American Medical Association Journal of Ethics

ETHICS CASE

Conscientious Refusal or Discrimination against Gay Parents?

Dr. Smith had been one of four members of a pediatric family practice for 19 years. Over the years, she had greatly enjoyed seeing her patients and getting to know their families, and she took pleasure in the routines of her practice, the cycles of back-to-school checkups and vaccination schedules, the Christmas cards from patients that accumulated on a bulletin board every December. She felt she'd long since found her rhythm as a pediatrician.

So it was with some surprise that she confronted a new situation when her 2 p.m. Wednesday appointment-expectant parents preparing for the birth of their first child- turned out to be not a mother and father but two women. What raced through her mind in the following second or two was the relationship that she formed with her patients' parents-often they shared other aspects of their lives with her and sought counsel on all sorts of matters. Dr. Smith knew she could not pretend to have that degree of comfort with and interest in this couple.

Dr. Smith regained her composure and shook their hands, hoping she was disguising her discomfort. She took notes, mustered up enough normalcy to give terse answers to the parents' questions, and saw them out the door with a tight smile. When they'd left, she looked back over her notes and thought, "I don't want to treat a patient with lesbian parents. Children should be raised by a mother and a father. And I don't think I should have to do this. Shouldn't this family be assigned to one of my partners?"

Commentary
The birth of a baby is one of the most beautiful moments in the life of any parent. It is also the sacred establishment of a family. With a child's entrance into the world, the parents take on the awesome responsibility of providing nurturance, nourishment, protection, love, education, and a future for the little new being entrusted to them. The transformation of a couple into a family is supported by the parents' own families, the community around them, and the larger society. A key member of the community in this transformation is the health care professional who delivers anticipatory guidance and preventive health care and is a backstop in case of illness and other emergencies.

In this case, a physician is considering "turfing" the expected newborn patient because her parents are lesbians. From the case description, we do not know whether the

parents have experienced other rejections or discriminatory reactions from their own families, but here is a professional considering refusing to support the creation of this new family because of her personal belief and bias. Since family, community, and societal support all bolster family formation, this refusal to provide professional health care needs to be examined.

This case raises a number of questions:

1. What does it mean for a physician to judge a patient or patient's family based on sexual orientation? Is this discrimination on the part of the physician? Will it have specific effects on the couple's child or children?

2. If a doctor questions the parenting abilities of individuals based on their sexual orientation and considers treating their children against her conscience, what other characteristics might a physician consider against her own conscience?

3. What would make people unfit or "wrong parents" and what actions would be appropriate for a physician to take "in good conscience"?