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Obstetrician-gynaecologists' opinions about conscientious refusal of a request for abortion: results from a national vignette experiment
  1. Kenneth A Rasinski1,
  2. John D Yoon1,
  3. Youssef G Kalad2,
  4. Farr A Curlin3
  1. 1Department of Medicine, The University of Chicago, Chicago, Illinois, USA
  2. 2Undergraduate Division, The University of Chicago, Chicago, Illinois, USA
  3. 3Department of Medicine, MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, Illinois, USA
  1. Correspondence to Kenneth A Rasinski, Research Associate, Department of Medicine, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA; krasinsk{at}


Background and objectives Conscientious refusal of abortion has been discussed widely by medical ethicists but little information on practitioners' opinions exists. The American College of Obstetricians and Gynecologists (ACOG) issued recommendations about conscientious refusal. We used a vignette experiment to examine obstetrician-gynecologists' (OB/GYN) support for the recommendations.

Design A national survey of OB/GYN physicians contained a vignette experiment in which an OB/GYN doctor refused a requested elective abortion. The vignette varied two issues recently addressed by the ACOG ethics committee—whether the doctor referred and whether the doctor disclosed their objection to the abortion.

Participants and setting 1800 OB/GYN randomly selected physicians were asked to complete a mail survey containing the vignette. The response rate was 66% (n=1154) after excluding 40 ineligible cases.

Measurement Physicians indicated their approval for the vignette doctor's decision.

Main results Overall, 43% of OB/GYN physicians responded that the conscientious refusal exercised by the vignette physician was appropriate. 70% rated the vignette doctor as acting appropriately when a referral was made. This dropped to 51% when the doctor disclosed objections to the patient, and to 12% when the doctor disclosed objections and refused to make a referral. Consistent with previous research, males were more likely to support disclosure and refusal to refer. Highly religious physicians supported non-referral but not disclosure.

Conclusion OB/GYN physicians are less likely to support conscientious refusal of abortion if physicians disclose their objections to patients. This is at odds with ACOG recommendations and with some models of the doctor–patient relationship.

  • Right to refuse treatment
  • moral and religious aspects
  • demographic surveys/attitudes

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  • Funding This project was funded by grants from the Greenwald Foundation and the Templeton Foundation both awarded to FAC.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of The University of Chicago.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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