{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:20:01Z","timestamp":1777940401380,"version":"3.51.4"},"reference-count":23,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2020,5,1]],"date-time":"2020-05-01T00:00:00Z","timestamp":1588291200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"George Washington University, School of Nursing, Center for Health Policy and Media Engagement"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Policy, Politics, &amp; Nursing Practice"],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:p>Conscientious objection refers to refusal by a health care provider (HCP) to provide certain treatments, including the standard of care, to a patient based upon the provider\u2019s personal, ethical, or religious beliefs. Federal and state rules regarding conscientious objection have expanded the scope of legal protections that HCPs and institutions can invoke in support of refusal. Opponents of these rules argue that allowing refusal of care deprives patients of care that conforms to professionally established guidelines, contradicts long-standing principles related to informed consent, interferes with the ability of health care facilities to provide safe and efficient care, and leaves the patient without means of redress for injury. Proponents respond that such rules are necessary to preserve the moral integrity of providers, including institutions. Although refusal rules are most often associated with abortion, some HCPs have cited moral concerns regarding contraception, sterilization, prevention\/treatment of sexually transmitted infections, transition-related care for transgender individuals, medication-assisted treatment of substance use disorders, the use of artificial reproductive technologies, and patient preferences for end-of-life care. Evidence suggests that the burden of conscientious refusal falls disproportionately on vulnerable populations, and legitimate concern exists that moral disagreement is merely pretext for discrimination. A careful balance must be struck between the defending the conscience rights of HCPs and the civil rights of patients.<\/jats:p>","DOI":"10.1177\/1527154420926156","type":"journal-article","created":{"date-parts":[[2020,5,23]],"date-time":"2020-05-23T00:47:39Z","timestamp":1590194859000},"page":"120-126","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":16,"title":["A Matter of Conscience: Examining the Law and Policy of Conscientious Objection in Health Care"],"prefix":"10.1177","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5689-5996","authenticated-orcid":false,"given":"Eileen K.","family":"Fry-Bowers","sequence":"first","affiliation":[{"name":"Hahn School of Nursing and Health Science, Betty and Bob Beyster Institute for Nursing Research, Advanced Practice and Simulation, University of San Diego"},{"name":"School of Nursing, George Washington University"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2020,5,22]]},"reference":[{"key":"bibr2-1527154420926156","unstructured":"American Medical Association. (2018).\n                      HHS should withdraw proposal on health care conscience rights\n                      . https:\/\/www.ama-assn.org\/delivering-care\/ethics\/hhs-should-withdraw-proposal-health-care-conscience-rights"},{"key":"bibr3-1527154420926156","unstructured":"American Nurses Association and American Academy of Nurses. (2018).\n                      Letter to Office of Civil Rights, Department of Health and Human Services, March 23, 2018\n                      . https:\/\/www.nursingworld.org\/\u223c4988e1\/globalassets\/docs\/ana\/anaaanletter-statutoryconsciencerights_final-03232018.pdf"},{"key":"bibr4-1527154420926156","unstructured":"Bricker E. (n.d.).\n                      Healthcare fast facts \u2013 Top 30 largest hospital systems in America\n                      . https:\/\/www.compassphs.com\/blog\/healthcare-trends\/healthcare-fast-facts-top-30-largest-hospital-systems-in-america\/"},{"key":"bibr5-1527154420926156","unstructured":"Catholic Health Care Association of the United States. (2019).\n                      Facts-statistics: Catholi\n                      c health care in the United States\n                      . https:\/\/www.chausa.org\/about\/about\/facts-statistics"},{"key":"bibr6-1527154420926156","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa065316"},{"key":"bibr7-1527154420926156","unstructured":"Guttmacher Institute. (2019).\n                      State laws and policies: Refusing to provide health services\n                      . https:\/\/www.guttmacher.org\/state-policy\/explore\/refusing-provide-health-services"},{"issue":"3","key":"bibr8-1527154420926156","volume":"34","author":"Harrington M.","year":"2007","journal-title":"Florida State University Law Review"},{"key":"bibr9-1527154420926156","unstructured":"Hellman J., Weixel N., Sullivan P. (2020). Overnight health care.\n                      The Hill\n                      . https:\/\/thehill.com\/policy\/healthcare\/overnights\/477013-overnight-health-care-democrats-worries-grow-as-obamacare-court"},{"key":"bibr10-1527154420926156","unstructured":"Kaiser Family Foundation. (2017).\n                      Total health care employment\n                      . https:\/\/www.kff.org\/other\/state-indicator\/total-health-care-employment\/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D"},{"key":"bibr11-1527154420926156","unstructured":"Keith K. (2019a, May 3). Trump administration finalizes broad religious and moral exemptions for health care workers.\n                      Health Affairs Blog\n                      . https:\/\/doi.org\/10.1377\/hblog20190503.960127"},{"key":"bibr12-1527154420926156","unstructured":"Keith K. (2019b, July 2). Provider conscience rule delayed due to lawsuits.\n                      Health Affairs Blog\n                      . https:\/\/doi.org\/10.1377\/hblog20190702.497856"},{"key":"bibr13-1527154420926156","unstructured":"Keith K. (2019c, November 7). New York court vacates conscience rule.\n                      Health Affairs Blog\n                      . https:\/\/doi.org\/10.1377\/hblog20191107.342050"},{"key":"bibr14-1527154420926156","unstructured":"Keith K. (2019d, November 20). Third court rules against provider conscience rule.\n                      Health Affairs Blog\n                      . https:\/\/doi.org\/10.1377\/hblog20191120.14018"},{"key":"bibr15-1527154420926156","doi-asserted-by":"publisher","DOI":"10.1080\/20502877.2016.1151252"},{"key":"bibr16-1527154420926156","unstructured":"London E., Siddiqi M. (2019).\n                      Center for American Progress. Religion and values. Religious liberty should do no harm\n                      . https:\/\/www.americanprogress.org\/issues\/religion\/reports\/2019\/04\/11\/468041\/religious-liberty-no-harm\/"},{"key":"bibr17-1527154420926156","doi-asserted-by":"publisher","DOI":"10.1080\/15265161.2018.1478017"},{"key":"bibr18-1527154420926156","doi-asserted-by":"publisher","DOI":"10.1080\/15265161.2018.1478021"},{"key":"bibr19-1527154420926156","author":"Sawicki N. N.","journal-title":"California Law Review"},{"key":"bibr20-1527154420926156","unstructured":"Simmons-Duffin S. (Writer). (2019). What\u2019s behind a rise in conscience complaints for health care workers? [Radio]. In NPR Shots. Transcript available at https:\/\/www.npr.org\/sections\/health-shots\/2019\/05\/09\/721532255\/whats-behind-a-rise-in-conscience-complaints-for-health-care-workers"},{"key":"bibr21-1527154420926156","unstructured":"Somashekhar S., Zauzmer J. (2016, May 5). Report: 1 in 6 hospital beds in U.S. is in a Catholic institution, restricting reproductive care.\n                      The Washington Post\n                      . https:\/\/www.washingtonpost.com\/news\/acts-of-faith\/wp\/2016\/05\/05\/report-1-in-6-hospital-beds-in-u-s-is-in-a-catholic-hospital-restricting-reproductive-care\/"},{"issue":"2","key":"bibr22-1527154420926156","first-page":"269","volume":"6","author":"Swartz M.","year":"2006","journal-title":"Yale Journal of Health Policy, Law, and Ethics"},{"key":"bibr23-1527154420926156","unstructured":"The Public Rights\/Private Conscience Project. (2018).\n                      Letter, U.S. Department of Health and Human Services, Office for Civil Rights\n                      . https:\/\/lawrightsreligion.law.columbia.edu\/sites\/default\/files\/content\/Policy%20Analyses\/Policy_HHSRule_3.27.18.pdf"},{"issue":"1","key":"bibr24-1527154420926156","volume":"9","author":"Wardle L. D.","year":"2010","journal-title":"Ave Maria Law Review"}],"container-title":["Policy, Politics, &amp; Nursing Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1527154420926156","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1527154420926156","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1527154420926156","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T05:48:32Z","timestamp":1777700912000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1527154420926156"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5]]},"references-count":23,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2020,5]]}},"alternative-id":["10.1177\/1527154420926156"],"URL":"https:\/\/doi.org\/10.1177\/1527154420926156","relation":{},"ISSN":["1527-1544","1552-7468"],"issn-type":[{"value":"1527-1544","type":"print"},{"value":"1552-7468","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5]]}}}