Answers to the questions of what justifies conscientious objection in medicine in general and which specific objections should be respected have proven to be elusive. In this paper, I develop a new framework for conscientious objection in medicine that is based on the idea that conscience can express true moral claims. I draw on one of the historical roots, found in Adam Smith’s impartial spectator account, of the idea that an agent’s conscience can determine the correct moral norms, even if (...) the agent’s society has endorsed different norms. In particular, I argue that when a medical professional is reasoning from the standpoint of an impartial spectator, his or her claims of conscience are true, or at least approximate moral truth to the greatest degree possible for creatures like us, and should thus be respected. In addition to providing a justification for conscientious objection in medicine by appealing to the potential truth of the objection, the account advances the debate regarding the integrity and toleration justifications for conscientious objection, since the standard of the impartial spectator specifies the boundaries of legitimate appeals to moral integrity and toleration. The impartial spectator also provides a standpoint of shared deliberation and public reasons, from which a conscientious objector can make their case in terms that other people who adopt this standpoint can and should accept, thus offering a standard fitting to liberal democracies. (shrink)

This article considers the difficult question of whether there are any reasons for theocratic religious devotees to affirm liberalism and liberal institutions. Swaine argues not only that there are reasons for theocrats to affirm liberalism, but that theocrats are committed rationally to three normative principles of liberty of conscience, as well. Swaine subsequently discusses three institutional and strategic implications of his arguments. First, he outlines an option of semisovereignty for theocratic communities in liberal democracies, and explains why an appropriate valuation (...) of liberty of conscience may justify a standard of that kind. Second, he addresses the question of permissible government aid for religion and symbolic endorsement of religious groups. Third, Swaine considers innovations and new approaches that could be employed internationally to better display liberal government's affirmation of religiosity, to promote liberty of conscience, and to help improve relations between liberal and theocratic parties around the globe. (shrink)