Concluding Note

In this work, I have covered a lot of ground. I have aimed to systematize the literature by naming the major views, to critically analyze the main theories, and to examine a neglected fault line in this debate—the role of justification in conscientious objections in medicine. I have defended the reason-giving requirement at length. I maintain that we have good reason to avoid views on the proper scope of conscientious objection which grant carte blanche exemptions, and we should refuse to endorse positions that allow (virtually) no conscientious exemptions. In fact, I have argued that other views are plausible to the extent that they implicitly adopt the notion of reasonability and the commitment that conscientious objectors must provide sufficient justification before being granted an accommodation. Defenders of these views should instead explicitly adopt the reason-giving requirement.

I have also offered a model reason-giving view based on a distinctive standard of reasonability, and I have suggested and developed a policy proposal to establish conscientious objector status in medicine to deploy my favored reasonability standard. Both moving pieces are subject to debate. I could be mistaken about details of my reasonability standard or the suggestion to establish CO status in medicine but still be correct about the reason-giving requirement—the core of this book. I have developed a multifaceted account of intrinsic reasonability that relies upon a Rawlsian standard of public reasonability, and I have made clear that the positive view I offer is contextual. The extrinsic conditions of my analysis derive from the professional requirements of medicine—most centrally, the tenet to ascribe primacy to the patient’s interests. I have argued that other views do not sufficiently consider the professional obligations ofmedical practitioners and balance these duties against the toleration of reasonable beliefs in a diverse society. The existence of a reasonable conscientious objection on my analysis serves as a sufficient countervailing consideration to defeat health care providers’ prior prima facie duty to deliver legally available, medically indicated, and safe services requested by patients, yet a conscience claim does not simply eradicate one’s professional obligation to heed the primacy tenet. I have presented many advantages of the Reasonability View, including its proactive nature, its progressive edge, and its grounding in a philosophically sophisticated approach to toleration in a pluralistic society.

To my mind, this work changes the burden of proof in the debate: if my core argument is correct, thinkers in the literature on conscientious objection in medicine who are not reason-givers must explain why. They must explain how they avoid extending exemptions to empirically mistaken conscientious objections, discriminatory objections, and the like without being committed to unacceptable consequences or their view collapsing into a species of the Reasonability View. If they are unsuccessful in doing so, then they should become reason-givers. Such thinkers should then work out a foundational account for a standard of assessment and present a workable public policy to employ their favored standard. At present, medical providers around the world can conscientiously object without even giving a reason, yet the status quo is outrageously immoral and disrespectful. I submit that the Reasonability View is the clearest way forward to change this state of affairs.

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