Conscience in Reproductive Health Care Prioritizing Patient Interests

Conscience in Reproductive Health Care responds to the growing worldwide trend of health care professionals conscientiously refusing to provide abortions and similar reproductive health services in countries where these services are legal and professionally accepted. Carolyn McLeod argues that conscientious objectors in health care should prioritize the interests of patients in receiving care over their own interest in acting on their conscience. She defends this "prioritizing approach" to conscientious objection over the more popular "compromise approach" without downplaying the importance of health care professionals having a conscience or the moral complexity of their conscientious refusals. McLeod's central argument is that health care professionals who are gatekeepers of services such as abortions are fiduciaries for their patients and for the public they are licensed to serve. As such, they owe a duty of loyalty to these beneficiaries and should give primacy to their beneficiaries' interests in accessing care. This conclusion is informed by what McLeod believes is morally at stake for the main parties to the conflicts generated by conscientious refusals: the objector and the patient. What is at stake, according to McLeod, depends on the relevant socio-political context, but typically includes the objector's integrity and the patient's interest in avoiding harm.

Carolyn McLeod, University of Western Ontario

Carolyn McLeod is Professor and Chair of Philosophy at the University of Western Ontario. Her philosophical research centres on pressing issues in public policy, particularly matters that concern the creation or dissolution of families with children. She has been directly involved in policy discussions in Canada about the right of health care professionals to make conscientious objections, public funding for in vitro fertilization, and improvements to our adoption systems. McLeod is the author of Self-Trust and Reproductive Autonomy (MIT 2002) and co-editor of Family-Making: Contemporary Ethical Challenges (Oxford 2014) and The Healthy Embryo: Social, Biomedical, Legal and Philosophical Perspectives (Cambridge 2010).

Introduction
Part I: What's at Stake
1. The Value of Conscience
2. Harm or Mere Inconvenience?
3. Damage to Trust
Part II: Regulating Conscientious Refusals
4. Why not Compromise?
5. Fidelity to Patients
6. Fidelity to Purposes
Conclusion