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Medical professionals have a duty to prioritize patient needs and well-being, even when doing so is deemed distasteful or unpleasant. This does not mean, however, that such professionals are obliged to provide medical interventions when participation threatens their core moral integrity. Myriad state and federal "conscience clause" statutes and regulations have codified such protections, but in a way that makes it too easy to claim exemption. This essay argues that, given professional obligations and systemic power asymmetries, the burden of proof falls upon professionals to show that participation in the requested service represents a genuine threat to their integrity, as opposed to being merely offensive or economically disadvantageous. It concludes with a suggested mechanism for determining whether the exemption request is justified.