Department of Philosophy, Queen's University, Watson Hall 309, Kingston, ON, Canada.
Theor Med Bioeth. 2019 Dec;40(6):523-538. doi: 10.1007/s11017-019-09510-y.
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.
鉴于医疗专业人员在提供此类服务方面的垄断地位，他们基于良心拒绝为符合条件的患者提供护理是有问题的。本文回顾了支持凭良心拒绝者入住的标准伦理论点，并认为这些论点有不足之处。它讨论了涉及旨在测试拒绝的真实性和合理性的妥协解决方案，并拒绝了这些解决方案。一些司法管辖区已经出台了政策，要求凭良心拒绝者提供有效的转介。这些政策已经变得不可行。它们使患者面临医疗保健提供的彩票，这与医疗专业精神的基本价值观是不相容的。本文揭示了跨国努力，这些努力旨在通过凭良心拒绝者的入住主张来破坏生殖健康方面取得的进展。主张从后果主义伦理角度以及与医疗专业精神本身有关的角度来看，对凭良心拒绝者的入住是站不住脚的。
