Author Affiliations: Program on Ethics and Decision Making in Critical Illness, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (Dr White); and Center for Ethics, Baylor College of Medicine, and Department of Philosophy, Rice University, Houston, Texas (Dr Brody).
Moral pluralism is a valuable aspect of a free society1 but sometimes creates conflicts in medical care when individual physicians object to providing certain legal but morally controversial services, such as abortion, physician-assisted suicide (where it is legal), and palliative sedation to unconsciousness. Genuine conscience-based refusals (CBRs) are refusals in which a physician believes that providing the requested service would violate his or her core moral beliefs (religious or secular), thereby causing personal moral harm.2 Conscience-based refusals should be a “shield” to protect individual physicians from being compelled to violate their core moral beliefs rather than a “sword” to force their beliefs onto patients. This partially explains why many physicians who invoke CBRs refer their patients to physicians willing to provide the requested care.
White DB, Brody B. Would Accommodating Some Conscientious Objections by Physicians Promote Quality in Medical Care?. JAMA. 2011;305(17):1804-1805. doi:10.1001/jama.2011.575