Public Health and Primary CareCOMMENTARY

The establishment of conscientious monopolies in rural communities

Forrest Bohler, BS; and Allison Garden, BS
Notes and Affiliations
Notes and Affiliations

Received: January 16, 2024

Accepted: March 13, 2024

Published: March 26, 2024

  • Forrest Bohler, BS, 

    Oakland University William Beaumont School of Medicine
    , 586 Pioneer Drive, Rochester, MI, USA

  • Allison Garden, BS, 

    Edward Via College of Osteopathic Medicine – Carolinas Campus
    , Spartanburg, SC, USA


In the United States, healthcare providers have the federally protected right to conscientiously refuse to provide treatments or services that they feel violate their moral or religious values. This refusal of services is colloquially known as “conscientious objection,” which has become a polarizing topic in today’s medical and ethical landscape. Typically, physicians exercising their right to conscientious objection do not represent a barrier in access to care for most patient populations. This dynamic shifts, however, in rural America, where there are relatively few providers. In this commentary, we discuss some of the unique ramifications that are likely to occur when rural providers invoke conscientious objection in their medical practice and how this can in turn establish conscientious monopolies for the members of their communities.

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