Physicians Must Distinguish Law From Ethics in Medical Practice

Physicians often conflate professional standards with the law, but understanding the distinction is critical. An experienced bioethics instructor recently noted that licensed doctors frequently misuse these terms, creating confusion when they must decide whether to honor a patient’s request for treatment. The difference between laws, ethics, professional standards, and morals helps determine what a physician may be permitted to do.

The legal framework

Laws are formal rules enacted by legislatures, such as the U.S. Congress or state congresses. A bill introduced in either the House or the Senate must pass both chambers before reaching the President’s desk for signature. Once signed, the bill becomes law. Regulations, often called “rules,” are written by federal or state agencies to implement these laws. Under the Administrative Procedure Act, agencies must publish proposed rules for public comment before issuing a final rule that becomes legally binding.

While laws are mandatory and carry legal consequences, ethics are different. The American Medical Association established the first national code of ethics for physicians to promote adherence to professional standards. These written standards help preserve patient trust and public confidence in the medical profession. However, the AMA’s opinions are not rigid or legally binding. The code contains a wide range of scenarios, and the outcome often depends on the totality of the facts and circumstances.

Ethics and morals share a basis in right and wrong, but they differ in origin. Ethics concern rules from an external source, whereas morals are based on an individual’s own principles. Morals are not legally binding, and a person may hold a general moral belief while carving out an exception for specific material facts. A bright-line rule against using illegal drugs, for instance, may not apply if a prescription is required for treatment.

This distinction becomes complicated when a physician objects to a procedure based on moral or religious beliefs. The text notes that conscientious objection often arises in reproductive health care. To handle this, physicians should first consider whether the situation is an emergency. Federal laws like the Church Amendments and the Weldon Amendment, as well as provisions in the Affordable Care Act, govern these refusals.

Professional standards add another layer. The American College of Obstetrics and Gynecology (ACOG) publishes ethical standards for its members, including Committee Opinion No. 385. That document states that conscientious refusals should be accommodated only if the primary duty to the patient can be fulfilled. Providers must provide accurate and unbiased information to patients, give prior notice of their moral commitments, and refer patients in a timely manner to other providers if they cannot in conscience provide requested services.

Conscientious objection

Conscientious refusals occur when a physician declines to provide a specific medical service due to moral or religious beliefs. The source indicates that these conflicts are most common in reproductive health care. Additionally, the Affordable Care Act contains provisions that address this issue. The first step for a physician in this situation is determining whether the case involves an emergency. If it is an emergency, the provider may have an obligation to provide care.

Professional standards offer further guidance for these situations. Committee Opinion No. 385 outlines the requirements for conscientious refusals.