Book excerpt: In Conscience in Reproductive Health Care, Carolyn McLeod responds to a growing worldwide trend of health care professionals conscientiously refusing to provide abortions and similar reproductive health services in countries where these services are legal and professionally accepted. She argues that conscientious objectors in health care should have to prioritize the interests of patients in receiving care over their own interest in acting on their conscience. McLeod defends this 'prioritizing approach' to conscientious objection over the more popular 'compromise approach' in bioethics--without downplaying the importance of health care professionals having a conscience or the moral complexity of their conscientious refusals. She begins with a description of what is at stake for the main parties to the conflicts generated by conscientious refusals in reproductive health care: the objector and the patient. Her central argument for the prioritizing approach is that health care professionals who are charged with gatekeeping access to services such as abortions are fiduciaries for their patients and for the public they are licensed to serve. As such, they have a duty of loyalty to these beneficiaries and must give primacy to their interests in gaining access to care. McLeod provides insights into ethical issues extending beyond the question of conscientious refusal, including the value of conscience and the fundamental moral nature of the relationships health care professionals have with current and prospective patients.