Those arguing that conscientious objection in medicine should be declared unethical by professional societies face the following challenge: conscientious objection can function as an important reforming mechanism when it involves health care workers refusing to participate in certain medical interventions deemed standard of care and legally sanctioned but which undermine patients’ rights. In such cases, the argument goes, far from being unethical, conscientious objection may actually be a professional duty. I examine this sort of challenge and ultimately argue that these acts of conscience done in the interest of reforming professional norms or medical regulations are best understood as episodes of civil disobedience rather than episodes of conscientious objection. In contrast to the private, exempting nature of conscientious objection, civil disobedience is a public breach of a norm or law undertaken with the aim of bringing about a change in governmental policies or professional standards. Consequently, clinicians may have a duty to engage in civil disobedience even while professional societies are right to declare limitations on the ethical appropriateness of conscientious objection.

那些认为医学上的依良心拒服兵役应被专业协会宣布为不道德的人面临以下挑战：当医护人员拒绝参与某些被视为医疗标准并受到法律制裁但被法律制裁的医疗干预措施时，依良心拒服兵役可以作为一种重要的改革机制发挥作用。损害患者权益。在这种情况下，争论说，远非不道德，良心拒服兵役实际上可能是一种职业责任。我研究了这种挑战，并最终认为，为了改革专业规范或医疗法规而做出的这些良心行为最好理解为公民不服从事件，而不是出于良心反对的事件。与出于良心拒服兵役的私人、豁免性质相反，公民不服从是公开违反规范或法律的行为，其目的是改变政府政策或专业标准。因此，即使专业协会有权宣布出于良心拒服兵役的伦理适当性的限制，临床医生也可能有义务进行公民抗命。