A US Department of Health and Human Services Final Rule, Protecting Statutory Conscience Rights in Health Care (2019), and a proposed bill in the British House of Lords, the Conscientious Objection (Medical Activities) Bill (2017), may well warrant a concern that—to borrow a phrase Daniel Callahan applied to self-determination—conscientious objection in health care has “run amok.” Insofar as there are no significant constraints or limitations on accommodation, both rules endorse an approach that is aptly designated “conscience absolutism.” There are two common strategies to counter conscience absolutism and prevent conscientious objection in medicine from running amok. One, non-toleration, is to decline to accommodate physicians who refuse to provide legal, professionally accepted, clinically appropriate medical services within the scope of their clinical competence. The other, compromise or reasonable accommodation, is to impose constraints on accommodation. Several arguments for non-toleration are critically analyzed, and I argue that none warrants its acceptance. I maintain that non-toleration is an excessively blunt instrument to prevent conscientious objection in medicine from running amok. Instead, I defend a more nuanced contextual approach that includes constraints on accommodation.

中文翻译：

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防止出于良心拒服医学反对：合理安排的辩护

美国卫生与公共服务部的最终规则，《保护医疗保健中的法定良知权》（2019年）以及英国上议院的一项拟议法案，《良心反对（医疗活动）法案》（2017年），可能值得关注借用丹尼尔·卡拉汉（Daniel Callahan）的自决一词，在医疗保健中出于良心拒服兵役已经“风行一时”。只要对调适没有明显的限制或限制，两条规则都认可一种被恰当地称为“良心专制主义”的方法。有两种常见的策略可以对抗良心专制主义和防止出于良心拒服医学的反对。一，非-宽容拒绝接受拒绝在其临床能力范围内提供法律，专业认可，临床上适当的医疗服务的医生。另一个是妥协或合理的调和，是对调和施加限制。对不容忍的几个论点进行了严格的分析，我认为没有一个值得保证。我坚持认为，不容忍是一种过分钝的工具，可以防止出于良心拒服医学的反对。相反，我捍卫了一种更细微的上下文方法，其中包括对适应性的限制。