The Overweighted Integrity Problem: Conscience, Complicity, and Moral Standing

Abstract

Most states in the United States have conscience laws protecting conscientious refusal to perform some medical service. Yet many state conscience laws protect providers from being even indirectly involved with some procedure they find objectionable, which can include not only referrals but also simply informing patients of medically indicated but morally contentious options. I argue that such policies are unjust, offering too much protection for integrity in the face of competing values and patient interests. In other words, these policies grant too much weight to integrity. One promising response to this concern is that in addition to integrity, the state should protect professionals so that they avoid complicity that could undermine their moral right to hold others accountable. I argue that this response fails, since it is implausible that these professionals actually lose that right in such contexts. I conclude that these policies should be restricted to better protect patient interests.