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A compromise approach to conscience-based refusals by health care professionals seeks to strike a reasonable balance between the integrity interests of health care professionals and the health care needs and interests of patients. In Chapter 2, I considered and rejected two extreme alternatives to a compromise approach: the incompatibility thesis and conscience absolutism. On the one hand, I argued that none of the common accounts of the professional obligations of physicians, nurses, and pharmacists unequivocally supports the incompatibility thesis – the claim that conscientious objection is incompatible with those obligations. On the other hand, with the possible exception of accounts of professional obligations based on general ethical theories, I argued that conscience absolutism – the view that there are no ethical constraints on the exercise of conscience – is incompatible with the accounts of professional obligations considered in Chapter 2. With the possible exception of accounts based on general ethical theories, all favor a compromise approach.
In this chapter, I explain and defend a compromise approach, according to which the justifiability of conscience-based refusals is context-dependent. I will argue that core professional obligations to patients justify ethical constraints on the exercise of conscience. I will also explain and defend ethical constraints in relation to employers and supervisors, colleagues, and members of other health care professions.
The focus of this chapter is on ethical limitations on conscience-based refusals (i.e. those based on a practitioner's core moral beliefs).