Conscientious refusal in family medicine residency training

Conscientious refusal among physicians to provide medical care is known to exist. The prevalence of conscientious refusal in residents and behaviors surrounding moral objections is largely unknown. The purpose of this study was to identify the prevalence of moral objections among family medicine residents and faculty members and to identify beliefs and actions surrounding conscientious refusal.

A Web-based survey was e-mailed to residents and faculty in six family medicine residency programs. Those respondents identifying a moral objection were asked about their beliefs and practices regarding disclosure and referral.

A total of 154 physicians responded (44.9% response rate).The majority reported a moral objection to at least one procedure with abortion for gender selection eliciting the largest number of moral objections (79.2%). Of the 14 procedures identified, at least four respondents (2.6%) reported an objection. The majority believed that a physician with a moral objection has a duty to disclose his or her objection to colleagues, but the majority had not done so. Resident and faculty physicians were generally felt to have the same right to refuse. Fifty-five percent of all respondents reported having participated in morally objectionable care based on medical futility.

This study is the first to demonstrate the prevalence of moral objection to legally available medical procedures among family medicine residents and faculty. The survey responses demonstrate that conscientious objection exists and that there is support for physicians exercising moral objection in clinical practice, provided they engage in appropriate patient education and referral.