No conscientious objection without normative justification: Against conscientious objection in medicine

Bioethics. 2019 Jan;33(1):146-153. doi: 10.1111/bioe.12521. Epub 2018 Sep 26.


Most proponents of conscientious objection accommodation in medicine acknowledge that not all conscientious beliefs can justify refusing service to a patient. Accordingly, they admit that constraints must be placed on the practice of conscientious objection. I argue that one such constraint must be an assessment of the reasonability of the conscientious claim in question, and that this requires normative justification of the claim. Some advocates of conscientious object protest that, since conscientious claims are a manifestation of personal beliefs, they cannot be subject to this kind of public justification. In order to preserve an element of constraint without requiring normative justification of conscientious beliefs, they shift the justificatory burden from the belief motivating the conscientious claim to the condition of the patient being refused service. This generally involves a claim along the lines that conscientious refusals should be permitted to the extent that they do not cause unwarranted harm to the patient. I argue that explaining what would constitute warranted harm requires an explanation of what it is about the conscientious claim that makes the harm warranted. 'Warranted' is a normative operator, and providing this explanation is the same as providing normative justification for the conscientious claim. This shows that resorting to facts about the patient's condition does not avoid the problem of providing normative justification, and that the onus remains on advocates of conscientious objection to provide normative justification for the practice in the context of medical care.

Keywords: conscience; conscientious objection in medicine; medical ethics; philosophy of medicine; professionalism; reasonability.

MeSH terms

  • Attitude of Health Personnel*
  • Conscience*
  • Culture
  • Delivery of Health Care / ethics*
  • Dissent and Disputes*
  • Ethical Analysis
  • Ethical Theory*
  • Ethics, Medical
  • Health Status
  • Humans
  • Morals
  • Refusal to Treat / ethics*