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Conscience-based refusal of patient care in medicine: a consequentialist analysis

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Abstract

Conscience-based refusals by health care professionals to provide care to eligible patients are problematic, given the monopoly such professionals hold on the provision of such services. This article reviews standard ethical arguments in support of conscientious refuser accommodation and finds them wanting. It discusses proposed compromise solutions involving efforts aimed at testing the genuineness and reasonability of refusals and rejects those solutions too. A number of jurisdictions have introduced policies requiring conscientious refusers to provide effective referrals. These policies have turned out to be unworkable. They subject patients to a health care delivery lottery, which is incompatible with the fundamental values of medical professionalism. This paper sheds light on transnational efforts aimed at undermining progress made in reproductive health by means of conscientious refusal accommodation claims. The view that the accommodation of conscientious refusers is indefensible on consequentialist ethical grounds, as well as on grounds related to medical professionalism itself, is defended.

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Acknowledgements

I thank Jason T. Eberl and Ricardo D. Smalling as well as an anonymous reviewer chosen by this journal for their detailed, constructive comments on an earlier version of this paper. Their valiant critical efforts triggered numerous changes to the manuscript. A very special thank you is due to this journal’s Managing Editor at the time of writing, Katelyn MacDougald, a doctoral student in Georgetown University’s Department of Linguistics—a genius copy editor if there ever was one, and here’s hoping that she doesn’t have to correct this line. All remaining errors are my own.

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  1. Department of Philosophy, Queen’s University, Watson Hall 309, Kingston, ON, Canada

    Udo Schuklenk

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Correspondence to Udo Schuklenk.

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Schuklenk, U. Conscience-based refusal of patient care in medicine: a consequentialist analysis. Theor Med Bioeth 40, 523–538 (2019). https://doi.org/10.1007/s11017-019-09510-y

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