Conscience, Professionalism, and Pluralism

The rights of health care professionals to refuse to participate in procedures such as abortion and sterilization that they judge to be wrong on moral or religious grounds have been protected by federal legislation and regulations for several decades. Recently, rights of conscience have been invoked in the pharmaceutical context, where the applicability of such claims has generated significant controversy. This article responds to those controversies in three steps. First, it critiques the major arguments that would deny rights of conscience to dissenting pharmacists. Second, it explores traditional discussions of the subjective and objective aspects of duties of conscience. Third, it employs the conceptual and practical links between subjective and objective aspects of conscience to develop a four-fold typology of case categories for interpreting the relative weight of claims of conscience against other values.