Conscientious refusal, the requirement of justification, and the fetishisation of conscience in healthcare: a Polish perspective

A dogma accepted in many ethical and legal frameworks is that the reasons that lie behind conscientious objection (CO) in healthcare cannot be evaluated or judged by anyone other than the objector herself, because conscience is individual, autonomous, and inaccessible to any outside evaluation. In this paper I argue that this view is mistaken: physicians have an obligation to reveal and explain their reasons for CO and that these reasons may be evaluated either ex ante or ex post. In arguing for my claims I refer mostly to the Polish context and I defend some novel claims that have not been analyzed extensively in the debates on CO. First, I introduce a moral threshold requirement: CO is justified only if the reasons behind a refusal are of moral nature and meet a certain threshold of importance. Second, I highlight the similarities between CO in healthcare and the regulations concerning military refusals, including an emerging practice of granting the right to selective CO status to professional soldiers, that places the burden of proof on a petitioner for CO status. My argument highlights the special status of refusing to kill human organism (military conflicts, abortion, assisted-suicide), and shows that certain other common forms of CO do not warrant accommodation (e.g. emergency contraception).