Lack of clarity about the proper limits of conscientious refusal to participate in particular healthcare practices has given rise to fears that, in the absence of clear parameters, conscience-based exemptions may become increasingly widespread, leading to intolerable burdens on health professionals, patients, and institutions. Here, we identify three factors which clarify the proper scope of conscience-based exemptions: the liminal zone of 'proper medical treatment' as their territorial extent; some criteria for genuine conscientiousness; and the fact that the exercise of a valid conscience-based exemption carries certain duties with it. These restricting factors should reassure those who worry that recognising rights of conscience at all inevitably risks rampant subjectivity and self-interest on the part of professionals. At the same time, they delineate a robust conscience zone: where a claim of conscience relates to treatment with liminal status and satisfies the criteria for conscientious character, as well as the conditions for conscientious performance, it deserves muscular legal protection.

No abstract

Drawing on earlier work on the conceptual structure of dignity, this paper will suggest a

, and I am grateful to David A Jones, Toni Saad, and others who were present at that event for helpful discussion of the main themes. I would also like to thank my frequent co-author and collaborator Sara Fovargue of Lancaster University for our frequent (and often vigorous) conversations about conscience, including discussion of the themes explored in this chapter.

The idea of ‘human dignity’ is, notoriously, as ambiguous as it is compelling. Notwithstanding the absence of any clear or settled definition of human dignity, either in the abstract or in terms of what it means in practice, it is an idea which takes pride of place in international legal documents, in judicial reasoning, and in scholarship across a range of disciplines, where it seems, particularly in recent years, to have become the focus for an explosion of academic interest and an accompanying proliferation of literature. Much of the existing literature attempts to uncover the meaning, or multiple meanings, of ‘human dignity’, focusing on the uncertainty surrounding the substance or content of the idea and trying to compose a catalogue of use-types. In this paper, my primary aim will be to address another type of uncertainty, namely uncertainty about the role, function or status within legal frameworks of the ‘dignity norm’ – the norm requiring respect for human dignity. I want to explore several possibilities: first, that the dignity norm is simply a proxy for respect for autonomy; second, that it is a right in the sense that we can speak of a specific ‘right to have dignity respected’; and third, that it is a legal principle. Having problematised each of these in turn, I will contend that the function of the dignity norm is best captured by describing it as the ‘substantive basic norm’ of the legal systems wherein it appears.