The tension between a medical care practitioner’s right to refuse to participate in certain types of medical care and a patient’s right to receive care begins in medical school and residency training. The constitutional right to exercise one’s religion freely has always been limited by the state’s right to pass laws that apply equally to all citizens. Although the state has the right to specify the required training and specific factual knowledge of persons it licenses to practice medicine, this is usually left to the discretion of accreditation agencies for medical training programs. These agencies determine the extent to which a medical student or resident may avoid certain procedures and still be allowed to be certified.

Medical training programs must meet the requirements of their accrediting organizations if their students and residents are to be eligible for licensing or advanced certification after completing their training. The federal courts have recently upheld the right of the Accreditation Council for Graduate Medical Education (ACGME) to require residents in an ACGME-accredited program to receive training in abortion, sterilization, and contraception. The case in question arose when the ACGME rescinded the accreditation of a residency based in a Catholic hospital. Many Catholic hospitals prohibit residents from performing these procedures in the hospital itself. This program was unusual in forbidding the residents to perform the procedures in other hospitals, thus ensuring that the residents did not learn techniques for abortion and sterilization or have adequate training to provide information on contraception. The court found that the training requirement was not religiously motivated. Since the requirement did not advocate a religious doctrine and was nondiscrimatorily applied, it did not violate the First Amendment protections on free exercise of religion. [St. Agnes Hosp. v. Riddick, 748 F. Supp. 319 (1990).]

Once they are in independent practice, medical care practitioners must make any self- imposed limitations on the care they offer clear to their patients as early in the encounter as feasible. Ideally, patients will be asked what care they are seeking when making their initial appointment. If the patient is seeking care that the medical care practitioner is unwilling to provide, the patient can be directed elsewhere at once. Under no circumstances should medical care practitioners withhold their beliefs in an attempt to persuade the patient to change her mind. Implicitly or explicitly holding out the availability of services that are not in fact available is deception.

Putting the patient on notice of the medical care practitioner’s refusal to provide certain types of care does not obviate the medical care practitioner’s duty to inform the patient when this care is appropriate. For example, if the medical care practitioner discovers that the patient has a medical condition that would make pregnancy difficult, the medical care practitioner must counsel the patient on the availability of contraception and sterilization. The requirement that a health care practitioner refer a patient to an alternative source of care is the same whether the medical care practitioner is unable to provide the care or the health care practitioner has personal objections to the care. A medical care practitioner may not abandon a patient on religious grounds. The medical care practitioner–patient relationship carries with it a duty to continue care until an alternative is provided.