Are Conscientious Refusal and Conscientious Provision Mutually Exclusive? A Critique of Kelusa and Giubilini's...

This article challenges the claim that conscientious refusal and conscientious provision in healthcare are mutually exclusive and thus asymmetrical. While US law protects healthcare providers who refuse to perform medical services on moral or religious grounds, it offers no equivalent protections to those who feel morally compelled to provide care when the service is legally prohibited. This legal asymmetry has become more pressing following the Dobbs v. Jackson Women's Health Organization decision, which overturned Roe v. Wade and triggered a wave of state-level abortion bans. Responding to recent arguments by Kulesa and Giubilini, who contend that the symmetry thesis is false and that conscientious refusal and provision cannot be justified within the same professional framework, this article argues that their position misrepresents the symmetry and constructs a strawman. It demonstrates that refusal and provision are not intended to apply simultaneously in identical cases but rather arise in distinct legal and institutional contexts. The article also critiques the rigid distinction between "pathocentric" and "interest-centric" models of medicine, arguing that professional goals in medicine are plural, contested, and often internally conflicted. Denying moral and professional legitimacy to conscientious provision while protecting conscientious refusal undermines ethical consistency, professional integrity, and respect for moral diversity. In a society with conflicting moral frameworks, protecting both negative and positive conscience claims is necessary to uphold justice, respect provider autonomy, and ensure patient care. The symmetry thesis, understood as the equal moral and legal status of conscience-based refusal and provision, is both defensible and essential.