Article Text

Download PDFPDF
Are conscientious objectors morally obligated to refer?
  1. Samuel Reis-Dennis1,
  2. Abram L Brummett2
  1. 1 Alden March Bioethics Institute, Albany Medical College, Albany, New York, USA
  2. 2 Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
  1. Correspondence to Dr Samuel Reis-Dennis, Alden March Bioethics Institute, Albany Medical College, Albany, NY 12208, USA; reisdes{at}


In this paper, we argue that providers who conscientiously refuse to provide legal and professionally accepted medical care are not always morally required to refer their patients to willing providers. Indeed, we will argue that refusing to refer is morally admirable in certain instances. In making the case, we show that belief in a sweeping moral duty to refer depends on an implicit assumption that the procedures sanctioned by legal and professional norms are ethically permissible. Focusing on examples of female genital cutting, clitoridectomy and ‘normalizing’ surgery for children with intersex traits, we argue that this assumption is untenable and that providers are not morally required to refer when refusing to perform genuinely unethical procedures. The fact that acceptance of our thesis would force us to face the challenge of distinguishing between ethical and unethical medical practices is a virtue. This is the central task of medical ethics, and we must confront it rather than evade it.

  • conscientious objection
  • children
  • moral and religious aspects
  • minors/parental consent
  • sexuality/gender

Data availability statement

There are no data in this work.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors Both authors wrote and revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

Other content recommended for you