Conscience Rules: Introduction
Conscience Rules: Professional Integrity
Conscience Rules: Personal Conscience
Are These Cases of Discrimination?


- It depends on if you look at it from the point of view of the patient or the provider.
- Yes, it’s legal to conscientiously refuse care to LGBTQ+ individuals in some states. AND
- Many perceive this refusal as discrimination.
- A provider-centered definition of discrimination holds that it is discrimination when providers are required to treat LGBTQ+ patients despite such treatment conflicting with their conscience.
- A patient-centered definition of discrimination holds that permitting providers to turn away LGBTQ+ patients based on their identity is discrimination.
Consider the example of prescribing hormone blockers to transgender youth. Some providers object to providing this treatment based on their personal, professional, religious, and/or moral beliefs. And others believe that refusing to provide this treatment is discriminatory.
Consider also the case of a bisexual student who went to his university clinic to get a prescription for PrEP (HIV prevention medication). The provider conscientiously refused to provide this prescription so as not to “enable immoral behavior”.
- This case, explored in detail in the 2020 Clinical Ethics article, When Conscientious Objection Runs Amok: A Physician Refusing HIV Preventative To a Bisexual Patient, introduces the term “conscience creep” in which some providers may invoke conscience objection in instances beyond the traditional contexts of abortion, sterilization, or physician aid in dying.
Take-away Questions:
- How do we balance the rights of providers AND the rights of patients?
- How can health care providers respectfully step away from providing care that conflicts with their conscience without stepping in the way of patients receiving the care that they need?
Further reading:
Conscientious Objection and LGBTQ Discrimination in the United States – Journal of Public Health Policy, April 2021.