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US primary care physicians’ opinions about conscientious refusal: a national vignette experiment
  1. Simon G Brauer1,
  2. John D Yoon2,
  3. Farr A Curlin3
  1. 1Sociology Department, Duke University, Durham, North Carolina, USA
  2. 2Department of Medicine, MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois, USA
  3. 3Trent Center for Bioethics, Humanities and History of Medicine, Duke University, Durham, North Carolina, USA
  1. Correspondence to Simon G Brauer, Sociology Department, Duke University, 268 Soc/Psych Building, Box 90088, Durham, NC 27708-0088, USA; simon.brauer{at}


Objective Previous research has found that physicians are divided on whether they are obligated to provide a treatment to which they object and whether they should refer patients in such cases. The present study compares several possible scenarios in which a physician objects to a treatment that a patient requests, in order to better characterise physicians’ beliefs about what responses are appropriate.

Design We surveyed a nationally representative sample of 1504 US primary care physicians using an experimentally manipulated vignette in which a patient requests a clinical intervention to which the patient's physician objects. We used multivariate logistic regression models to determine how vignette and respondent characteristics affected respondent's judgements.

Results Among eligible respondents, the response rate was 63% (896/1427). When faced with an objection to providing treatment, referring the patient was the action judged most appropriate (57% indicated it was appropriate), while few physicians thought it appropriate to provide treatment despite one's objection (15%). The most religious physicians were more likely than the least religious physicians to support refusing to accommodate the patient's request (38% vs 22%, OR=1.75; 95% CI 1.06 to 2.86).

Conclusions This study indicates that US physicians believe it is inappropriate to provide an intervention that violates one's personal or professional standards. Referring seems to be physicians' preferred way of responding to requests for interventions to which physicians object.

  • Conscientious Objection

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