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date: 24 September 2018

Abstract and Keywords

This article examines conflicts of conscience that arise between patients, healthcare providers, and institutions in the field of medicine, especially with regard to reproductive health and end-of-life care. More specifically, it considers “conscientious refusal”—a provider’s exercise of his or her conscience in refusing to perform or participate in a procedure that is deemed ethically and legally permissible. The discussion begins with an overview of the history and development of legislative and court protections for conscientious refusals of healthcare. It then turns to theoretical justifications for protecting conscience in medicine, along with proposals to strike a balance between patient access and provider conscience. It also analyzes current legislation governing refusal vis-à-vis true exercise of conscience and argues that institutional conscience poses practical and theoretical challenges to the protection of conscience. The article concludes with an assessment of future directions for research.

Keywords: conflicts of conscience, patients, conscientious refusal, healthcare, conscience in medicine, patient access, legislation, healthcare providers

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