I would argue that a patient cannot enter into the implied but profound covenant with a physician if something in that doctor's ideology or commitment might interfere with patient care. If I am transacting with a physician, I am not covenanting with him or her to be my priest. My religious convictions may be quite different from my doctor's. I am happy if she has organized herself around some healing approach, be it religious, philosophical, or practical. But I will assess the value of our relationship not on the basis of what she does in the mosque, but in the clinic, not in the chapel but in the hospital ward.

So, the physician's covenant comes first.

We admire doctors who refused to enter a profession or who leave it or subvert it when the whole profession is built upon a lie and dedicated to destruction. The German physicians who were chartered to deal death-dealing human experiments had to put "religion" or "humanistic beliefs" first, and did.

For most physicians the call to make an exception to "standard practice" is rare, and has to be dealt with as such. If that "rarity" becomes all-consuming, it may mean that a physician may have to leave a practice. Or she can make quite public her unwillingness to be committed to certain medical procedures, in which case patients would be referred to someone else. In any case, such exceptions would have to be made public and dare not be the result of some hidden scruples about which the patient does not know.

There are thousands of exceptions to any rules about vocation. But since we were asked to generalize, I'd come back to: the commitment to the patient comes first.