Abstract
Clinicians have a federally protected right to conscientiously refuse to provide treatment that conflicts with their core moral or religious values. The American Medical Association affirms that, among other obligations, a physician should give advance notification "before entering into a patient-physician relationship" by making "clear any specific interventions or services the physician cannot in good conscience provide" (Opinion 1.1.7). We apply this guidance to the rural health care context by considering whether giving notification of conscientious refusals is best done in advance of, or during, the clinical encounter. We conclude that giving advance notice should be the moral default in rural contexts, but giving notice during the clinical encounter can be justified where patients are especially dependent upon their primary care physician for their overall medical care.