Sample Essays on Conscientious Refusal and Ethical Obligation

The thin Line between Conscientious Refusal and Ethical Obligation

Conscientious refusal in the medical profession refers to the intent, wish to refuse or the definite rejection of a course of action asked for by a patient or of the standard care in the healthcare profession (Mclean, 2011). Refusal to the patient’s expected care is based on a conflict of the patient’s request with the medical practitioner’s belief. This belief can be grounded in religion like in Noesen’s case or not. Noesen felt that he would have compromised his personal uprightness, his integrity or self-identity. Noesen thus deserves some protection as a human being. There are instances in which one is allowed to assert religious objections to fulfilling their professional obligations even in the medical profession.

However, refusal whose basis is conscience is about not only the professional, but it also impacts on the patient’s right to get medical care and their health too. Conscientious refusal has a social impact that extends beyond the affected individual (Mclean, 2011). Noesen’s denial of the student’s request to fill the patient’s oral contraceptives prescription put the patient at the risk of an unwanted pregnancy. The student might have been forced out of school or to live a life that she had not planned for. The adverse impact of a refusal of service due to one’s conscience in reproduction falls solely on a woman.

Therefore, the two issues present in this case are both the clients’ perspective and the pharmacists’ perspective. The pharmacist could not fill the prescription because it was against his belief. He also could not transfer the prescription or advice the young female student on where to get the prescription as that he believed was being party to wrongdoing. On the other hand, the patient was at the risk of an unwanted pregnancy while still in school. The question is where does a medical manager draw the line between their own beliefs and what is expected of them by the medicine ethics.

Another issue is Noesen’s failure to notify his employer that he would not transfer prescription of contraceptive drugs. Though Noesen stated his misgivings about not being part to administering contraceptive drugs, he failed to mention that he would not be transferring prescriptions.

According to the American college executives Healthcare Executives code of ethics, a healthcare manager/practitioner should demonstrate zero tolerance for any abuse of power that compromises patients or others served. In this case, Noesen abused his power by his refusal to fill the prescription thus putting the patient at the risk of an unwanted pregnancy.

To the organization, Noesen was expected to respect the practices and customs or others served consistent with the organization’s philosophy. A pharmacy is expected to serve its customers according to their needs as long as they are legit. A pharmacist is accountable to do no harm (unforeseeable or unnecessary) and perform their duties in the best concern of the patient. Like all other employees in the medical profession, medical managers should learn to subordinate their interest and prioritize on the patient’s interest regardless of their opinion (Pera et al., 2005).

To the community, according to the American College of Healthcare Executives ethical code (2012), a healthcare manger should work to identify and meet the need of the community. In this case, the community is represented by the neighboring community where the pharmacy was located. The university student was among the people in that community and she did not have her needs met. Noesen thus went against the code of ethics. He put the women of that community in the danger of unwanted pregnancy and the risk of the many dangers associated with abortion. He put the patient at a health and welfare disadvantage just because his conscience could not allow him to at least transfer the prescription.

A medical practitioner should be allowed to step away from fulfilling their duties if they are against their belief or their conscience. This is in line with the ethical code that requires them to promote the wellbeing of each patient in a compassionate, confidential and caring manner (Mclean, 2011). For the medical practitioner to be caring and compassionate when serving the customer then they must be at peace with what they are doing. If they feel they are doing wrong, they will not act with passion. A medical practitioner should be allowed to step away to be able to serve their patient with compassion as opposed to when their hand is forced. However, stepping away does not necessarily mean jeopardizing the patient’s health. Before a medical practitioner steps away from helping a patient before they have ensured that it is safe to step away. This is to mean that in this case, Noesen should have ensured that there was a person to fill the prescription that he could no fill. He should have transferred the prescription of the patient.

A patient’s interest should always come first. They are the first priority in the medicine profession (Pera et al., 2005). According to the American College Healthcare executive ethical code, patients’ interest should always precede those of the health practitioner (2012). In this case, Naesen let his self interest precede those of the patient and by doing so he put her in danger.


According to the ACHE (2012) code of ethics, a healthcare manager should work to ensure there is a process in place to help with the resolution of differences that may arise when the values of patients and their families vary from those of physicians and employees in the healthcare profession. A healthcare manager also needs to develop policies for conflict resolution. They should also ensure that they have thoroughly vetted their employees before they employ them to reduce chances of conflict of interests.



American College of Healthcare Executives. (2012). ACHE healthcare executive competencies     assessment tool, 2013. Chicago, Ill.: American College of Healthcare Executives.

Mclean, R. M. (2011) A case of conscientious refusal rights and responsibility Santa Clara University. Retrieved from:

Pera, S. A., & Van, T. S. (2005). Ethics in health care. Lansdowne, South Africa: Juta.