) mandate that patients be fully informed of all legal, medically reasonable care options; and (4) encourage institutions to implement ethical management protocols for CBRs, including referral mechanisms. The piece also highlights the ethical tension surrounding conscientious provision of care that may be legally restricted (e.g., post-Dobbs abortion services), emphasizing the moral distress and legal risks faced by clinicians. The article concludes by urging legal safeguards that balance conscience rights with fiduciary obligations and patient-centered access