Patient requests for a female or male obstetrician are fairly common and are routinely respected when a physician of the desired gender (usually female) is available. We examine whether compliance with such gender-based requests is legal, based on accepted standards for employment discrimination and five reported cases of gender-based employment policies in nursing. (There are no reported cases of such policies with regard to physicians.) Legally, we argue, compliance with such requests is permissible but not obligatory. We then consider whether compliance with such requests is ethical, based on considerations of justice as fairness, distinguishing between individual justice claims and social justice claims. We conclude that hospitals and physicians should honor those gender-based patient requests that are based on the individual patient's history or psyche, but they should not honor those that are based on gender generalizations.