Theoretical Medicine and Bioethics

, Volume 29, Issue 3, pp 187–200 | Cite as

Conscientious refusal by physicians and pharmacists: who is obligated to do what, and why?



Some medical services have long generated deep moral controversy within the medical profession as well as in broader society and have led to conscientious refusals by some physicians to provide those services to their patients. More recently, pharmacists in a number of states have refused on grounds of conscience to fill legal prescriptions for their customers. This paper assesses these controversies. First, I offer a brief account of the basis and limits of the claim to be free to act on one’s conscience. Second, I sketch an account of the basis of the medical and pharmacy professions’ responsibilities and the process by which they are specified and change over time. Third, I then set out and defend what I call the “conventional compromise” as a reasonable accommodation to conflicts between these professions’ responsibilities and the moral integrity of their individual members. Finally, I take up and reject the complicity objection to the conventional compromise. Put together, this provides my answer to the question posed in the title of my paper: “Conscientious refusal by physicians and pharmacists: who is obligated to do what, and why?”.


Conscience Complicity Ethics 


  1. 1.
    Scope Note. 2006. Pharmacists and conscientious objection. Kennedy Institute of Ethics Journal 16 (4): 379–396.CrossRefGoogle Scholar
  2. 2.
    Rohde, Marie. 2008. Rebuke upheld in refusal to fill birth control. Accessed 23 May 2008.
  3. 3.
    Childress, James. 1985. Civil disobedience, conscientious objection, and evasive non-compliance: A framework for the analysis and assessment of illegal actions in health care. Journal of Medicine and Philosophy 10 (1): 63–83.Google Scholar
  4. 4.
    Benn, Piers. 2007. Conscience and health care ethics. In Principles of health care ethics: Second edition, ed. Richard Ashcroft, Angus Dawson, Helen Draper, and J. McMillan. London: Wiley.Google Scholar
  5. 5.
    Sulmasy, Daniel. 2008. What is conscience and why is respect for it so important? Theoretical Medicine and Bioethics 29 (3). doi:10.1007/s11017-008-9072-2
  6. 6.
    Lawrence, Ryan, and Farr Curlin. 2007. Clash of definitions: Controversies about conscience in medicine. American Journal of Bioethics 7 (12): 10–13.CrossRefGoogle Scholar
  7. 7.
    Rawls, John. 1993. Political liberalism. New York: Columbia University Press.Google Scholar
  8. 8.
    Brock, Dan. 1995. Public moral discourse. In Society’s choices: Social and ethical decision making in biomedicine. Washington, DC: National Academy Press.Google Scholar
  9. 9.
    Wicclair, Mark. 2000. Conscientious objection in medicine. Bioethics 14 (3): 205–227.CrossRefGoogle Scholar
  10. 10.
    National Women’s Law Center. Partners in access: Working with state pharmacy boards to stop refusals in the pharmacy. Accessed 23 May 2008.
  11. 11.
    Wicclair, Mark. 2006. Pharmacies, pharmacists, and conscientious objection. Kennedy Institute of Ethics Journal 16 (3): 225250.CrossRefGoogle Scholar
  12. 12.
    Card, Robert. 2007. Conscientious objection and emergency contraception. American Journal of Bioethics 7 (6): 8–14.CrossRefGoogle Scholar
  13. 13.
    FIGO Committee for the Ethical Aspects of Human Reproduction and Women’s Health. 2006. Issues in current service delivery: Ethical guidelines on conscientious objection. Reproductive Health Matters 14 (27): 148–149.CrossRefGoogle Scholar
  14. 14.
    Dickens, Bernard, and Roberta Cook. 2000. The scope and limits of conscientious objection. International Journal of Gynecology & Obstetrics 71: 71–77.CrossRefGoogle Scholar
  15. 15.
    State of Oregon Death with Dignity Act. Accessed 23 May 2008.
  16. 16.
    Charo, R. Alta. 2005. The celestial fire of conscience: Refusing to deliver medical care. New England Journal of Medicine 352 (24): 2471–2473.CrossRefGoogle Scholar
  17. 17.
    Savulescu, Julian. 2006. Conscientious objection in medicine. British Medical Journal 332: 294–297.CrossRefGoogle Scholar
  18. 18.
    Curlin, Farr, Ryan Lawrence, Marshall Chin, and John Lantos. 2007. Religion, conscience, and controversial clinical practices. New England Journal of Medicine 356: 593–600.CrossRefGoogle Scholar
  19. 19.
    Brown v. Board of Education of Topeka. 1954. 347 U.S. 483.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  1. 1.Department of Social MedicineHarvard Medical SchoolBostonUSA

Personalised recommendations