The subject of this book is conscientious objection in health care. Although conscientious objection historically has been associated with military service, it has become a significant phenomenon in health care. Some physicians, nurses, and pharmacists have refused to provide or assist in providing goods and services for reasons of conscience. Many of these conscience-based refusals are related to the perennial and sometimes controversial issues of sex/reproduction and death. Examples in the former category include abortion, sterilization, contraception, and assisted reproduction. Examples in the latter category include palliative sedation (the practice of sedating terminally ill patients to unconsciousness until death) and forgoing medically provided nutrition and hydration. Novel technologies, procedures, and therapeutic measures also have occasioned conscience-based refusals by health care professionals, and can be expected to do so in the future. Recent examples include conscience-based objections to participation in embryonic stem cell research, genetic testing and counseling, and donation after cardiac death (retrieving organs after life support has been withdrawn from patients who do not satisfy the neurological or whole brain criterion of death).

In this book, I offer an ethical analysis of conscientious objection in three representative health care professions: medicine, nursing, and pharmacy. There are several reasons for considering these three professions together. First, from the perspective of conscientious objection, the three professions are interdependent. On the one hand, physician conscience-based objections can affect the practice of pharmacists and nurses.