I am pleased that the term ‘effective referral’ will be removed from the Conscientious Objection Standard. A referral implies that the physician is recommending a specific course of action, which, in the case of MAID, is not acceptable to those physicians who understand it to be incompatible with the centuries-long Hippocratic tradition of medicine. Physicians who decline to provide a service, such as MAID, are doing so because they believe it is in the best interest of their patients, not to mention the medical profession and society in general. It is their care of their patients that compels them to take this position. For this reason, an obligation of physicians to refer their patients for contested procedures will result in moral injury. Upholding physicians' conscience rights, so that they can practice with integrity, will best protect the public. "Acting against one's conscience is similar to suicidal action against one's own life, and it is no accident that both frequently go together." Dietrich Bonhoeffer