Physicians' Refusals of Service on Grounds of Conscience

Abstract

What is conscience, and when should we let it be our guide? Only when it threatens indictment for nonadherence to an ethically valid duty? How do we know when that is? Doesn't conscience change? And shouldn't we change it intentionally sometimes, for example, on the basis of an all-things-considered judgment? Is conscience subject to reason-guided amendment? Mightn't it be immune to change based on a cost-benefit analysis? Isn't that its deontic characteristic? Suppose we can't help fearing conscience, should we be excused for knuckling under to it? Is conscience then a bully we can't evade? When should society and the law respect physicians' divergent consciences? Mustn't physicians subordinate their interest in being on good terms with conscience to the fiduciary duty owed to patients? Isn't that what fidelity to the goals of medicine requires? Whose medicine? Wouldn't dogmatism about this eradicate physicians' moral agency? This essay provides partial and tentative answers to these questions.