Not so conscientious objection: When can doctors refuse to treat? Not so conscientious objection: When can doctors refuse to treat? - STAT In overturning the Trump administration’s attempt to expand the so-called conscience rule for health care workers this week, a federal judge has brought renewed attention to a long-simmering debate in medicine over when doctors can decline to provide treatment to patients without abdicating their professional responsibilities. The revised rule, issued last spring by the Department of Health and Human Services, was aimed at protecting doctors, nurses, and others from, in the words of HHS, being “bullied out of the health care field” for refusing to participate in abortions, gender reassignment surgery, or other medical procedures based on religious beliefs or conscience. Critics of the rule charge that it would enable discrimination by allowing providers to deny health care to certain patients, particularly women and LGBTQ+ individuals. U.S. District Judge Paul Engelmayer ruled that HHS overstepped its authority, though the rule sought to “recognize and protect undeniably important rights.” But what are those rights, and in what circumstances can physicians ethically withhold treatment that a patient wants? There are three general contexts in which it is permissible and sometimes obligatory to refuse care: when doctors are subjected to abusive treatment, when the treatment requested is outside a doctor’s scope of practice, or when providing the requested treatment would otherwise violate one’s duties as a physician, such as the Hippocratic mandate to “first do no harm.” But none of these rationales can justify physicians denying care based on their personal beliefs.