That a standard of medical care must outline services that benefit the patient is relatively uncontroversial. However, one must determine how the practices outlined in a medical standard of care should benefit the patient. I will argue that practices outlined in a standard of medical care must not detract from the patient’s well-functioning and that clinicians can refuse to provide services that do. This paper, therefore, will advance the following two claims: (1) a standard of medical care must not cause dysfunction, and (2) if a physician is medically rational to not provide some service which fails to meet the above condition (i.e. fails to be a standard of medical care), then she may refuse to do so. I then apply my thesis to the prescription of puberty blockers to children with gender dysphoria.

医疗护理标准必须概述对患者有利的服务，这一点相对没有争议。然而，人们必须确定医疗护理标准中概述的实践如何使患者受益。我认为，医疗护理标准中概述的做法不得有损于患者的良好功能，并且临床医生可以拒绝提供有损于患者功能的服务。因此，本文将提出以下两个主张：（1）医疗护理标准不得造成功能障碍；（2）如果医生在医学上合理，不提供某些不符合上述条件的服务（即不提供服务），成为医疗护理的标准），那么她可能会拒绝这样做。然后，我将我的论文应用于为患有性别不安的儿童开青春期阻滞剂的处方。