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May 4, 2011

Would Accommodating Some Conscientious Objections by Physicians Promote Quality in Medical Care?

Author Affiliations

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).

JAMA. 2011;305(17):1804-1805. doi:10.1001/jama.2011.575

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.

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