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Professionals have a prima facie obligation to do what their profession requires. This is an uncontroversial principle. Equally uncontroversial is that our conscience is essential to our moral integrity. On any account of conscience (whether religious, philosophical or psychological), conscience encompasses core and self-identifying moral beliefs.1 ,2 Therefore, there is also a prima facie duty to respect conscience. The issue of conscientious objection in healthcare is the issue of whether and how to strike a balance between these two prima facie duties when they conflict with each other, for example, when doctors have a conscientious objection to abortion.
The problem of genuineness: medical tribunals are useless
One problem is that sometimes objection to abortion is not genuinely conscientious. For example, in Italy some doctors who are formally conscientious objectors in public hospitals perform illegal abortions in private clinics.3 Unfortunately, it is extremely difficult to pick out such cases. We might introduce ‘medical tribunals’ that assess the genuineness of conscientious objection. According to Christopher Cowley,4 however, such tribunals would be useless, because nothing could constitute evidence for genuineness. For example, Cowley says that the fact that a doctor behaves like a good Catholic in her private life (eg, she goes to Church every Sunday) is no evidence that her objection to abortion is genuinely based on religious conscience.
I agree with Cowley on this point, but not for the same reasons he offers. Cowley's reason is …
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