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Can an attorney refuse to represent someone whom they know or believe to be guilty...let's say a rapist is caught in the act or a man is arrested with the bloody knife in his hand and the dead man at his feet?!
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The rules are somewhat different in a criminal case, than being forced to accept a civil one.
Harris County (Houston) is the death penalty capital of the US, and indeed sentences more people to death than all but a handful of countries in the world, and yet is the only metro area I know of in the entire US that does not have a public defenders office.
All cases are individually appointed by judges to individual defense attorneys.
Those attorneys are placed on a rotation list, according to experience level and are assigned cases randomly. Refusal is not an option (barring procedural reasons like attorney was a witness or conflict of interest).
Additionally there would come an occasional case where it maybe it was a difficult client or gruesome fact pattern, or complicated issues and the judge would appoint to someone he saw in his courtroom that was good enough to handle those type cases. (I ended up “volunteering” for many of them)
It would be professional suicide to refuse and in some rare cases you could end up in trouble with the bar. The general rule is (and any attorney of my experience and ability could find exceptions) you cannot refuse a case merely because you do not like the defendant or the fact pattern.
On the other hand, an attorney in private practice that does not take court appointments is generally given more leeway.