Conscientious refusal or conscientious provision: We can't have both.

Area of Science:

• Medical Ethics
• Bioethics
• Professional Responsibility

Background:

• The "symmetry thesis" posits that if clinicians can conscientiously refuse services, they can also conscientiously provide abortion services.
• This argument draws parallels between conscientious refusal and conscientious provision in medical practice.

Purpose of the Study:

• To critically evaluate the "symmetry thesis" regarding conscientious objection in healthcare.
• To determine if conscientious refusal and conscientious provision of services are compatible within medical ethics.

Main Methods:

• Analysis of two primary ethical frameworks for the medical profession: "pathocentric" (patient-centered) and "interest-centric" (patient autonomy-centered) views.
• Examining the professional justifications for both conscientious refusal and provision of services under these frameworks.

Main Results:

• The symmetry thesis is demonstrably false under both pathocentric and interest-centric ethical views.
• On pathocentric views, refusal is justified if a service harms or contradicts medical goals, while provision is not.
• On interest-centric views, refusal is unjustified if a service aligns with patient preferences, while provision is justified.

Conclusions:

• Conscientious refusal and conscientious provision of medical services are mutually exclusive, not symmetrical.
• The goals of medicine, whether focused on patient health or patient preferences, do not support the symmetry thesis.