Conscience and clinical practice: medical ethics in the face of moral controversy

Abstract

Physicians sometimes refuse to provide legally permitted medical services on the grounds that they cannot do so in good conscience. Such conscientious refusals are at least as old as the Hippocratic movement. Yet new events, such as the refusal by health care professionals to prescribe or dispense post-coital (‘‘emergency’’) contraception, have kindled new debates about what physicians are obligated to do when patients request legal medical interventions to which their physicians have moral objections. In a recent national survey, we found that a large majority of physicians believe they are obligated in such circumstances to present all possible options to the patient, including information about obtaining the requested intervention, and to refer the patient to a clinician who does not object to the requested intervention. Yet a substantial minority of physicians—particularly those who are more religious and/or who themselves object to common controversial practices—disagree with these majority opinions [1]. In hopes of stimulating further discourse about these matters, eight eminent scholars were invited to participate in a conference focusing on the role of the clinician’s conscience in the ethical practice of medicine. We asked contributors to address one or more of the following questions: What is the nature of conscience and what part does it play in the moral life, both public and private? In making good clinical decisions, what role should the clinician’s conscience play relative to his or her knowledge of scientific data, the standards of professional bodies, and/or the law? What should a clinician do when patients request legal and professionally permitted medical interventions to which he or she has a religious or other moral objection? What boundaries ought the profession place, if any, on the range of