Reasons and Refusals: The Relevance of Moral Distress

Health-care professionals sometimes appeal to their own consciences in order to justify their exemption from professional duties. I argue that we can only understand the content of a conscientious refusal as either a claim about the psychological dispositions of the refusing professional or as a purely normative claim about the status of the action that is the object of the refusal. If we adopt the former view, we would still need to adjudicate these refusals in terms of the acceptability of the moral views that ground them. If the latter, then we effectively abandon the conception of conscientious refusals that is most widely discussed in the philosophical literature. Whichever option we choose, we must conclude that there is no reason to allow for traditionally understood conscientious refusals by health-care professionals.