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Hardcover | Out of Print | 368 pp. | 6 x 9 in | None | September 2008 | ISBN: 9780262123051
Paperback | $4.75 Short | £4.95 | 368 pp. | 6 x 9 in | None | August 2010 | ISBN: 9780262515054
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Conflicts of Conscience in Health Care

An Institutional Compromise


Physicians in the United States who refuse to perform a variety of legally permissible medical services because of their own moral objections are often protected by “conscience clauses.” These laws, on the books in nearly every state since the legalization of abortion by Roe v. Wade, shield physicians and other health professionals from such potential consequences of refusal as liability and dismissal. While some praise conscience clauses as protecting important freedoms, opponents, concerned with patient access to care, argue that professional refusals should be tolerated only when they are based on valid medical grounds. In Conflicts of Conscience in Health Care, Holly Fernandez Lynch finds a way around the polarizing rhetoric associated with this issue by proposing a compromise that protects both a patient’s access to care and a physician’s ability to refuse. This focus on compromise is crucial, as new uses of medical technology expand the controversy beyond abortion and contraception to reach an increasing number of doctors and patients. Lynch argues that doctor-patient matching on the basis of personal moral values would eliminate, or at least minimize, many conflicts of conscience, and suggests that state licensing boards facilitate this goal. Licensing boards would be responsible for balancing the interests of doctors and patients by ensuring a sufficient number of willing physicians such that no physician’s refusal leaves a patient entirely without access to desired medical services. This proposed solution, Lynch argues, accommodates patients’ freedoms while leaving important room in the profession for individuals who find some of the capabilities of medical technology to be ethically objectionable.

About the Author

Holly Fernandez Lynch is Executive Director at the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School and a member of the faculty at Harvard Medical School’s Center for Bioethics.


“Brilliant...This book is interdisciplinary bioethics as its finest.”—Choice
“Lynch's pragmatic approach is also innovative and refreshing in a policy arena that is often fraught with an overabundance of criticism with little substance on reform.”—Dhrubajyoti Bhattacharya, The Journal of Legal Medicine


“This is a book for which many concerned either to protect conscientious objection to medical procedures or to ensure patients' access to lawful, non-discriminatory health services have been waiting. Respectful of the interests both of religiously-motivated health service providers and of patients requiring (particularly reproductive) health services, Holly Fernandez Lynch proposes practical means to reconcile the rights of both with minimal compromise. A timely and powerful book.”
Bernard Dickens, Professor Emeritus of Health Law and Policy, University of Toronto
“Lynch’s new book reveals that conscientious refusals in medicine extendfar beyond the archetypal case of abortion. From the hospital bedside,to the home hospice, to the fertility clinic, to the stem cell researchlaboratory, moral objections to the provision of medical services plagueneedy patients and conflicted physicians alike. Lynch brings aninformed legal, moral, and practical approach to the negotiating table,offering a values-based pairing system aimed at widening the comfortzone for all stakeholders. Matchmaking in medicine? It may just be thecure for a vexing systemic ailment.”
Judith F. Daar, Professor of Law, Whittier Law School, and Clinical Professor of Medicine, University of California Irvine College of Medicine
“This book is an original and significant contribution to the highly contentious issue of conscientious objection in medicine. The author proposes and systematically defends a licensing model solution to conflicts of conscience. Readers who disagree with Lynch’s conclusions will nevertheless benefit from her comprehensive and incisive analyses and arguments. The book is a must read for anyone with an interest in the subject.”
Mark R. Wicclair, Department of Philosophy, West Virginia University, and Center for Bioethics and Health Law, University of Pittsburg


Choice Outstanding Academic Title, 2009.