Conscience-based refusals by health care professionals to provide care to eligible patients are problematic, given the monopoly such professionals hold on the provision of such services. This article reviews standard ethical arguments in support of conscientious refuser accommodation and finds them wanting. It discusses proposed compromise solutions involving efforts aimed at testing the genuineness and reasonability of refusals and rejects those solutions too. A number of jurisdictions have introduced policies requiring conscientious refusers to provide effective referrals. These policies have turned out to be unworkable. They subject patients to a health care delivery lottery, which is incompatible with the fundamental values of medical professionalism. This paper sheds light on transnational efforts aimed at undermining progress made in reproductive health by means of conscientious refusal accommodation claims. The view that the accommodation of conscientious refusers is indefensible on consequentialist ethical grounds, as well as on grounds related to medical professionalism itself, is defended.

中文翻译：

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基于良心的医学护理拒绝：结果分析。

鉴于医疗专业人员对提供此类服务的垄断，因此医疗专业人员基于良心拒绝提供医疗服务存在问题。本文回顾了标准的道德论点，以支持出于良心拒服兵役者的住处，并发现他们有需要。它讨论了提议的折衷解决方案，其中涉及旨在测试拒绝的真实性和合理性的工作，并且也拒绝了这些解决方案。许多司法管辖区已经出台了政策，要求认真拒绝的人提供有效的转介。这些政策被证明是行不通的。他们使患者接受医疗保健彩票，这与医学专业精神的基本价值观不符。本文阐明了旨在通过出于良心拒服兵役要求破坏生殖健康进步的跨国努力。有观点认为，基于结果主义的道德理由以及与医学专业精神本身有关的理由，对依良心拒服者的容忍是不可辩驳的。