here (see the commentary by Curlin [2007] for a gesture in this direction), the counterintuitive nature of the suggestion that one must act against that which one knows to be right indicates that we should not dismiss conscience as a uniquely religious concept sheltered from the scrutiny of reason. Conscience need not be confined to the status of moral refuge. All moral decisions are decisions of conscience insofar as the conscience determines all moral acts, whether religious or non-religious in origin.

Finally, future challenges to conscience in the clinical context will call into question the decisions of healthcare professionals who refuse to participate in an activity that they deem to be both morally problematic and outside of the proper ends of medicine. It is obvious that we ought not to tolerate a physician who refuses to treat a patient on account of gender or ethnicity. Such a decision is blatantly contrary to the ends of medicine. The difficulties lie in those cases in which there is disagreement about the ends of medicine and the obligations they impose on its practitioners. It may very well be the case that in focusing our attention on particular acts of conscientious objection, we will fail to attend to the