Two concepts of conscience and their implications for conscience-based refusal in healthcare

Healthcare professionals are not currently obliged to justify conscientious objections. As a consequence, there are currently no practical limits on the scope of conscience-based refusals in healthcare. Recently, a number of bioethicists, including Christopher Meyers, Robert D. Woods, Robert Card, Lori Kantymir, and Carolyn McLeod, have raised concerns about this situation and have offered proposals to place principled limits on the scope of conscience-based refusals in healthcare. Here, I seek to adjudicate among their proposals. I argue that to adjudicate among them properly it is important to consider the theoretical bases for conscientious objection. I further argue that there are two such bases to be considered. Some conscientious objections are justified by appeal to all-things-considered moral judgments, and some are justified by appeal to the “dictates of conscience.” I argue that both of these bases are legitimate and that both should be accommodated in any principled scheme to limit the scope of conscientious refusals in healthcare.