This chapter explains why conscientious objection (refusal) by physicians is generally considered ethical behavior. Perhaps the most common example of conscientious objection for anesthesiologists in the US is that of anesthetizing a patient who is having an abortion. When claiming conscientious objection, individuals endeavor to preserve a sense of self, their integrity or wholeness that enables their human spirit to flourish. Personal integrity includes a set of coherent principles that have been expressed verbally (or in writing), and manifest conduct that is consistent with those stated principles. There are concerns with the potential abuse of conscience clauses as they could involve the inappropriate application of personal beliefs to the physician-patient relationship. There are legal protections for physicians who conscientiously refuse to participate in medical services to which the patient is legally entitled. Most ethical dilemmas raised by conscientious refusal can be prevented by forethought, communication, planning and accommodation.