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The Italian Ministry of Health reports annually on activities related to abortion and fertility, providing quantitative data that looks ripe for analysis. Actors ranging from activists to medical providers to European courts have criticised the data as misleading, but the Ministry reports have not changed. In this piece, we bring together different perspectives on this data from inside and outside academia and offer guidance on how it should-and should not-be used in research.In this article, we collect a wide variety of publications ranging from civil society groups' reports to court decisions, academic articles and investigative reporting and harmonise the way they engage with the Italian Ministry of Health's data regarding abortion and particularly conscientious objection.Analyses rooted in the demographic and medical data about abortion seekers, the abortion rates over time, the different methods of abortion, etc are trustworthy and can be used to extrapolate levels of abortion access. This dataset on conscientious objectors systematically undercounts objectors, implying a false equivalence between people who do not object and people who actually work in an abortion service. We recommend that the Ministry report both the number of objectors and the number of medical doctors working in abortion services.The Italian Ministry of Health produces some valuable data about abortion, but conscientious objection is the key feature of abortion access in Italy, and this key datapoint is flawed. The Ministry could improve clarity and increase citizens' trust in government reports by adding data on the number of abortion providers., Competing Interests: Competing interests: The authors declare no competing interests., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Physicians may under some circumstances decline to provide a clinical service that is within accepted medical standards due to a deeply held moral belief that to do so would be wrong. Conscience objection in medicine is legally protected, but ethically limited by physician obligations to put patient interests first. Accommodation to conscientious objections, when possible, recognizes the diverse moral perspectives and benefits for both the objectors and the profession as a whole. When these situations arise, physicians have obligations to respectfully resolve the distress of conscientious objectors while still honoring the primacy of patient care needs., Competing Interests: Disclosure The author serves as an Editorial Board member for Clinical Reviews and update reviewer for Procedures Videos for Elsevier Inc, Philadelphia PA. The author has no other financial interests or funding relevant to this publication., (Copyright © 2023 Elsevier Inc. All rights reserved.)

A woman's right to a safe legal abortion in South Africa conflicts with a health care professional's freedom of conscience. Conscientious objection or treatment refusal on the basis of conscience may be protected by the constitution but its morality has not been explored. This study uses Kantian Deontology to elucidate the ethical duties of health care professionals based on the Physician's Pledge. It concludes that conscience is morally empty and that health care professionals have a duty to treat all patients equally irrespective of the condition they present. Drawing on Kantian promise keeping, the study also concludes that health care professionals should place patients health and wellbeing above all other considerations. Using the categorical imperative, the study shows that health care professionals have a perfect duty not to refuse treatment. The study recommends that conscientious objection be rejected in all circumstances except where the psychological wellbeing of the health care professional will be affected. This can be achieved through legislative and professional body regulation of conscientious objection., (© 2023 The Authors. Developing World Bioethics published by John Wiley & Sons Ltd.)

"Conscientious provision" refers to situations in which clinicians wish to provide legal and professionally accepted treatments prohibited within their (usually Catholic) health care institutions. It mirrors "conscientious objection," which refers to situations in which clinicians refuse to provide legal and professionally accepted treatments offered within their (usually secular) health care institutions. Conscientious provision is not protected by law, but conscientious objection is. In practice, this asymmetry privileges conservative religious or moral values (usually associated with objection) over secular moral values (usually associated with provision). In this article, we first argue for a legal right to one kind of conscientious provision: referral for procedures prohibited at Catholic hospitals. We then argue that a premise in that argument-the principle of comparably trivial institutional burdens-justifies legal protections for some additional forms of conscientious provision that include, for example, writing prescriptions for contraception or medical abortions. However, this principle cannot justify legal protections for other forms of conscientious provision, for instance, the right to perform surgical abortions or gender-affirming hysterectomies at Catholic hospitals., (© 2024 The Hastings Center.)

Some authors argue that it is permissible for clinicians to conscientiously provide abortion services because clinicians are already allowed to conscientiously refuse to provide certain services. Call this the symmetry thesis. We argue that on either of the two main understandings of the aim of the medical profession-what we will call "pathocentric" and "interest-centric" views-conscientious refusal and conscientious provision are mutually exclusive. On pathocentric views, refusing to provide a service that takes away from a patient's health is professionally justified because there are compelling reasons, based on professional standards, to refuse to provide that service (e.g., it does not heal, and it is contrary to the goals of medicine). However, providing that same service is not professionally justified when providing that service would be contrary to the goals of medicine. Likewise, the thesis turns out false on interest-centric views. Refusing to provide a service is not professionally justified when that service helps the patient fulfill her autonomous preferences because there are compelling reasons, based on professional standards, to provide that service (e.g., it helps her achieve her autonomous preferences, and it would be contrary to the goals of medicine to deny her that service). However, refusing to provide that same service is not professionally justified when refusing to provide that service would be contrary to the goals of medicine. As a result, on either of the two most plausible views on the goals of medicine, the symmetry thesis turns out false., (© 2024 The Authors. Bioethics published by John Wiley & Sons Ltd.)

Settling the debate over conscientious refusal (CR) in liberal democracies requires us to develop a conception of the healthcare provider's moral role. Because CR claims and resulting policy changes take place in specific sociopolitical contexts with unique histories and diverse polities, the method we use for deriving the healthcare norms should itself be a democratic, context-dependent inquiry. To this end, I begin by describing some prerequisites-which I call publicity conditions-for any democratic account of healthcare norms that conflict or jibe with CR. Next, drawing on Ronald Dworkin's jurisprudence and Tom Beauchamp & James Childress's approach to bioethical reasoning, I briefly introduce one method for generating healthcare norms that is faithful to the publicity conditions and has potential to constructively, and democratically, derive important boundaries for CR. Finally, I argue that many critics of CR fail to similarly ground their accounts of healthcare norms in healthcare professionals' sociopolitical contexts, often relying instead on their own interpretation of a generally stateable healthcare norm. This leads to their misconstruing both the value judgments on which their own approaches rest and the public, political values that are often invoked in favor of CR., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Healthcare professionals often face ethical conflicts and challenges related to decision-making that have necessitated consideration of the use of conscientious objection (CO). No current guidelines exist within Spain's healthcare system regarding acceptable rationales for CO, the appropriate application of CO, or practical means to support healthcare professionals who wish to become conscientious objectors. As such, a procedural framework is needed that not only assures the appropriate use of CO by healthcare professionals but also demonstrates its ethical validity, legislative compliance through protection of moral freedoms and patients' rights to receive health care. Our proposal consists of prerequisites of eligibility for CO (individual reference, specific clinical context, ethical justification, assurance of non-discrimination, professional consistency, attitude of mutual respect, assurance of patient rights and safety) and a procedural process (notification and preparation, documentation and confidentiality, evaluation of prerequisites, non-abandonment, transparency, allowance for unforeseen objection, compensatory responsibilities, access to guidance and/or consultative advice, and organizational guarantee of professional substitution). We illustrate the real-world utility of the proposed framework through a case discussion in which our guidelines are applied., (© 2024. The Author(s).)

Emergency contraception (EC) has been prescribed for decades, in order to lessen the risk of unplanned and unwanted pregnancy following unprotected intercourse, ordinary contraceptive failure, or rape. EC and the linked aspect of unintended pregnancy undoubtedly constitute highly relevant public health issues, in that they involve women's self-determination, reproductive freedom and family planning. Most European countries regulate EC access quite effectively, with solid information campaigns and supply mechanisms, based on various recommendations from international institutions herein examined. However, there is still disagreement on whether EC drugs should be available without a physician's prescription and on the reimbursement policies that should be implemented. In addition, the rights of health care professionals who object to EC on conscience grounds have been subject to considerable legal and ethical scrutiny, in light of their potential to damage patients who need EC drugs in a timely fashion. Ultimately, reproductive health, freedom and conscience-based refusal on the part of operators are elements that have proven extremely hard to reconcile; hence, it is essential to strike a reasonable balance for the sake of everyone's rights and well-being.

Objective:  The aim of this study was to verify the existence of conscientious objection to comprehensive health care for the victim of sexual violence, as well as to understand the service structure of institutions authorized in the health care system for victims of sexual violence in the state of Minas Gerais., Methods:  This is a quantitative, cross-sectional, descriptive, and analytical field study aiming to collect data from institutions authorized to assist victims of sexual violence in the state. The instrument was handed in to the coordinators of these services., Results:  It was found that 11% have no physician in service and that 31% had no training for this type of care. It was revealed that 85% of these institutions have already encountered patients wishing to have a legal abortion, but 83% of them have not had their request granted. There was a 60% presence of conscientious objection by the entire medical team, the main reason being religious (57%)., Conclusion:  The assistance system is not prepared for comprehensive care for victims of sexual violence, especially in terms of legal abortions, with conscientious objection being the main obstacle. A functional referral and counter-referral system is needed to alleviate such a serious and evident problem. It is hoped that the research results will promote dialogues in the state that favor appropriate actions on legal abortion, and respect the medical professional, in case of conscientious objection., Competing Interests: The authors have no conflict of interests to declare., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)

In the medical field, conscientious objection is claimed by providers and pharmacists in an attempt to forgo administering select forms of sexual and reproductive healthcare services because they state it goes against their moral integrity. Such claim of conscientious objection may include refusing to administer emergency contraception to an individual with a medical need that is time-sensitive. Conscientious objection is first defined, and then a historical context is provided on the medical field's involvement with the issue. An explanation of emergency contraception's physiological effects is provided along with historical context of the use on emergency contraception in terms of United States Law. A comparison is given between the United States and other developed countries in regard to conscientious objection. Once an understanding of conscientious objection and emergency contraception is presented, arguments supporting and contradicting the claim are described. Opinions supporting conscientious objection include the support of moral integrity, religious diversity, and less regulation on government involvement in state law will be offered. Finally, arguments against the effects of conscientious objection with emergency contraception are explained in terms of financial implications and other repercussions for people in lower socioeconomic status groups, especially people of color. Although every clinician has the right and responsibility to treat according to their sense of responsibility or conscience, the ethical consequences of living by one's conscience are limiting and negatively impact underprivileged groups of people. It is the aim of this article to advocate against the use of provider's and pharmacist's right to claim conscientious objection due to the inequitable impact the practice has on people of color and individuals with lower incomes.

Conscientious objection refers to refusal by a health care provider (HCP) to provide certain treatments, including the standard of care, to a patient based upon the provider's personal, ethical, or religious beliefs. Federal and state rules regarding conscientious objection have expanded the scope of legal protections that HCPs and institutions can invoke in support of refusal. Opponents of these rules argue that allowing refusal of care deprives patients of care that conforms to professionally established guidelines, contradicts long-standing principles related to informed consent, interferes with the ability of health care facilities to provide safe and efficient care, and leaves the patient without means of redress for injury. Proponents respond that such rules are necessary to preserve the moral integrity of providers, including institutions. Although refusal rules are most often associated with abortion, some HCPs have cited moral concerns regarding contraception, sterilization, prevention/treatment of sexually transmitted infections, transition-related care for transgender individuals, medication-assisted treatment of substance use disorders, the use of artificial reproductive technologies, and patient preferences for end-of-life care. Evidence suggests that the burden of conscientious refusal falls disproportionately on vulnerable populations, and legitimate concern exists that moral disagreement is merely pretext for discrimination. A careful balance must be struck between the defending the conscience rights of HCPs and the civil rights of patients.

Background: The concept of conscientious objection is well described; however, because of its nature, little is known about real experiences of nursing professionals who apply objections in their practice. Extended roles in nursing indicate that clinical and value-based dilemmas are becoming increasingly common. In addition, the migration trends of the nursing workforce have increased the need for the mutual understanding of culturally based assumptions on aspects of health care delivery., Aim: To present (a) the arguments for and against conscientious objection in nursing practice, (b) a description of current regulations and practice regarding conscientious objection in nursing in Poland and the United Kingdom, and (c) to offer a balanced view regarding the application of conscientious objection in clinical nursing practice., Design: Discussion paper., Ethical Considerations: Ethical guidelines has been followed at each stage of this study., Findings: Strong arguments exist both for and against conscientious objection in nursing which are underpinned by empirical research from across Europe. Arguments against conscientious objection relate less to it as a concept, but rather in regard to organisational aspects of its application and different mechanisms which could be introduced in order to reach the balance between professional and patient's rights., Discussion and Conclusion: Debate regarding conscientious objection is vivid, and there is consensus that the right to objection among nurses is an important, acknowledged part of nursing practice. Regulation in the United Kingdom is limited to reproductive health, while in Poland, there are no specific procedures to which nurses can apply an objection. The same obligations of those who express conscientious objection apply in both countries, including the requirement to share information with a line manager, the patient, documentation of the objection and necessity to indicate the possibility of receiving care from other nurses. Using Poland and the United Kingdom as case study countries, this article offers a balanced view regarding the application of conscientious objection in clinical nursing practice.

Background: Conscientious objection (CO) is a complex topic of great clinical and philosophical importance which recently came again under fire. Both the so-called absolutist and pro-choice extreme positions (pro and against CO, respectively) cannot stand up to arguments. Moreover, there is not satisfactory compromise position between the conflicting rights., Discussion: The conflicting claims (objectors' and patients') are (almost) equally strong and as such should be accommodated at the same time, when the following conditions are met: objectors' claims are entrenched in society, no anti-democratic values are manifested, and patients' claim is incontestably de lege lata legitimate. The judgment about the de lege lata legitimacy of any given patient's claim should result from the dynamic process of an ongoing dialogue in accordance with the rawlsean "reflective equilibrium" held against a background of shifting sand: people change, medicine changes, society changes. The dialogue should be informed by the ongoing universal dialectic between absolutism and relativism. In accordance with the principle of mutuality, the state and other involved stakeholders (i.e. institutions) have the moral obligation to investigate all the "alternative options and circumstances" under which the conflict can be eliminated, circumvent or a true compromise can be achieved. With this path locked, the conflicting parties should find a fair mutual concession accommodating both the conflicting claims to the greatest extent possible, at the same time. Both the conflicting parties are placed under the obligation to tolerate a "reasonably" minimal harm. This may be the case with referral obligation. If an objective (not personal) referral obligation would be recognized the right to CO would be limited without, however, losing its core physiognomy, provided that the right to CO is a flimsy subjective right that is structured like a molecular aggregation. Besides, a very low amount of wrongness can be conferred upon the act of referral. Who makes it is an in-the-rear-actor in a "wrongdoing" which, in addition, is preparatory act of the principal moral wrongdoing., Conclusion: On the basis of the bioethical principle of mutuality the paper provides a proposal in two steps for obtaining a normatively reasonable (if not true) compromise position.

I defend the feasibility of a medical conscience in the following sense: a medical professional can object to the prevailing medical norms because they are incorrect as medical norms. In other words, I provide an account of conscientious objection that makes use of the idea that the conscience can issue true normative claims, but the claims in question are claims about medical norms rather than about general moral norms. I further argue that in order for this line of reasoning to succeed, there needs to be an internal morality of medicine that determines what medical professionals ought to do qua medical professionals. I utilize a constructivist approach to the internal morality of medicine and argue that medical professionals can conscientiously object to providing treatment X, if providing treatment X is not in accordance with norms that would have been constructed, in light of the end of medicine, by the appropriate agents under the appropriate conditions., (© 2019 John Wiley & Sons Ltd.)

Background: While conscientious objection is a well-known phenomenon in normative and bioethical literature, there is a lack of evidence to support an understanding of what it is like for nurses to make a conscientious objection in clinical practice including the meaning this holds for them and the nursing profession., Research Question: The question guiding this research was: what is the lived experience of conscientious objection for Registered Nurses in Ontario?, Research Design: Interpretive phenomenological methodology was used to gain an in-depth understanding of what it means to be a nurse making a conscientious objection. Purposive sampling with in-depth interview methods was used to collect and then analyze data through an iterative process., Participants and Research Context: Eight nurse participants were interviewed from across practice settings in Ontario, Canada. Each participant was interviewed twice over 9 months., Ethical Considerations: This study was conducted in accordance with Health Science Research Ethics Board approval and all participants gave consent., Findings: Six themes emerged from data analysis: encountering the problem, knowing oneself, taking a stand, alone and uncertain, caring for others, and perceptions of support., Discussion: This study offers an initial understanding of what it is like to be a nurse making a conscientious objection in clinical practice. Implications for nursing practice, education, policy, and further research are discussed., Conclusion: Addressing ethical issues in nursing practice is complex. The need for education across nursing, healthcare disciplines and socio-political sectors is essential to respond to nurses' ethical concerns giving rise to objections. Conscience emerged as an informant to nurses' conscientious objections. The need for morally inclusive environments and addressing challenging ethical questions as well as the concept of conscience are relevant to advancing nursing ethics and ethical nursing practice.

Answers to the questions of what justifies conscientious objection in medicine in general and which specific objections should be respected have proven to be elusive. In this paper, I develop a new framework for conscientious objection in medicine that is based on the idea that conscience can express true moral claims. I draw on one of the historical roots, found in Adam Smith's impartial spectator account, of the idea that an agent's conscience can determine the correct moral norms, even if the agent's society has endorsed different norms. In particular, I argue that when a medical professional is reasoning from the standpoint of an impartial spectator, his or her claims of conscience are true, or at least approximate moral truth to the greatest degree possible for creatures like us, and should thus be respected. In addition to providing a justification for conscientious objection in medicine by appealing to the potential truth of the objection, the account advances the debate regarding the integrity and toleration justifications for conscientious objection, since the standard of the impartial spectator specifies the boundaries of legitimate appeals to moral integrity and toleration. The impartial spectator also provides a standpoint of shared deliberation and public reasons, from which a conscientious objector can make their case in terms that other people who adopt this standpoint can and should accept, thus offering a standard fitting to liberal democracies., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Aims: To explore the meaning of conscience for nurses in the context of conscientious objection (CO) in clinical practice., Design: Interpretive phenomenology was used to guide this study., Data Sources: Data were collected from 2016 - 2017 through one-on-one interviews from eight nurses in Ontario. Iterative analysis was conducted consistent with interpretive phenomenology and resulted in thematic findings., Review Methods: Iterative, phased analysis using line-by-line and sentence highlighting identified key words and phrases. Cumulative summaries of narratives thematic analysis revealed how nurses made meaning of conscience in the context of making a CO., Results: Conscience issues and CO are current, critical issues for nurses. For Canadian nurses this need has been recently heightened by the national legalization of euthanasia, known as Medical Assistance in Dying in Canada. Ethics education, awareness, and respect for nurses' conscience are needed in Canada and across the profession to support nurses to address their issues of conscience in professional practice., Conclusion: Ethical meaning emerges for nurses in their lived experiences of encountering serious ethical issues that they need to professionally address, by way of conscience-based COs., Impact: This is the first study to explore what conscience means to nurses, as shared by nurses themselves and in the context of CO. Nurse participants expressed that support from leadership, regulatory bodies, and policy for nurses' conscience rights are indicated to address nurses' conscience issues in practice settings., (© 2018 John Wiley & Sons Ltd.)

Background:: Ethical nursing practice is increasingly challenging, and strategies for addressing ethical dilemmas are needed to support nurses' ethical care provision. Conscientious objection is one such strategy for addressing nurses' personal, ethical conflicts, at times associated with conscience. Exploring both conscience and conscientious objection provides understanding regarding their implications for ethical nursing practice, research, and education., Research Aim:: To analyze the concepts of conscience and conscientious objection in the context of nurses., Design:: Concept analysis using the method by Walker and Avant., Research Context:: Data were retrieved from Philosopher's Index, PubMed, and CINAHL with no date restrictions., Ethical Consideration:: This analysis was carried out per established, scientific guidelines., Findings:: Ethical concepts are integral to nursing ethics, yet little is known about conscientious objection in relation to conscience for nurses. Of note, both concepts are well established in ethics literature, addressed in various nursing codes of ethics and regulatory bodies, but the meaning they hold for nurses and the impact they have on nursing education and practice remain unclear., Discussion and Conclusion:: This article discusses the relevance of conscience and conscientious objection to ethical nursing practice and proposes a model case to show how they can be appreciated in the context of nurses. Conscientious objection is an option for ethical transparency for nurses but is situated in contentious discussions over its use and has yet to be fully understood for nursing practice. Conscience is an element in need of more exploration in the context of conscientious objection. Further research is warranted to understand how nurses respond to conscience concerns in morally, pluralistic nursing contexts.

While mainstream, establishment medical journals have published opinion pieces condemning conscientious refusals in medical care, American law has consistently and repeatedly supported a right to such refusals. Law has not relied on a particular philosophical basis for health care. Indeed, legal precedents reject any monolithic model, whether based on consumerism or on professional obligations. Law focuses on the coexistence of diverse understandings, motivations, and delivery models. Scholarly approaches tend to ignore the fact that, fundamentally, conscientious objection involves a minority telling the majority that the objector(s) cannot ethically participate according to the majority's preferred model or set of rules. Religious liberty is protected in the US by applying strict scrutiny. Any governmental burden on religious liberty must further a compelling governmental interest and be implemented using the least restrictive means reasonably available. After years of scholarly controversy, strict scrutiny continues to be the law. The moral basis for the legal right of conscientious objection has been affirmed and expanded by Hobby Lobby in 2014, outlined in an Attorney General Memorandum in 2017, and codified in a Final Conscience Rule by the Department of Health and Human Services in May 2019.

This essay analyzes the conflicts that arise between an individual's deeply held beliefs and the collective norms of society. Sometimes these conflicts are framed in religious terms. The author argues that such a framing is too narrow and inappropriately puts the focus on a specific set of (largely Christian) beliefs about matters related to sexuality. This essay attempts to broaden the discussion in order to highlight the ways in which conflicts between individual beliefs and practices, on the one hand, and prevailing societal norms, on the other, create the tension that can lead to societal change.

Lauris Kaldjian defends conscientious objection against opponents who claim that there is no place for a physician's personal moral beliefs in the practice of medicine. This essay argues that Kaldjian's defense of conscientious objection relies on a controversial "thick" conception of conscience that opponents may justifiably question. It offers a defense that relies on a relatively "thin" conception of conscience as an agent's core moral beliefs and that understands conscience-based refusals to provide medical services as refusals based on those core beliefs. Enabling physicians to practice medicine without compromising their moral integrity is an important pro tanto reason to accommodate physicians who conscientiously object to providing medical services. However, giving due consideration to the professional obligations of physicians requires constraints on accommodation. Accommodation should not: (1) impede a patient's timely access to relevant information; (2) impede a patient's timely access to referral and counselling; (3) impede a patient's timely access to medical services that are consistent with prevailing professional standards; (4) enable physicians to practice invidious discrimination; (5) place an excessive burden on other health professionals and institutions; or (6) authorize physicians to unilaterally decide to forgo life-sustaining treatment against the wishes of patients or surrogates.

What is conscience, and when should we let it be our guide? Only when it threatens indictment for nonadherence to an ethically valid duty? How do we know when that is? Doesn't conscience change? And shouldn't we change it intentionally sometimes, for example, on the basis of an all-things-considered judgment? Is conscience subject to reason-guided amendment? Mightn't it be immune to change based on a cost-benefit analysis? Isn't that its deontic characteristic? Suppose we can't help fearing conscience, should we be excused for knuckling under to it? Is conscience then a bully we can't evade? When should society and the law respect physicians' divergent consciences? Mustn't physicians subordinate their interest in being on good terms with conscience to the fiduciary duty owed to patients? Isn't that what fidelity to the goals of medicine requires? Whose medicine? Wouldn't dogmatism about this eradicate physicians' moral agency? This essay provides partial and tentative answers to these questions.

In his work on medical ethics, Lauris Kaldjian identifies conscience with integrity. However, there are competing notions of integrity that may guide the conscience. This paper addresses debates over conscientious refusals by considering Cicero's account of integrity, a conception previously not discussed in the context of this debate. Cicero offers a framework for understanding integrity and conscience for the physician that is an alternative to Alasdair MacIntyre's notion of the completely unified life, an idea appropriated by Kaldjian in his argument that there can be no clean distinction between personal, private, practical reasoning and moral decision-making. Cicero's account rejects the modern-individualist idea of the autonomous self living a wholly compartmentalized life. It agrees with Kaldjian's stress on flexible decision-making, the internal morality of medicine, the importance of virtues, and the need to accommodate pluralism. However, Ciceronian integrity is better suited than the MacIntyreian account to our present liberal order. It offers a place for the "moral hero" while recognizing that the vast majority of moral agents will be "progressors" who lack the consistency of the moral hero's fully integrated life. The inclusion of both types of individuals in the medical field may offset the potentially harmful tendencies to which each is prone.

Background: In the debate on conscientious objection in healthcare, proponents of conscience rights often point to the imperative to protect the health professional's moral integrity. Their opponents hold that the moral integrity argument alone can at most justify accommodation of conscientious objectors as a "moral courtesy", as the argument is insufficient to establish a general moral right to accommodation, let alone a legal right., Main Text: This text draws on political philosophy in order to argue for a legal right to accommodation. The moral integrity arguments should be supplemented by the requirement to protect minority rights in liberal democracies. Citizens have a right to live in accordance with their fundamental moral convictions, and a right to equal access to employment. However, this right should not be unconditional, as that would unduly infringe on the rights of other citizens. The right must be limited to cases where the moral basis is more fundamental in a sense that all reasonable citizens in a liberal democracy should accept, such as the constitutive role of the inviolability of human life in liberal democracies., Conclusion: There should be a legal, yet circumscribed, right to accommodation for conscientious objectors refusing to provide healthcare services that they reasonably consider to involve the intentional killing of a human being.

Objective:  We have evaluated the prevalence of and the motivating factors behind the refusal to provide reproductive health services and the ethical knowledge of the subject among medical students from the Escola Bahiana de Medicina e Saúde Pública, in the state of Bahia, Brazil., Methods:  The present cross-sectional study involved 120 medical students. A questionnaire was utilized. The dependent variables were students' objections (or not) regarding three clinical reproductive health cases: abortion provided by law, contraceptive guidance to an adolescent without parental consent, and prescription of emergency contraception. The independent variables were age, gender, religion, ethical value, degree of religiosity, and attendance at worship services. Ethical knowledge comprised an obligation to state the reasons for the objection, report possible alternatives, and referral to another professional. Data were analyzed with χ 2 tests and t -tests with a significance level of 5%., Results:  Abortion, contraception to adolescents, and emergency contraception were refused by 35.8%, 17.5%, and 5.8% of the students, respectively. High religiosity ( p  < 0.001) and higher attendance at worship services ( p  = 0.034) were predictors of refusing abortion. Refusal to provide contraception to adolescents was significantly higher among women than men ( p  = 0.037). Furthermore, 25% would not explain the reason for the refusal, 15% would not describe all the procedures used, and 25% would not refer the patient to another professional., Conclusion:  Abortion provided by law was the most objectionable situation. The motivating factors for this refusal were high commitment and religiosity. A reasonable portion of the students did not demonstrate ethical knowledge about the subject., Competing Interests: The authors have no conflicts of interest to declare., (Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil.)