Table 2 Examples of grounds stated by health care professionals for exercising CO

Treatment of unvaccinated children [30].

Harm or risk to other unvaccinated children and to the immunosuppressed.

Perception of medical malpractice by the parents of non-vaccinated children for breach of standard of care.

Facilitation of the dying process (i.e. euthanasia, medically-assisted suicide) [31].

Belief in unconditional protection and preservation of life.

Principle of non-maleficence.

Potential negative emotional and psychological impact (e.g. exacerbating inherent fears of death).

Fear of legal repercussions and social stigma.

Difficulties with confirming patient competence to make decisions (due to lack of experience, lack of time, excessive care burden) in setting of an irreversible outcome.

Offer and/or provision of life-sustaining treatment [32].

Principle of non-maleficence

Belief in unconditional protection and preservation of life.

Voluntary termination of pregnancy [33,34,35,36].

Belief in unconditional protection and preservation of life from time of conception.

Principle of non-maleficence.

Principle of prudence: in cases of doubt, it is preferable not to induce / practice abortion.

Fear of social stigma.

Lack of perceived clinical benefit.

Prescription of post-coital contraceptive medications [33, 37].

Belief in unconditional protection and preservation of life from time of conception.

Selective sterilization [33].

Avoidance of means of conception considered “natural” or “correct”.

Sex change [33].

Fears of regret after a potentially irreversible outcome.

Assisted reproduction techniques.

Negative cultural value for future generations (e.g., homosexual couples are not as “good” parents as heterosexual ones) [33, 36].

Avoidance of means of conception considered “natural” or “correct” [38].

Destruction of unused frozen embryos [36].

Fear of potential for misuse (i.e. in research, for infertile couples, etc.).

Refusal of performing abortions in “objecting institutions” [39].

Violation of the safety, well-being, and decision-making of patients.

Forced feeding of prisoners during hunger strikes [36].

Avoidance of acts deemed to be forms of torture.

Principle of autonomy and capacity of decision-making.

Treatment of individuals of other genders [36].

Religious exception.

Use of life-sustaining treatments in patients over predetermined age limits (e.g. 80 years of age) [36].

Distributive justice (rational use of resources).

Inclusion of disabled individuals (e.g. children with Down syndrome) on organ transplant waiting lists [36].

Distributive justice (equitable candidacy for a restricted resource).

Prescription of potentially harmful medications to individuals with questionable motives (e.g. heroin substitute opioids, which can be sold on black market) [40].

Indirect harm to third parties.

Female genital mutilation [38, 41].

Principle of non-maleficence

Animal experimentation.

Avoidance of acts deemed to be forms of torture to all sentient beings, especially in the presence of reasonable alternatives [42].

Learning curve with animals.