When Physician Conscience Influences Patient Care

Conscience can influence physicians’ interactions with patients in myriad ways, and sometimes make it challenging for a doctor to provide the treatment that a patient seeks. In recent news, high-profile conflicts between physician conscience and patient care have included the following issues: aid in dying (both whether it should be legal and how physicians should respond when it is); whether to provide an abortion for a woman who is miscarrying or refer a woman to an abortion provider if asked; and whether to provide procedures such as breast implants for transgender patients. In addition to affecting patient care, these conflicts can influence the interactions and internal dynamics of an entire health care team.

This year, the American Medical Association’s Council on Ethical and Judicial Affairs released a report on physicians’ exercise of conscience to provide guidance on this complex topic. The AMA’s report appropriately balance the obligations physicians have to their patients and profession, and the rights of physicians as moral agents to exercise their conscience. While the opinion is an effective starting point, further guidance is necessary to clarify the process by which physicians should identify, manage, and, if necessary, report their conscientious refusals to patients, supervisors, or colleagues. For more information on a proposed process for identifying and managing issues of conscience, see Tanenbaum’s response to the AMA’s opinion, published in the most recent version of The Journal of Clinical Ethics.

For more information on conscientious refusals in workplaces beyond the health care industry, see Tanenbaum’s Conscientious Refusals Fact Sheet.


Artwork by Bansky, San Francisco