The Fiduciary Argument Against Conscientious Refusal in Healthcare

The question of when, if ever, healthcare professionals with conscientious objections should be accommodated by permitting them to refuse to provide medical interventions to which they morally object is a heated issue that has received significant attention in the medical ethics literature. While many professional medical associations have long held that such objections may be accommodated in a broad range of cases, a vocal and growing minority has been fervently arguing that the medical profession should cease accommodating conscientious objections and should rarely, if ever, permit clinicians to refrain from providing medical care merely because it conflicts with their conscience. One of the most popular arguments offered by non-accommodationists focuses on the claim that conscientious refusal is incompatible with healthcare professionals' fiduciary duty to put patients' interests ahead of their own. The aim of this paper is to show that, despite its initial plausibility, this argument is unable to withstand scrutiny. There is no fiduciary duty that is obviously incompatible with conscientious refusal that it is plausible to think healthcare practitioners actually have.