Should doctors have the legal right to refuse care?

(Reuters Health) - Physicians shouldn’t have the legal right to act as conscientious objectors and refuse to provide services like abortion or assisted suicide even when these things conflict with their personal values, some doctors argue.

That’s because access to care should take priority, and conscientious objectors may make it more difficult for patients to get treatment they need, Dr. Julian Savulescu of the University of Oxford in the U.K. and Udo Schuklenk of Queens University in Ontario, Canada, argue in an article in the journal Bioethics.

They make their case as a growing number of countries worldwide are grappling with how much autonomy to give patients and doctors to make decisions about care at the very beginning and end of life, particularly in an era when new technology and social media keep pushing the boundaries of long-held personal and religious beliefs.

“Doctors have values, often deeply held values, like everybody else. However, unlike in most professions, doctors can sometimes be asked to perform activities that go against some people’s values,” Savulescu told Reuters Health by email.

“Although there are situations where conscientious objection could be allowable where there is an ample and readily available choice of alternative provision including those who do offer the service, it should not be a legal right for the doctor,” Savulescu added.

In some countries, including Sweden and Finland, doctors are barred from refusing to provide any medical care that is legal and can be fired for doing so, the authors note.

Elsewhere, including countries like Australia, Canada, the U.K. and the U.S, laws have historically allowed for conscientious objection and doctors often enter the profession with an expectation that they won’t be forced to provide care that conflicts with their religious or personal beliefs, the authors point out.

With contraception, they argue, doctors should have no legal right to refuse it because women don’t have another way to get it. Moreover, to the extent women want birth control, family planning is a social good that may help prevent overpopulation.

Their paper is a rebuttal to a defense of conscientious objection by Christopher Crowley of University College Dublin that appeared in Bioethics last year. (

On the point of contraception, Crowley argues in his paper that general practitioners who might provide birth control as a very small part of their practice should have the right to refuse this service in much the same way they might be accommodated if a back injury prevented them from performing certain job duties.

With contraception, or with abortion or physician-assisted suicide, a general practitioner who has moral objections to the service can refer patients to a provider that has no such objection, Crowley notes. This way, the conscientious objector doesn’t necessarily limit access to care.

But in their rebuttal, the authors of the current paper argue that people who don’t believe doctors should provide contraception shouldn’t become general practitioners. Instead, they should choose another medical specialty or pursue a different career.

It’s best for patients and for physicians for people to get care from clinicians that willingly provide it, said Holly Fernandez Lynch, a bioethics researcher at Harvard University in Boston who wasn’t involved in either paper.

“The medical profession has a responsibility to make sure there are adequate professionals willing to provide various services under its monopoly – this doesn’t necessarily mean forcing objectors out, but rather incentivizing willing professionals,” Lynch said by email.

Whenever possible, patients should ask doctors up front about any services they won’t provide, and physicians should volunteer any objections to specific types of care, Lynch added.

Sometimes, hospitals have religious prohibitions against providing services such as abortion that limit what doctors can do, noted Arthur Caplan, head of bioethics at New York University Langone Medical Center.

“For example, in seeking admission to a hospice, nursing home or home care program it is crucial to ask about their values and practices in managing end of life issues,” Caplan, who wasn’t involved in either paper, said by email. “At any hospital they have an ethics committee and be ready to use it in case of a conflict with a doctor.”

SOURCE: Bioethics, online September 22, 2016.