HEC Forum (2012) 24:6382

DOI 10.1007/s10730-011-9156-7

Abortion: At the Still Point of the Turning

Conscientious Objection Debate
Elliott Louis Bedford

Published online: 17 July 2011

 Springer Science+Business Media B.V. 2011

Abstract Abortion is the central issue in the conscientious objection debate. In

this article I demonstrate why this is so for two philosophical viewpoints prominent
in American culture. One, represented by Patrick Lee and Robert P. George, holds
that the fundamental moral value of being human can be found in bare life and the
other, represented by Tom Beauchamp and James Childress, holds that this fundamental value is found in the life that can choose and determine itself. First, I
articulate Lee and Georges philosophical theory and demonstrate how the fundamental moral value of their theory, personhood, is represented in the issue of
abortion. Second, I examine Beauchamp and Childress theoretical vision and
demonstrate how their fundamental moral value, the right to autonomous selfdetermination, is represented in abortion. Third, I sketch the theoretical and practical dynamics of the conscientious objection debate as well as each authors
understanding of conscience. Fourth, I demonstrate how abortion, which represents
their respective fundamental value, shapes each perspectives approach to the
conscientious objection debate. I conclude that because each theory finds its fundamental value represented in the issue of abortion, each perspective is bound to
engage the conscientious objection debate in a way that centers on the issue of
abortion.
Keywords

Abortion
Conscientious objection
Personhood
Self-determination

E. L. Bedford (&)
Albert Gnaegi Center for Health Care Ethics, Saint Louis University, St. Louis, MO, USA
e-mail: ebedford@slu.edu; ebedford@ascensionhealth.org
E. L. Bedford
Ethics Department, Ascension Health, St. Louis, MO, USA

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Introduction and Background

According to R. Alta Charo present day conscience clauses exist, largely as
artifacts of the abortion wars (Charo 2005, p. 2471). This concerns her because,
with abortion at the center of a wider discussion, a medical professionals duty to
refer is increasingly circumvented by legislation, which ultimately leads, as she sees
it, to a loss of professional integrity (Charo 2005, p. 2471). For Charo this creep
of conscience clauses, to use a term from Julie Cantor, a legal representative of an
affiliate of Planned Parenthood, is nothing other than, abortion opponents
search[ing] for proxy warsto rehearse arguments on the value of biologic but
nonsentient human existence. Conscience clauses represent but another battle in the
so-called culture wars (Charo 2005, p. 2472). Is there a unique tie between
abortion and conscientious objection? Cantor seems to think so, candidly
explaining, We allow conscience based exceptions because abortion remains
controversial in the United States (Cantor 2009, p. 1485). Of course, it would seem
unreasonable to think that settling the abortion debate would entail settling the
conscientious objection debate, especially since medical professionals can conscientiously object to a variety of actions that differ significantly from abortion, e.g.,
physician-assisted suicide. Nonetheless, this paper aims to articulate why, as Charo
alleges, abortion maintains a unique place at the center of the wider conscience
debate for two philosophical viewpoints.1
Two of the more prominent voices within public bioethical debate are
philosophical views that, on the one hand, hold up bare (human) life as its
fundamental value, and, on the other, hold up the life that can choose as its
fundamental value. For the purposes of this paper, I take two sets of authors to be
representative of these more general voices fully aware of the limits of such
reductionistic representation. I have nonetheless selected these authors as
representatives for two reasons. (1) They both seek to defend a moral theory that
is (a) ascertainable by reason, for Patrick Lee and Robert P. George, Natural Law,
for Tom Beauchamp and James Childress, Common Morality-Principlism, and
(b) common for humanity across cultures. (2) Despite the commonalities between
their theories, these authors locate their vision of fundamental value in differing
phenomena, which is for each a particular vision of the human person. The Lee and
George (L&G) perspective grounds itself in ontology and employs arguments based
on the notion of a personal human essence. Beauchamp and Childress (B&C)
perspective centers on self-determination and frames arguments premised on
positive and negative duties for enabling or enhancing self-determination.

I do not think that there is any agreement concerning the content of the concept of conscience, or a
conscience in the current American debate. Nonetheless, the term is still widely used. As will be shown,
the lack of agreement regarding the thing often called conscience is, in important respects, the crux of
the conscientious objection debate in the morally pluralistic culture of twenty-first century America.
Hence, I will speak of conscience noting its lack of widely agreed upon content. Further, while the
abortion and conscientious objection debates are not unique to the United States, Charo and Cantor
function within American culture to generate their positions. Therefore, in order to provide an analysis as
consistent with the authors as possible, my analysis proceeds from the same frame of reference.

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Introduction and Background

According to R. Alta Charo present day conscience clauses exist, largely as
artifacts of the abortion wars (Charo 2005, p. 2471). This concerns her because,
with abortion at the center of a wider discussion, a medical professionals duty to
refer is increasingly circumvented by legislation, which ultimately leads, as she sees
it, to a loss of professional integrity (Charo 2005, p. 2471). For Charo this creep
of conscience clauses, to use a term from Julie Cantor, a legal representative of an
affiliate of Planned Parenthood, is nothing other than, abortion opponents
search[ing] for proxy warsto rehearse arguments on the value of biologic but
nonsentient human existence. Conscience clauses represent but another battle in the
so-called culture wars (Charo 2005, p. 2472). Is there a unique tie between
abortion and conscientious objection? Cantor seems to think so, candidly
explaining, We allow conscience based exceptions because abortion remains
controversial in the United States (Cantor 2009, p. 1485). Of course, it would seem
unreasonable to think that settling the abortion debate would entail settling the
conscientious objection debate, especially since medical professionals can conscientiously object to a variety of actions that differ significantly from abortion, e.g.,
physician-assisted suicide. Nonetheless, this paper aims to articulate why, as Charo
alleges, abortion maintains a unique place at the center of the wider conscience
debate for two philosophical viewpoints.1
Two of the more prominent voices within public bioethical debate are
philosophical views that, on the one hand, hold up bare (human) life as its
fundamental value, and, on the other, hold up the life that can choose as its
fundamental value. For the purposes of this paper, I take two sets of authors to be
representative of these more general voices fully aware of the limits of such
reductionistic representation. I have nonetheless selected these authors as
representatives for two reasons. (1) They both seek to defend a moral theory that
is (a) ascertainable by reason, for Patrick Lee and Robert P. George, Natural Law,
for Tom Beauchamp and James Childress, Common Morality-Principlism, and
(b) common for humanity across cultures. (2) Despite the commonalities between
their theories, these authors locate their vision of fundamental value in differing
phenomena, which is for each a particular vision of the human person. The Lee and
George (L&G) perspective grounds itself in ontology and employs arguments based
on the notion of a personal human essence. Beauchamp and Childress (B&C)
perspective centers on self-determination and frames arguments premised on
positive and negative duties for enabling or enhancing self-determination.

I do not think that there is any agreement concerning the content of the concept of conscience, or a
conscience in the current American debate. Nonetheless, the term is still widely used. As will be shown,
the lack of agreement regarding the thing often called conscience is, in important respects, the crux of
the conscientious objection debate in the morally pluralistic culture of twenty-first century America.
Hence, I will speak of conscience noting its lack of widely agreed upon content. Further, while the
abortion and conscientious objection debates are not unique to the United States, Charo and Cantor
function within American culture to generate their positions. Therefore, in order to provide an analysis as
consistent with the authors as possible, my analysis proceeds from the same frame of reference.

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65

The paper proceeds as follows. First, I briefly review Lee and Georges theory
and their position on abortion. Second, I discuss Beauchamp and Childress theory
and position on abortion. Third, I sketch the theoretical and practical dynamics of
the conscientious objection debate, as well as the authors theory as it pertains to
conscientious objection. Fourth, I demonstrate that because abortion represents the
fundamental value for each theory it shapes their approach to the conscientious
objection debate. I conclude that because each theory finds its fundamental value
represented in the issue of abortion, each perspective is bound to engage the
conscientious objection debate in a way that centers on the issue of abortion.

Lee and George

Within their respective theories both sets of authors seek to articulate what is most
meaningful about being human. At the theoretical level, L&G follow the
AristotelianThomistic tradition arguing that what distinguishes man as significant,
metaphysically and morally, is his essential nature. They hold that man is, an
individual substance (that is, a unique substance) of a rational nature (Lee and
George 2008, p. 83, n. 67). This definition follows the Aristotelian genusspecies
taxonomical system of classification highlighting a particular feature that distinguishes the human animal from things that are otherwise similar to him. Following
Boethius and St. Thomas Aquinas, L&G argue that human beings are persons,
which is to say they are animals that differ radically from all other animals because
of their rational soul, their intellect and will (Lee and George 2008, p. 51).
Personhood is the fundamental ground for the moral significance of human
individuality for L&G. As they put it, One could say that the criterion for full
moral worth is being a person, since a person is a rational morally responsible
subject (Lee and George 2008, p. 83). The individuality of personhood links
intimately with the individuality of the organism. For example, L&G argue that the
human person is the biologically human organism that begins at conception (Lee
and George 2005, pp. 1416; 2008, pp. 494). Thus, L&G argue that human beings
are intrinsically valuable in virtue of the kind of thing they are, which is a person,
from the moment they first exist, which is conception.2
Given their vision of the human person as a fully integrated bodysoul
composite, any opposing theoretical claim that holds the value of the human person
is not already bodily is viewed as a form of dualism, either of the Substance type,
which holds that human persons and human organisms are two distinct substances,
or the Evaluative type, which admits that fetuses are persons but do not have the
same moral status as fully functional adult human beings (Lee and George 2005,
pp. 1520). Against Substance Dualism they argue to demonstrate that the personal
substance with a will and rational intellect is also the same substance that
experiences bodily sensations, that is, a human person is a single substance. Against
2

While both authors are Roman Catholic their argument for the personhood and value of the human
embryo/fetus is philosophical in nature. The unchanging moral teaching of the Church against abortion
rests on the belief that fetus should be treated with full moral consideration, not on the metaphysical
argument that the embryo is a human person. See Connery (1977, pp. 304313).

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the Evaluative Dualist, L&G argue to demonstrate that human beings have full
moral status from the moment they substantially exist, which is at conception.
Throughout their argumentation, the concept of personhood is understood as a
content-thick notion and is a fundamental starting point for arguments concerning
issues such as abortion or conscientious objection which concern most immediately
individual persons. Thus, for L&G, the individuals moral status is grounded in his
or her personal essence, i.e., rational nature, which includes the bare life of the
individual human being.
Based on this understanding of the individual human person they follow the
AristotelianThomistic tradition in the political realm. Arguing that politics is the
queen of the sciences because man contemplates and seeks his fullest flourishing
politically, Aristotle claims a polis is constituted for the pursuit of an overarching,
communal telos.3 Tracing the notion of community back to its smallest unitsthe
husband and wife, and the master and slavehe demonstrates how every larger
community builds upon these smaller units comprised by individuals (Aristotle
2009, Politics, Book I, Chaps. 12). Nonetheless, each community forms to seek
some overarching good which for Aristotle is eudaimonia, full flourishing.
Similarly, for L&G, the political realm is a place where individual human persons
seek their integral fulfillment within a larger community.4 However, their
understanding of personhood shapes their vision of the political realm. For
example, they cite personhood as the fundamental ground for the natural rights that
individual human beings enjoy (Lee and George 2005, pp. 1920). This vision of
rights is not per se political in the sense that these rights do not originate from
political determinations. Human persons have these rights in virtue of the kind of
thing they are, i.e. based on their substantial, rational nature, not the political system
in which they live. The political realm is a place where these rights are recognized.
By recognizing these natural rights, political discourse can be directed towards
making decisions that enable human persons to achieve integral fulfillment.

Aristotle explains the significance of politics as follows: Now, since politics uses the rest of the
sciences, and since, again, it legislates what we are to do and what we are to abstain from, the end of this
science must include those from the others, so that this end must be the good for man. For even if the end
is the same for a single man and for a state, that of the state seems at all events something greater and
more complete whether to attain or preserve; though it is worthwhile to attain the end for merely one man,
it is finer and more godlike to attain it for a nation or for city-states. See Aristotle (1998, Nicomachean
ethics, 1094b6-12).

For example, they explain, We are by nature members of communities. Our moral goodness or
character consists to a large extent (though not solely) in contributing to the communities of which we are
members. We ought to act for our genuine good or flourishing (we take that as a basic ethical principle),
but our flourishing involves being in communion with others. And communion with others of itselfeven
if we find ourselves united with others because of a physical or social relationship which precedes our
consententails duties or responsibilities. Moreover, the contribution we are morally required to make to
others will likely bring each of us some discomfort and pain. This is not to say that we should simply
ignore our own good, for the sake of others. Rather, since what (and who) I am is in part constituted by
various relationships with others, not all of which are initiated by my will, my genuine good includes the
contributions I make to the relationships in which I participate. Thus, the life we constitute by our free
choices should be in large part a life of mutual reciprocity with others (Lee and George 2005,
pp. 2223).

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However, political discourse and determinations can also, for whatever reason, not
recognize these rights and thus hinder or act against the good of individual persons.
Abortion
Abortion represents a fundamental threat to L&Gs theory because it strikes at the
fundamental value the theory is built upon: the intrinsic value of the human person
based on being the particular kind of thing it is, a bodysoul composite. Thus for
L&G the abortion question concerns itself at the theoretical level with the
ontological status of the fetus. To the question of abortion, their response begins by
asking: is it a person? In their argument, once the personal nature of the fetus is
recognized, it is then possible to ascertain how one can and should treat it.
Accordingly, this view denies the absolute validity of the so-called is/ought
fallacy. Most importantly, L&G do recognize their fundamental value represented
in the issue of abortion: being human means having a personal essence from
conception onward and due to this particular kind of essence ought not to be
intentionally killed. Intentionally killing the fetus means denying its intrinsic value
as a human person, and so too the value of human persons as such. Respecting the
life of the fetus by not killing it means affirming its intrinsic value as a human
person, and so too the value of human persons as such. Therefore, in abortion L&G
find their fundamental value, personhood, potentially either wholly denied or
affirmed.
When L&Gs theory engages the question of abortion at the level of the
individual human being it engages the ontology of concrete human individuality,
most specifically the individuality of the fetus. That is, at the individual level, the
abortion question focuses on a particular beingthe fetus at handand asks, can
this fetus be intentionally destroyed? Indeed, for the question of abortion to apply
in any specific, practical circumstance, the individuality of the fetus must be
determined for it to be identified as a fetus by L&G; complete hydatidiform moles, a
form of gestational trophoblastic disease involving a mass of abnormal placental
cells in the uterus are not fetuses and therefore can be treated differently. Since
L&G argue the fetus individuality is present (biologically and personally) and
morally significant from conception onward, they respond to the abortion question
at the individual level asking, is this living being a fetus, or rather, is this thing a
person? If it is, then it possesses full moral worth; if it is not then it does not. Here
again, the fundamental value of L&Gs moral vision is at stake in abortion: the
moral worth that flows from the personhood of this individual fetus is potentially
either wholly denied or affirmed.
At the political level, L&Gs theory would generally ask, Does abortion help
the polis pursue its telos? This question immediately refers back to the conditions
for individual flourishing and aborting an individual fetus. If abortion is not morally
good for individuals it cannot aid in helping them pursue their communal telos.
Hence, for L&G, the question of abortion is not merely or even immediately a legal
or political matter in which the state must decide whether the action should be
protected or outlawed. Rather the L&G view first asks, primarily, whether it is the
kind of thing that is perfective of the polis and should be allowed or encouraged to

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help the population flourish. Abortion is considered a legal matter only derivatively
from questions concerning its moral status. Therefore, the nature of the act of
abortion informs the L&G political view of what helps contribute to a communal
pursuit of the good life.
In this view, the political argument against abortion goes: if persons are things that
ought not be killed, because allowing them to be killed would not contribute to the
full-flourishing of the polis, but rather things that should be protected by the polis, then
abortion should not be allowed, socially or politically. At the level of the individual,
particular instances of abortions were at issue. Here, in the political level, abortion is
considered in general, as a thing that happens within the polis; though, also within the
private realm of oikos, the home. Here too the integrity of L&Gs fundamental value is
at stake: the nature of the thing that grounds the polis and contributes to its full
flourishing is either affirmed or denied by political determinations. That is, for the
L&G, if a fetus has a personal essence, but its mother can legally abort it, then that
particular polis does not consider a personal essence as the ground for inclusion in the
protected community or sufficient to contribute to aid in the pursuit of the communal
telos. Hence, the fundamental value of the L&G view is capable of being denied in full
in the political sanctioning of abortion.

Beauchamp and Childress

B&C dismiss debates over personhood as unhelpful (Beauchamp and Childress 2009,
pp. 6971). Instead, they argue for a continuum of moral status among human beings
(Beauchamp and Childress 2009, p. 84). Within this continuum autonomy is the
distinctive moral characteristic of being human. That is, being an autonomous agent
expresses the value of what it means to be human. To affirm and protect this value they
articulate the ethical principle of Respect for Autonomy as a way to ensure the
integrity of the individual autonomous agent. As they state, To respect autonomous
agents is to acknowledge their right to hold views, to make choices, and to take actions
based on their personal values and beliefs (Beauchamp and Childress 2009, p. 103).
This principle is invoked to safeguard the good of an individual through respecting
their right to make autonomous choices, as Childress explains, This principle
provides the justificatory basis for the right to make autonomous decisions. This right
in turn takes the form of specific autonomy-related (if not autonomy-based) rights
such as liberty and privacy (Childress 1990, p. 13). What does it mean for an
individual to be autonomous in B&Cs vision? They explain, The autonomous
individual acts freely in accordance with a self-chosen plana person of diminished
autonomyis in some respect controlled by others or incapable of deliberating or
acting on the basis of his or her desires and plans (Beauchamp and Childress 2009,
p. 99). Though some argue that this principle trumps the other threeBeneficence,
Justice, and NonmaleficenceB&C hold that autonomy is limited, and so too should
Respect for Autonomy (Gillon 2003, pp. 312313; Beauchamp and Childress 2009,
p. 99).
The limitations on Respect for Autonomy correspond to the obligations that it
imposes. In their vision, Respect for Autonomy involves both a negative obligation,

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which they derive from Immanuel Kant, and a positive obligation, which they derive
from John Stuart Mill. Regarding the former, they hold along with Kant that
respecting the autonomy of an agent entails treating them as an end and never as a
means for ones own purposes. With Mill as their guide, they articulate the positive
obligation as an obligation to enhance an individuals capability for autonomous
choice. Thus, at minimum, Respect for Autonomy means both not coercing an
individual and positively enabling his or her autonomous decision-making. To do so
is to respect the individual agent in his or her individuality, i.e. his or her
autonomous will, which serves as the ground for his or her individual rights for selfdetermination.5
Individuals should afford other individuals the ability to exercise their
fundamental rights for self-determination. Not to do so would mean violating the
other individuals fundamental rights. However, just as there are restrictions on the
legitimate exercise of autonomy, there are limitations to the scope of whom Respect
for Autonomy applies. They explain,
Obligations to respect autonomy do not extend to persons who cannot act in a
sufficiently autonomous manner (and who cannot be rendered autonomous)
because they are immature, incapacitated, ignorant, coerced, or exploited.
Infants, irrationally suicidal individuals, and drug-dependent patients are
examples. (Beauchamp and Childress 2009, p. 105)
Thus, individuality is an important element of being human in B&Cs perspective
because individuals are the bearers of autonomy rights, and, as such, beings capable
of self-determination. Therefore, individuals have a duty to respect, both positively
and negatively, another individuals autonomy rights. However, if the individual
does not possess autonomy there can be no autonomy that calls for respect or that
possesses rights.
At the political level, autonomy rights are very important to B&Cs vision of
liberal individualism (Beauchamp and Childress 2009, pp. 350356). According to
B&C,
Rights are justified claims that individuals and groups can make on other
individuals or on society; to have a right is to be in a position to determine, by
ones choices, what others should or should not do. All rights exist or fail to
exist because of a normative structure that either allows or disallows the claim
in question. (Beauchamp and Childress 2009, p. 351)
Under their vision, man lives the good life through his right to self-determination. In
contrast to L&G, B&C see rights as dependent upon political determinations; rights
depend upon a particular normative structure that determines whether the claim is
legitimate or not. The purpose of the state, therefore, is to secure the blessings of
5

Beauchamp and Childress make it quite clear, the fundamental requirement [of the health
professional] is to respect a particular persons autonomous choices, whatever they may be. Respect
for autonomy is not a mere ideal in health care; it is a professional obligation. Autonomous choice is a
rightnot a dutyof patients (Beauchamp and Childress 2009, p. 107). Also, while B&C hold
consequential decisions must be substantially autonomous, they also recognize that, being fully
autonomous is a mythical idea (Beauchamp and Childress 2009, p. 102).

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liberty for the individual citizen, i.e., to enable the individuals pursuit of the good
life through self-determination by supporting and defending his or her rights against
violation. The function of the state is to create the political conditions for the
possibility of citizens self-determinatively exercising their autonomy rights within a
community setting and punishing those who illegitimately violate the rights of
others. Thus, as they see it, maintaining and increasing the political conditions for
the exercise of autonomy rights at the political level is a primary concern.
Abortion
Since B&C do not ascribe full moral status to the fetus, abortion raises a different
set of questions than those engaged by L&G. Among the most fundamental are
questions concerning the maintenance of an agents ability for self-determination,
both in the present and into the future. Hence, to the theoretical question, can a
fetus be intentionally destroyed, B&Cs very general response would be, Does it
hinder ones capability for self-determination? Based upon their theory of moral
status, such a response seems to indicate that their answer to the abortion question is
neither a firm yes nor a firm no; it depends upon the degree to which a fetus can
make legitimate rights claims upon the mother. In this way, the B&C view addresses
the status of the fetus in order to understand whether it is a subject that possesses the
same rights to life and liberty that all men possess as self-determining agents. To the
degree it has such rights the fetus rights can limit the mothers ability for selfdetermination. However, if the fetus has no such rights then it is possible for the
mothers right for self-determination to override claims that the fetus could make on
the mother. Thus, in abortion at the theoretical level the B&C perspective finds its
fundamental valuethe value of the self-determining agent whose autonomy is due
respectoperative and determinative in the mothers ability to choose selfdeterminatively. Yet, here it also faces some fundamental questions. What are the
limits on the ability to be self-determining in regard to things that do not share the
protection of the principle of Respect for Autonomy? Can something that does not
have equivalent rights for self-determination (fetus) make a legitimate claim upon
someone who does (mother) such that it would limit the agents capability for
determining themselves? These questions strike at the very heart of what it means
for a person to have a right for self-determination, especially if a right to selfdetermination minimally includes the right to bodily self-determination.
On this point, Judith Jarvis Thompson, representing the B&C perspective, seems
to answer these questions. She acknowledges fetal biologic individuality but denies
it the moral weight to trump the mothers right to autonomous choice since it does
not have the right to use her body (Thompson 2006, pp. 4050). Using her Famous
Violinist analogy, Thompson argues the mothers right to bodily self-determination
can trump the claim that any individual fetus might have upon her. Thompson does
not argue that abortion is always permissible or that it is should be forbidden.
Rather, she argues that the possibility to choose abortion should be available for
people if they are in need. She is careful to note that her considerations only apply to
later term pregnancies because, A very early abortion is surely not the killing of a
person (Thompson 2006, p. 49). Regardless, she argues that a mothers right to

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an abortion does not entail that the mother has a right to secure the death of the
fetus. Rather, the mother has the right to end the pregnancy for her own sake, even
though the death of the fetus may result from its ending. Hence, Thompson argues
against denying the mother the possibility of choosing abortion, since, as she notes,
the mother has a right to bodily self-determination. In the same way B&C might
claim that if one does not have the capability for bodily self-determination, even
bodily self-determination that results in the death of a human fetus, one does not
truly have the capability for self-determination at all. Here again, the fundamental
value of the B&C view, which is expressed as the individuals right to bodily selfdetermination, is either wholly affirmed or denied. If a woman does not have a right
to bodily self-determination that trumps the claims of the fetus, which has no such
rights, then the core value of a right to self-determination has been denied: that
which has no such right has limited the most fundamental right of the mother. By
respecting the right of the individual mother to make the self-determining choice,
the value of a right to self-determination is affirmed as a value in itself.
At the political level B&C approach the question of abortion from the same
general perspective as the individual level, in essence, asking, Does it hinder
citizens rights for self-determination? Their position holds that the morality of the
act of abortion is a separate and somewhat unconnected question from whether it
should be legal, as they explain, the connections between moral norms and
judgments about policy or law are complicated and that a judgment about the
morality of acts does not entail a corresponding judgment about law and policy
(Beauchamp and Childress 2009, p. 10). Further, from B&Cs view the abortion
question also raises questions about the states role in safeguarding the citizenrys
rights for self-determination. For instance, if the fetus does have rights for selfdetermination, then the mothers self-determination is correspondingly limited to
not violate them. However, if the fetus does not carry the protection that rights to
self-determination afford, then it is within the scope of the state to enable the mother
to choose for herself whether or not she will abort. Again, from this perspective, the
state is not speaking to the morality of the abortion but rather enhancing the liberty
of the mother to make a personal, self-determining choice. If, however, the mother
did not have this freedom for self-determination, then it could possibly be
considered an unjust limitation by the state on the mothers right to bodily (or many
other forms of) self-determination. This would seemingly contradict the purpose and
function of the state; that is, unless the state had a compelling reason for such
encroachment upon the womans rights. Given the character of the self-determination represented in abortionbodily and sexual self-determinationthe bar for a
sufficiently compelling state interest is set very high. Hence, even at the political
level, the fundamental value of B&Cs vision is either affirmed or denied. If the
state does not allow for and enable this most basic right of bodily self-determination
then the state fails in its purpose and function: that which does not have rights has
limited the most basic rights of the citizenry. However, if the state serves its
purpose, as B&C see it, then the individuals right to bodily self-determination, the
most basic form of rights to self-determination, will not only be guarded from those
who would deny this right but it will also actively promote, enable and expand the
scope of this right in every manner and instance possible.

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Conscientious Objection
As we have seen, the abortion debate is one of value: the value of abortion is what
truly remains controversial in America. For L&G and B&C, the value at stake in
this debate can be understood as fundamental, the core element of their respective
views. Since each view recognizes the possibilities that abortion poses to their
fundamental valueeither affirmation or denialabortion provides the space in
which their fundamental values can come into conflict. The conscientious objection
debate therefore is a natural arena for this conflict. The conscientious objection
debate, which Charo and Cantor describe at the socio-political level, centers on a
question that can be roughly articulated as, How do we handle conflicts that arise
because people hold divergent moral perspectives, e.g., L&G and B&C?
Therefore, the conscientious objection debate it is not merely a debate about value;
it is also a debate about process and the values informing that process. Different
moral perspectives will approach this question in their own particular way. Hence,
just as there are conflicts of conscience between two moral views on an issue like
abortion, there are conflicts of conscience regarding how to best handle conflicts
of conscience. Furthermore, viewed from a socio-political level, it is possible that
the conscientious objection debate is more practically ineradicable than the abortion
debate: conscientious objection is neither limited to abortion nor logically
dependent upon it alone. Rather, it is logically dependent upon the possibility
that persons divergent moral views cause practical conflicts; abortion provides just
one example of such possibilities.
Theoretical Structure
Since the conscientious objection debate is logically dependent upon the possibility
of conflicts arising between persons because they hold divergent moral views that
conflict with one another, it seems to follow that, as long as people hold radically
divergent moral views, conflicts of conscience will remain logically possible.
Therefore, the debate about what to do when conflict does arise will also continue. In
general, there seems to be two options for handling these situations: (1) eliminate the
source of the conflict so that no conflict can arise or (2) allow conflicts to arise but
seek an effective way of managing them towards a relatively acceptable outcome for
those that are impacted. Furthermore, there seems to be two ways of achieving option
(1): (A) forcibly enacting a single moral view as the sole grounds for legitimate
discourse or (B) peaceably, that is, without violence or the threat of violence, convert
those in conflict to the same moral perspective. Now, since conflicts of conscience
can arise wherever two people hold divergent moral beliefs regarding a particular
issue, these general options for handling conscience conflicts, (1) and (2), seem to
present themselves on a case-by-base, issue-by-issue basis. Thus, it seems the reasons
for selecting one option over the other may vary depending upon the issue at hand
otherwise there would be no debate about how to handle such situations.6
6

It could also be the case that there is ultimately only a single answer, but, due to epistemic limitations,
people have not been able to know which is the very best way to handle conflict situations. However, as it

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How then are we to decide? When presented options such as these, (1) and (2),
the thinking of H. Tristram Engelhardt Jr. suggests why a libertarian option, in this
case (2), would be a fall-back position for any given conflict: The libertarian
position is the fall-back position when one cannot clearly establish an end-state
theory of justice and/or the [moral] authority to impose it by force (Engelhardt Jr.
1991, p. 105).7 For Engelhardt, this is because,
Moral authority in secular health care policy is derived from permission and
even in circumstances of complex collaborative undertakings is at its roots
consensual or contractual. Moral controversies in biomedicine are public
policy disputes to be resolved peaceably by agreeing to procedures for
creating moral rules based on the principle that force cannot be used against
the innocent without their consent. (Engelhardt Jr. 1999, p. 73)
While explaining the fall-back libertarian position, Engelhardt uses the concept
end-state theory of justice to demonstrate, in the context of a socio-political
discourse regarding a right to health care, an example of a fundamental value of
divergent moral views. If Engelhardts analysis regarding the libertarian position is
correct, this would suggest that, to the degree (1) cannot be satisfied, then (2) is the
appropriate response.8 Indeed, if the libertarian option manifests itself as
conscience clauses for medical professionals, then Engelhardts insight seems to
be accurate to some degree. Now, if we take each moral perspective, the L&G and
B&C, to have a fundamental value, then these respective fundamental values can be
understood to occupy the space that Engelhardt gives to an end-state theory of
justice. Reformulated for the current analysis, Engelhardts statement would read:
when deciding how to handle conscience conflicts, the libertarian position is the
fall-back position when one cannot clearly establish a view of the most meaningful
element of being human and/or the moral authority to impose it by force.
However, this formulation still seems to beg the question of what it means to
clearly establish a vision of the fundamental value of a particular theory. Both L&G
and B&C do affirm a clearfor them at leastview of the most meaningful
element of being human, a fundamental value. They need not automatically choose
(2), that is, if they can convince their opponent of the legitimacy of their position.
This is not to say they have a moral perspective that possesses a perfect and allencompassing insight into the most meaningful element of being human, but rather
that what they find most meaningful is, to them, clearly relevant in the issue at hand.
Footnote 6 continued
plays out in the American biomedical sphere, differing judgments are made to articulate differing ways of
handling conflicts of conscience: some advocate not squelching the possibility on the front end by not
having those with self-identified potential conscience conflicts allowed entrance to the profession, while
others argue for limited, respectful toleration of conscience.
7

Engelhardt presents these options based on the following argument: Insofar as there is skepticism
regarding the ability to discover the morally canonical character of such allocation and/or the ability to
derive moral warrants to impose such [health care] allocutions by force, one must derive authority for
common actions from negotiation and consent (Engelhardt Jr. 1991, p. 104).

That is, at least in a culture that derives moral authority from the consent of those involved, which he
takes the United Sates to be.

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However, the convincing nature of this clarity does not necessarily transfer from
one set of authors to the other, even through extensive argumentation. Moreover,
since they each hold different fundamental values, what counts as evidence and
clearly establishing a position is precisely what hinders these authors from reaching
an agreement. Since they cannot agree to what counts as evidence upon which to
establish a commonly accepted conclusion they are, as Engelhardt argues, left with
the option of agreeing to a resolution based on mutual consent, that is, if they are not
willing to resort to (1), force to impose their particular moral view.
Indeed, it may be the case that they perhaps do not fulfill the moral authority
requirement for imposing their view in the particular conflict situation because such
moral authority rests on the consent of the other in the conflict. Therefore, being
unable to persuade their opponent to be convinced and convert to their position, and,
in the interest of preserving the fundamental value of their own moral view as much
as possible by forestalling their opponents from forcibly advancing their respective
view, they might opt for (2). If this is the case, then it seems that (2) can be chosen
in order preserve the fundamental value of a particular moral viewpoint, though it
might not be the most desirable option to choose; it can be chosen for both offensive
and defensive purposes. By choosing a compromise resolution one might guard
against the possibility of having the fundamental value of ones own moral
viewpoint more fully violated by the other imposing their viewpoint without
receiving consent.
In essence, this is all just a way of saying people have fundamental beliefs and
are less likely to resolve a conflict about those beliefs through compromise the more
an issue threatens those core beliefs. Yet, can there be an issue in which the
fundamental value of a moral view is so threatened that ultimately no compromise
can be reached because doing so would amount to compromising the whole of ones
moral view? If so, can there be more than one such issue? If there were such an
issue, then any socio-political attempt to settle the matter practically by enacting
a law or policy, by either option (1A) or (2), would do nothing to actually settle
the matter at any level since acquiescence was never rendered. The issue would
remain controversial even at the socio-political level as long as people held the
endangered moral viewpoint. Given that it most clearly represents their respective
fundamental value, I hold that abortion is the quintessential example of this type of
issue for both the L&G and B&C viewpoints.
Practical Dynamics
The conscientious objection debate unfolds at the practical level cast in terms of
personal/private conscience against professional ethics/professionalism.9 A clear
example of this dichotomy can be found in the American College of Obstetrics and
Gynecologys (ACOG) definition and description of the characteristics conscience. Here the definition of conscience is shaped in juxtaposition to the so9

For instance, both Charo and Cantor argue for the limitation of conscience exceptions by arguing for a
stronger and more robust sense of medical professionalism which includes, as they see it, putting the
needs and requests of patients for treatments and services to which they are legally entitled ahead of the
personal beliefs of the medical professional.

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called professional ethics. Citing Childress, they define conscience as, The
private, constant, ethically attuned part of the human character. It operates as an
internal sanction that comes into play through critical reflection about a certain
action or inaction. Here, the significance of conscience arises from its impact on
a persons moral integrity. Yet, this internal sanction, also may conflict with
professional and ethical standards and result in inefficiency, adverse outcomes,
violation of patients rights and erosion of trust. However, they assert, Claims of
conscience are not always genuine. What are disingenuous claims of conscience?
ACOG explains, Positions that are merely self-protective do not constitute the
basis for genuine claims of conscience.10 That is, positions that are merely selfprotective violate the obligations of the principle of Respect for Autonomy to not
hinder but enable the autonomous agency of others.
While ACOG offers one view of genuine conscience claims, most debaters that
are theoretically willing to allow conscientious objection agree that, for conscientious objection to be significant, it must be genuine.11 So, the question for the wider
debate becomes: What is genuine objection? Generally, objection is said to be
genuine if the person actually believes that the particular action is morally bad and
performing said action would be morally wrong. The question for the specific case
then becomes, What does the person actually believe? Here the persons beliefs
on abortion serve as a sort of ground for the conscience debate as it is relevant to
abortion: it is the belief regarding abortion that provides the weight to any claim of
conscience in the individual case and ultimately at the socio-political level.12 If
one believes abortion is permissible, but objects, this is considered a non-genuine or
merely self-protective objection. In contrast, if one regards abortion as
impermissible and objects, then the genuineness qualifications are satisfied; and
so too are many commentators.
However, authors like Julian Savulescu and Cantor might argue that genuineness
qualifications merely distract from the real issue, which is the non-performance/
distribution of a legal medical treatment to a person legally entitled to such
treatment, which they claim is a violation of the principle of beneficence (Savulescu
2006, p. 295; 2007, p. 22; Cantor 2009, p. 1485).13 One might interpret their
10
All quotes in this paragraph taken from American College of Obstetricians and Gynecologists (2007,
p. 2).
11
Most debaters willing to accept the possibility of justified conscientious objection qualify their support
by claiming it only applies to genuine claims. However, similarly to concept of conscience, there
appears to be no content-thick, commonly understood meaning of the term genuine claim. For instance,
for ACOG genuine claims would be those that are not merely self-protective, grounding their definition in
their vision of the principle of beneficence.
12
This connection is not limited to abortion but rather includes all cases in which conflicts of
conscience arise. Thus, the individuals belief about issue X is the subject of the socio-political debate
about conscientious objection.
13

It may seem that in the realm of public policy formulation the conscientious objection issue holds a
primary place for B&C. After all, it deals directly with the ability for self-determination in the public
sphere. Indeed, one might argue that the entire debate concerns itself with balancing the capability for
self-determination of the physician against the capability for self-determination of the patient. It is under
these terms that the principle of beneficence is invoked, usually guiding the physician to limit his or her
own capacity for self-determination to those determinations which empower the patient to become more
fully capable of self-determination. Objection verification processes, like the military model, are then

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position as meaning that, practically speaking, the actual belief of the professional,
for or against abortion, does not matter; only the fact that the belief matters at all
matters for the likes of Savulescu and Cantor. Instead, they advocate for the
position, that, when practicing medicine, the professionals conscience is
coterminous with the law: ones duty is to dispense whatever treatments are legal,
to which the patient is entitled.14 Nonetheless, this is not a majority position. Most
commentators are willing to accept that the individuals actual particular moral
beliefs are a key determinant for conscientiously objecting. However, because of
differing fundamental values, what counts as a genuine claim is judged using
differing accounts of evidence.
Lee and George
In L&Gs view, the conscientious objection debate at the theoretical level seems to
admit a commonly agreed upon ontological premise, namely, that whatever it means
to be human involves possessing a conscience and that the debate hinges upon the
kind of thing that conscience is. For L&G the first step towards deciding how to
handle conscience conflicts is understanding what conscience is: defining it,
describing how it is part of the personal essence of a human being, its purpose, how
it operates, and if and how it can be disordered or mistaken. Once its nature has been
sufficiently understood, L&G can then respond to the initiating question concerning
how to deal with conflicting consciences.
Daniel Sulmasy, O.F.M., demonstrates the method in a recent article. Describing
conscience as a conjunction of will and judgment, Sulmasy distinguishes its two
faces: the thing itself and its acts. The former is a disposition of the will towards
the truth. It is, thus rooted in a fundamental commitment to morality. (Sulmasy
2008, p. 138). Acts of conscience are judgments, that what one has done or is
contemplating doing are in violation of this fundamental commitment to be moral
(Sulmasy 2008, p. 138). In this formulation the individuals conscience is shaped
both in origin and in application by the truth of the morality of the situation.15
Sulmasys understanding of conscience also acknowledges that an individual can
be morally culpable for participating in the wrongdoing of another and employs a
set of principles of cooperation in order to determine the level of an individuals
complicity. This last element of conscience plays a key role in shaping the L&G
approach to the conscientious objection debate.
Footnote 13 continued
viewed as tools for determining the proper balance between the self-determination of the physician and
the self-determination of the patient on a case-by-case basis. Thus, if the conscience claim is not
genuine, the patients capability for self-determination has been curtailed unjustifiably. This type of
curtailing of the capability for self-determination amounts to a mortal sin from the B&C perspective.
14
This would seem to be an extreme version of the B&C position as it would argue that, for whatever
reason, the self-determination of the patient is being limited and that this should only happen to the degree
it is justifiable. That is, in his or her very non-performance, the objecting medical professional is violating
the principle of beneficence as it is expressed by the standards of the medical profession, which is, serving
the patients interest over the professionals.
15
This moral vision assumes that there is an objective truth of the matter, though knowing this truth can
often be difficult and incomplete.

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Understanding the nature of what he takes to be conscience, Sulmasy admits

that it is possible for this conscience to be mistaken, erroneously formed, and
capable of being corrected. However, despite its fallibility, he recommends
toleration of conscience as the appropriate way to handle conflicts of conscience.
Still, he acknowledges that, toleration must have, as for any virtue, an Aristotelian
mean (Sulmasy 2008, p. 145).16 Hence, he admits tolerance has boundaries but
recommends, as a general rule, one should exhaust every other alternative before
compelling any practice that is based upon deeply held, self-identifying moral
beliefs (Sulmasy 2008, p. 145). So, for Sulmasy and L&G, understanding how to
resolve conflicts of conscience is fundamentally a question of understanding what
conscience is and then understanding how to deal with it based on that answer. For
instance, L&Gs theory would hold that conscience is something that can be misformed and can be corrected through counseling and guidance in light of the truth of
the morality of the action. Therefore, conscience does not serve as a moral trump
card used to manipulate a given situation for ones own purposes.
Sulmasys presentation highlights some aspects of the individual conscience
that are significant for the L&G approach to the conscientious objection debate.
First, individuals should act according to their conscience because it is their
fundamental commitment to the truth and morality. Second, individuals are required
by their commitment to the truth to form their conscience properly, i.e., in accord
with the truth. Third, the individual should tolerate the conscience of another out
of ones own commitment to the truth. Finally, individuals should use prudential
judgments of their conscience in order to avoid participating in the wrongdoing of
another because they will be morally culpable to the degree that they participate.
Informed by this vision of the conscience the L&G view engages the sociopolitical debate over the capability of the medical professional to conscientiously
object.
Hence, for L&G, discussion of conscience at the political level is grounded
upon a particular understanding of what conscience is in order to understand how
it should be treated and how conflicts that arise from it should be handled in a way
that contributes to the integral fulfillment of the members of the polis. Since, as they
understand it, it is part of the personal, ontological constitution of the members of
the polis, the L&G view tends to recognize communal aspects of conscience,
admitting that it can be incorrectly formed and is open to external criticism if it is to
aid in the pursuit of both the individual and communal telos. However, recognizing
the fallibility of individual conscience does not necessarily entail that the state is
justified in compelling a person to act against it. Similarly this does not give the
individual license to behave in anyway whatsoever, as long as they consider it
acting conscientiously. Rather, from the L&G perspective, the community is able
to make judgments upon the content of a persons conscience, i.e., Sulmasys acts
of conscience, as to whether it will contribute to the individuals and communitys
full-flourishing. In response, the individual can then reform his or her acts of

16
Here he places toleration between the extremes of repressive and licentious societal
circumstances.

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conscience in a way that is more conducive to their own flourishing and that of the
community.
What makes abortion a unique issue among possible issues that engender
conflicts of conscience for the L&G view, both at the individual and political
levels? Put simply, abortion represents the fundamental repudiation of the L&G
viewpoint on all levels. Since L&G define the most meaningful element of being
human ontologicallyas being a personal beingabortion represents a direct and
unmitigated threat to that very definition and the entire moral perspective that it
founds. If the L&G thesis is correct and a human being is a human person that is
intrinsically valuable as a possessor of rights based on his or her substantial nature
from the moment that the personal organism exists, then the very value that comes
with being such a being is denied in full to the fetus when it is aborted. Thus, this
action, which denies the fundamental value of the L&G perspective, threatens the
entire framework of thought in which being itself is always meaningful.
Though still profound, even suicide does not represent as fundamental a threat to
this vision. The social element of being human is not negated in the way that it is in
abortion; one human being is not killing another human being and thereby
separating him or her from participating in the community. Suicide that is physician
assisted does not reach the fundamental threat level posed by abortion, though it too
is close, because ostensibly the patient uses his or her personal and social nature to
actually bring about his or her death. That is, it is understood as one person helping
another make a choice for him or herself; but suicide is still suicide. Albeit, actions
such as suicide would be contrary to the nature of a personal essence in this
perspective. However, this contrariness is different from the total negation of the
significance of personal essence found in abortion. Finally, it is also differentiated
from killing in self-defense. The aggressor represents a threat to the full flourishing
of the individual person as well as, potentially, the common good of the community
of persons. He thereby sets himself against the full flourishing of the individual and,
possibly, the community. The just defense of the good of the attacked individual is
thus morally permitted even if it means causing the death of the aggressor. Hence,
abortion stands alone.
Because it represents such a fundamental threat to that which the L&G view
holds most dear, abortion will always occupy a central area of concern for the L&G
viewpoint in socio-political discourse of the conscientious objection debate.
Moreover, it shapes their approach to the conscientious objection debate in two
ways. First, since they see it as irrefutably true that abortion is gravely morally
wrong and since conscience is something that allows persons to be morally
culpable for their participation in that morally wrong act, L&Gs approach attempts
to create as great a distance as possible between the wrongdoing and the person
seeking to avoid cooperating in the wrong act. Second, given their understanding of
what abortion, conscience, and the purpose of the state are, the L&G view
attempts to establish the cultural environment that respects the value of human
persons. While not immediately political, this focus includes establishing laws that
respect the (pre-political) rights of persons to conscientiously object to cooperating
in actions for which they can and would be morally culpable. In this way, the L&G

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moral viewpoint seeks to protect its fundamental value from unconsented violation
by opposing moral viewpoints like that of B&C.
Beauchamp and Childress
At the theoretical level the B&C view of conscience is something much more
privatized than is the L&G view. As they explain, Conscienceis not a special
moral faculty or self-justifying moral authority. It is a form of self-reflection on, and
judgment about, whether ones acts are obligatory or prohibited, right or wrong,
good or bad. It is an internal sanction that comes into play through critical
reflection (Beauchamp and Childress 2009, p. 10). This vision of conscience
emphasizes determining the self as, and towards being, a morally integrated being:
it should be guided by self-reflection but not mere self-justification. This
interpretation of conscience as primarily self-reflective and sanctioning understands that conscience is significant because it helps an agent maintain their moral
integrity as an autonomous agent. Moral integrity in this view means that the self is
indeed self-determined and not unduly externally influenced. Acting contrary to
ones conscience would then mean not being self-determined but rather externally
determined. To do so would violate the integrity of the autonomous self.
Echoing this definition, the ACOG definition of conscience emphasizes its
individual (see: privatized) nature. That is, for them conscience pertains solely to
moral reflections of self-determinative actions of the individual and stands in
contrast to the professional code of ethics. The moral reflections are concerned with
the moral integrity of the individual as they attempt to live out their life plan
through their own determinations. The more the individual is illegitimately and
externally constrained in determining his or her life, the less integrated the
individual is as a moral agent. Thus, he or she treated less as an end and more as a
means, a clear violation of his or her moral autonomy. However, in contrast to
Sulmasys view, ACOG claims that, the logic of conscience, as a form of selfreflection on and judgment about ones own acts are obligatory or prohibited, means
that it would be absurd to say I would have a guilty conscience if she did x
(American College of Obstetricians and Gynecologists 2007, p. 2). Regarding
concerns of complicity they respond, The logic of conscience entails that to act
according to conscience, the provider need not rebuke other providers or obstruct
them from performing the act (American College of Obstetricians and Gynecologists 2007, p. 2). That is, individual conscience cannot be an impediment to the
self-determination of others. Whereas Sulmasys view acknowledges that individuals can be morally culpable, as distinct from legally culpable, for participating in
the wrongdoing others, the ACOG interpretation seems to deny that possibility.
Instead, for ACOG and B&C, an individuals moral integrity depends upon the
degree to which he or she lives out his or her own life according to his or her own
choosing.
Nonetheless, conscience, as a privatized moral sensitivity and sanction for selfdetermination, is an important thing for the state to protect at the political level for
B&C. However, this is true only as far as a person following the dictates of his or
her conscience does not infringe on the rights to self-determination of another.

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Therefore, the state has the power and compelling interest to intervene in a conflict
situation in which one individual infringes upon anothers rights for selfdetermination, even if the one invokes his or her conscience to do so. At the
political level, the B&C view does not care about whether a conscience is well
formed or erroneous, especially as far as the state is concerned. Instead, all that
matters to the state is this: one individual is unjustifiably impinging upon the liberty
of another.
How then is abortion unique among all the other issues that might engender
conflicts of conscience for the B&C position? Some might argue that physicianassisted suicide (or suicide in general) best expresses an individuals ability for selfdetermination. In suicide, the argument would claim one is able to determine
oneself in a final and ultimate way: annihilation. Therefore, this act of selfdetermination epitomizes self-determination, since the self determines its own
existence: to be or not to be. To the contrary, I posit that abortion maintains, in a
significant way, the finality and ultimacy of suicide (enacting it upon the fetus which
is not yet capable of self-determination though it is biologically alive) while at the
same time maintaining the agents capability for self-determination into the future.
Whereas in suicide, self-determination ends the selfs capability of future selfdetermination, abortion does the opposite and preserves the selfs (mothers)
capability for future self-determination.
How is abortion different from any other form of killing another human being in
B&Cs view? First, in their view, self-determination is constrained by the legitimate
self-determination of the other; violating these constraints is ground for legal
punishment. Hence, murder is not a legitimate form of self-determination and is
punishable by law. Second, in the case of killing in self-defense (that is, killing
someone who forfeits the protection of the law by breaking the limits of legitimate
self-determination because they seek to violate the others rights) the standards by
which one deciphers legitimate self-determination apply to the situation: either the
agent did violate the rights of the other or they did not. For example, legal action can
be taken to decipher whether an act of killing was in self-defense or murder. One
could argue that in the case of self-defense the aggressors rights have not been
violated because he or she has forfeited the right to have his or her rights protected.
However, after being forfeited, it seems this right to their protection could also
return. Consider, for instance, if a manhaving thought better of ithalts his
attempted armed robbery of a young woman and flees, only to have that same young
woman hunt him down years later and kill him. Here it would seem at least plausible
that the mans rights for self-determination have indeed been violated, where once,
when he was the aggressor, they would perhaps not have been if the woman killed
him in self-defense. Hence, it makes sense that legal measures are taken to decipher
whether an action was murder or killing in self-defense. However, in abortion,
insofar as it is legalized, the conditions for the possibility of applying the standards
for determining legitimate self-determination are not present: it already has been
legitimized. Therefore, the continued life of the fetus, insofar as it is dependent upon
the mother, is entirely within the power of the decision of the mother for selfdetermination.

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Given that abortion represents the fundamental value for B&Cs view, it shapes
their approach to the conscientious objection debate in at least four ways. First, if
abortion is the paradigm of the right to self-determination, then any issue that
touches upon abortion, e.g., emergency contraception, is particularly threatening for
the B&C view. Thus adherents of this view, like Charo, will see efforts to provide a
legal way for medical professionals who hold views like L&G to distance
themselves from the wrong of abortion and what it represents as efforts of cultural
conquest against the value of self-determination (Charo 2005, p. 2473). Second,
since conscience is more of a privatized means for maintaining moral integration
in the B&C view, and that a person cannot have a guilty conscience for
participating in the wrongdoing of another, then the bar for justifiable cases of
conscientious objection is set at the level at which the objection will hamper the
patients right for self-determination, especially the right to bodily self-determination. Third, since the purpose of the state is to safeguard and promote the citizens
right for self-determination, they will argue that the state has the duty to establish
that the physicians right to conscientiously object only extends to the point where
it, as they see it, violates the patients right to self-determination. Finally, they will
argue, as Charo does, that since the state is responsible for granting medical
professionals a monopoly on the practice of medicine they are immediately
responsible for fulfilling the purposes for which the state granted them this
monopoly, which is, in the B&C vision, the fostering of a citizens right for
autonomous self-determination. Therefore, insofar as the law embodies this vision
of fundamental value, proponents of this viewpoint are just as guilty of the charges
of cultural conquest that Charo levels at proponents of L&Gs viewpoint.
However, since those who hold views like L&G have not, and cannot, consent to the
moral validity of such laws or any laws that threaten their vision of fundamental
moral value, they will seek to protect their fundamental value by choosing more
libertarian positions such as conscience clauses. If the tables were turned and the
L&G view dominated the public understanding of the medical profession, adherents
of the B&C view would take a similar approach in order to ensure that their vision
of fundamental value was protected.

Conclusion
Despite the gravity that abortion brings to the wider debate, the conscientious
objection debate will not evaporate if abortion somehow becomes uncontroversial.
However, there is a reason that, understood from the L&G and B&C perspectives,
abortion rests at the heart of conscientious objection debate: it is the battleground
between each perspectives vision of what is most meaningful about being human.
For L&G, the intrinsic inviolability of the organism defined by its personal essence
is potentially either denied in full, since it is allowed to be killed, or affirmed if it is
protected. For B&Cs view self-determination reaches its highest expression in
abortion: an individual is permitted to choose to kill without violating the rights of
another in order to exercise and maintain his or her capability for self-determination.
Hence, as B&Cs theory sees it, the fullest sense of self-determination is potentially

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denied or affirmed in full with regards to abortion. What I have shown here is that it
is not merely those who wish to to rehearse arguments on the value of biologic but
nonsentient human existence that are, as Charo claims, engaged in cultural
conquest (Charo 2005, pp. 24722473). In the conscientious objection debate, each
perspective is attempting to defend itself and its vision of fundamental value.
Therefore, just as Charo derides the conquest by the pro-life cultural forces, those
holding the opposing view see it as defense against the conquest of the pro-choice
cultural forces. In this back and forth, abortion is the central issue for each
perspective because it most clearly represents their respective fundamental value.
The conscientious objection debate, because it depends on the possibility of two
people holding conflicting moral viewpoints, will always center on those issues that
express most clearly the fundamental values of the conflicting parties. Therefore,
abortion will always remain the central issue in the conscientious objection debate.
Acknowledgment I would like to thank Griffin Trotter, MD, PhD, without whom this article would not
be possible, and my reviewers for their helpful criticism of earlier drafts.

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