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My Conscience May Be My Guide, but You May Not Need to Honor It



A number of healthcare professionals assert a right to be exempt from performing some actions currently designated as part of their standard professional responsibilities. Most advocates claim that they should be excused from these duties simply by averring that they are conscientiously opposed to performing them. They believe that they need not explain or justify their decisions to anyone, nor should they suffer any undesirable consequences of such refusal.

Those who claim this right err by blurring or conflating three issues about the nature and role of conscience, and its significance in determining what other people should permit them to do (or not do). Many who criticize those asserting an exemption conflate the same questions and blur the same distinctions, if not expressly, by failing to acknowledge that sometimes a morally serious agent should not do what she might otherwise be expected to do. Neither side seems to acknowledge that in some cases both claims are true. I identify these conflations and specify conditions in which a professional might reasonably refuse to do what she is required to do. Then I identify conditions in which the public should exempt a professional from some of her responsibilities. I argue that professionals should refuse far less often than most advocates do . . . and that they should be even less frequently exempt. Finally, there are compelling reasons why we could not implement a consistent policy giving advocates what they want, likely not even in qualified form.



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1. 42 U.S.C. §300a-7.

2. Existing protection of conscience laws. The Protection of Conscience Project; British Columbia, Canada; 2015; available at (last accessed 12 July 2015).

3. Grinberg E, Hassan C. Muslim flight attendant says she was suspended for refusing to serve alcohol. CNN 2015 (updated 6 Sept); available at (last accessed 8 Sept 2015).

4. Lawrence, RE, Curlin, FA. Clash of definitions: Controversies about conscience in medicine. The American Journal of Bioethics 2007 Dec 17;7(12):1014.

5. Raz, J. Authority, law and morality. The Monist 1985;68(3):295324.

6. Nagel, T. The View from Nowhere. New York: Oxford University Press; 1986.

7. Lipton, RJ. Nazi Doctors: Medical Killing and the Psychology of Genocide. New York: Perseus; 2000.

8. Jones, JH. Bad Blood: The Tuskegee Syphilis Experiment. Revised and expanded ed. New York: Free Press; 1993.

9. 50 SE 2nd 735 (I949) and at I99 US 306, 3I8 (I905).

10. Quill, T. Death and dignity: A case of individualized decision making. New England Journal of Medicine 1991;324:691–4.

11. Kelly, EI. Publicity. In: LaFollette, H, ed. International Encyclopedia of Ethics. Malden, MA: Blackwell; 2013.

12. Hayek, FA. The Road to Serfdom: Text and Documents: The Definitive Edition. Chicago: The University of Chicago Press 2014.

13. Kahneman, D. Thinking, Fast and Slow. New York: Macmillan; 2011.

14. Burton, RA. On Being Certain: Believing You Are Right Even When You’re Not. New York: St. Martin’s; 2009.

15. Loving v. Virginia, 388 U.S. 1 (1967).

16. Doris, JM. Talking to Our Selves: Reflection, Ignorance, and Agency. Oxford: Oxford University Press; 2015.

17. Dunning, D. Self-Insight: Roadblocks and Detours on the Path to Knowing Thyself. New York: Psychology Press; 2005.

18. Pronin, E. The introspection illusion. Advances in Experimental Social Psychology 2009;41:167.

19. Pronin, E, Kugler, MB. Valuing thoughts, ignoring behavior: The introspection illusion as a source of the bias blind spot. Journal of Experimental Social Psychology 2007;43(4):565–78.

20. Mill, JS. On Liberty. Indianapolis, IN: Hackett; 1985/1885: 17.

21. Wicclair, MR. Conscientious Objection in Health Care: An Ethical Analysis. Cambridge: Cambridge University Press; 2011.

22. See note 21, Wicclair 2011.

23. Pharmacist’s model conscience clause. Pharmacists for Life; 1988; available at (last accessed 2 Nov 2005).

24. Why a conscience clause is a must . . . NOW! Pharmacists for Life; 2005; available at (last accessed 2 Nov 2005). Also see note 23, Pharmacist’s model conscience clause 1988.

25. Brock, DW. Conscientious refusal by physicians and pharmacists: Who is obligated to do what, and why? Theoretical Medicine and Bioethics 2008;29(3):187200. Also see note 21, Wicclair 2011.

26. See note 21, Wicclair 2011.

27. Curlin, FA, Lawrence, RE, Chin, MH, Lantos, JD. Religion, conscience, and controversial clinical practices. New England Journal of Medicine 2007;356(6):593600.

28. Murphy S. Referral: A false compromise. The Protection of Conscience Project [serial on the Internet]; 2010; available at Also see note 24, Why a conscience clause is a must . . . NOW! 2005, and note 27, Curlin et al. 2007.

29. Combs, MP, Antiel, RM, Tilburt, JC, Mueller, PS, Curlin, FA. Conscientious refusals to refer: Findings from a national physician survey. Journal of Medical Ethics 2011 July 1;37(7):397401. Also see note 27, Curlin et al. 2007, and note 28, Murphy 2010.

30. Meyers, C, Woods, RD. Conscientious objection? Yes, but make sure it is genuine. American Journal of Bioethics 2007;7(6):1920.

I wish to thank participants at the Conscience and Conscientious Objection in Healthcare Conference at Oxford University for their helpful comments on the paper presented there. I especially thank Eva LaFollette for encouraging me to address this issue. I also thank Ingmar Persson, Alberto Giubilini, and Julian Savulescu, the conference organizers, and to the editors and reviewers of submissions to this special issue of the CQ for their incisive feedback on two versions of the article.


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My Conscience May Be My Guide, but You May Not Need to Honor It



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