Conscientious Objection In Healthcare Research Articles

Assessing Public Reason Approaches to Conscientious Objection in Healthcare.

Sometimes healthcare professionals conscientiously refuse to treat patients despite the patient requesting legal, medically indicated treatments within the professionals' remit. Recently, there has been a proliferation of views using the concept of public reason to specify which conscientious refusals of treatment should be accommodated. Four such views are critically assessed, namely, those of Robert Card, Massimo Reichlin, David Scott, and Doug McConnell. This paper argues that McConnell's view has advantages over the other approaches because it combines the requirement that healthcare professionals publicly justify the grounds of their conscientious refusals of treatment with the requirement that those grounds align with minimally decent healthcare. This relatively restrictive approach accommodates conscientious refusals from minimally decent healthcare professionals while still protecting good healthcare, the independence of the healthcare professions, and the fiduciary relationships.

Three Arguments Against Institutional Conscientious Objection, and Why They Are (Metaphysically) Unconvincing.

The past decade has seen a burgeoning of scholarly interest in conscientious objection in healthcare. While the literature to date has focused primarily on individual healthcare practitioners who object to participation in morally controversial procedures, in this article we consider a different albeit related issue, namely, whether publicly funded healthcare institutions should be required to provide morally controversial services such as abortions, emergency contraception, voluntary sterilizations, and voluntary euthanasia. Substantive debates about institutional responsibility have remained largely at the level of first-order ethical debate over medical practices which institutions have refused to offer; in this article, we argue that more fundamental questions about the metaphysics of institutions provide a neglected avenue for understanding the basis of institutional conscientious objection. To do so, we articulate a metaphysical model of institutional conscience, and consider three well-known arguments for undermining institutional conscientious objection in light of this model. We show how our metaphysical analysis of institutions creates difficulties for justifying sanctions on institutions that conscientiously object. Thus, we argue, questions about the metaphysics of institutions are deserving of serious attention from both critics and defenders of institutional conscientious objection.

Conscientious Objection in Healthcare: The Requirement of Justification, the Moral Threshold, and Military Refusals

ABSTRACTA dogma accepted in many ethical, religious, and legal frameworks is that the reasons behind conscientious objection (CO) in healthcare cannot be evaluated or judged by any institution because conscience is individual and autonomous. This paper shows that this background view is mistaken: the requirement to reveal and explain the reasons for conscientious objection in healthcare is ethically justified and legally desirable. Referring to real healthcare cases and legal regulations, this paper argues that these reasons should be evaluated either ex ante or ex post and defends novel conceptual claims that have not been analyzed in the debates on CO. First, a moral threshold requirement: CO is only justified if the reasons behind a refusal are of a moral nature and meet a certain threshold of moral importance. Second, this paper considers the rarely discussed conceptual similarities between CO in healthcare and the legal regulations concerning military refusals that place the burden of proof on conscientious objectors. This paper concludes that conscientious objection in healthcare can be accommodated only in some cases of destroying or killing human organisms.

Xavier Symons, Why Conscience Matters: A Defence of Conscientious Objection in Healthcare

Xavier Symons, <i>Why Conscience Matters: A Defence of Conscientious Objection in Healthcare</i>

Conscientious objection – A vignette-based, pilot study of international pharmacists’ perspectives

Background: Conscientious objection (CO) in healthcare has always been a controversial topic. Some healthcare professionals perceive CO as a freedom of conscience, others believe their duty-of-care overrides personal perspectives. There is a paucity of literature pertaining to pharmacists’ perspectives on CO. This study aimed to inform the development of a proposed questionnaire exploring pharmacists’ decision-making in complex scenarios around CO and reasons for their choices. Methods: This was a cross-sectional, mixed methods pilot study of international pharmacists, using an online, vignette-based questionnaire on scenarios related to medical termination, emergency contraception, IVF surrogacy for a same-sex couple and voluntary assisted dying (VAD). Results: Sixty-two FIP 2019 conference delegate pharmacists participated in this pilot study. Approximately half them believed pharmacists have the right to CO. Most pharmacists agreed to supply the prescriptions across all four vignettes. Regarding continuity of care, majority of pharmacists agreed (97%) it was necessary for equity of access. Strong self-reported religiosity had a statistically significant relationship with pharmacists’ decisions not to supply for medical termination, IVF surrogacy and VAD. Conclusion: This pilot study revealed insights into the various perspectives of international pharmacists on CO in healthcare and informed the development of a survey for future administration.

Conscientious objection to caring for transgender people: An ethical right or a discriminatory attitude?

In modern society, health professionals are often asked to use their technical skills to serve purposes other than treating illnesses. In such cases, some clinicians may express ethical reluctance to fulfill their patients' preferences. Conscientious objection in health care is the refusal by providers to perform a legally valid and scientifically approved clinical intervention because of moral concerns. Although health services and staff are obliged to respect gender identity and prohibit discrimination, some clinicians may exempt themselves from caring for transgender people, citing ethical reasons. The decision of health professionals to object to medical activities related to transgender care may collide with the interests of trans people and further marginalizes the already underprivileged gender-diverse population. This discussion paper analyses the concept of 'conscientious objection' and its application in health care settings in relation to transgender-related care. In general, the right of health professionals to abstain from contested duties on moral grounds must be protected. However, claims to conscience cannot be accepted within centers specialized in gender transitioning and for services unrelated to gender affirmation such as routine and urgent care. Personal responsibility and discretion on the part of clinicians is the most appropriate way to compromise between protecting the moral integrity of health professionals and shielding trans persons' access to care. Guidance is proffered on how to resolve the apparent impasse emerging from the denial of various types of health services to transgender people.

The ethical conundrum of conscientious objection in healthcare.

The ethical conundrum of conscientious objection in healthcare.

Current challenges faced by transgender and gender-diverse patients and providers in anesthesiology.

Current challenges faced by transgender and gender-diverse patients and providers in anesthesiology.

Some desiderata for a taxonomy of conscientious objection in health care: A reply to Gamble and Saad

In a recent issue of this journal, Gamble and Saad offer a taxonomy of conscientious objection in health care with the aim of increasing the common ground in the debate over conscientious objection to prevent parties from talking past each other and help facilitate greater progress on this issue. Although we agree that this is an important and worthwhile project, Gamble and Saad's proposal suffers from several serious weaknesses that limit its ability to do the work set out for it. In this paper, we identify some of the major problems with this particular attempt in order to highlight some desiderata for a taxonomy of conscientious objection in health care that can serve as a guide for developing improved taxonomies of this kind in the future.

Conscientious Objection Based on Patient Identity

Conscientious Objection Based on Patient Identity

Liberty to Request Exemption as Right to Conscientious Objection

There is a regulatory option for conscientious objection in health care that has yet to be systematically examined by ethicists and policymakers: granting a liberty to request exemption from prescribed work tasks without a companion guarantee that the request is accommodated. For the right-holder, the liberty’s value lies in the ability to seek exemption without duty-violation and a tangible prospect of reassignment. Arguing that such a liberty is too unreliable to qualify as a right to conscientious objection leads to the problem of consistently distinguishing its effects from those of a right to conscientious objection that is made conditional on an individual assessment of the objector’s motivation. These properties require that we distinguish the liberty to request exemption from more restrictive policy choices, and that we subject it to greater scrutiny in the wider moral discourse as a possible variant of a right to conscientious objection.

Between Orders and Relationships: Autonomy and Conscientious Objection in Health Care

Abstract Health professionals may refuse to provide health care because they consider it against their moral or religious beliefs by resorting to conscientious objection (CO). The right to abortion in the 1970s disrupted health professional practice, as well as the racing principle of patient autonomy, turning OC into a last resort for professionals to maintain hegemony over their practice. This article focuses on the link between the autonomy in doctor-patient relationship and the appearance of conscience-based refusals in health care, arguing that one of the problems is in the liberal notion of autonomy that interprets it as independence, where “others” are regarded as unwanted interferences, whether they are health professionals, loved ones, or an ethics committee. The perspective of relational autonomy is introduced, explaining the contributions that this alternative understanding might bring into CO in health care.

Conscientious Objection in Health Care: Why the Professional Duty Argument is Unconvincing.

The past decade has seen a burgeoning of scholarly interest in conscientious objection in health care. Specifically, several commentators have discussed the implications that conscientious objection has for the delivery of timely, efficient, and nondiscriminatory medical care. In this paper, I discuss the main argument put forward by the most prominent critics of conscientious objection-what I call the Professional Duty Argument or PDA. According to proponents of PDA, doctors should place patients' well-being and rights at the center of their professional practice. Doctors should be prepared to set their personal moral or religious beliefs aside where these beliefs conflict with what is legal and considered good medical practice by relevant professional associations. Conscientious objection, on this account, should be heavily restricted, if even allowed at all. I discuss two powerful objections against PDA. The first objection, which I call the fallibility objection, notes that law and professional codes of conduct are fallible guides for ethical conduct and that conscientious objection has in the past and continues today to provide a check on aberrations in law and professional convention. The second, which I call the professional discretion objection, states that restrictions on conscientious objection undermine one of the cornerstones of good medical practice, namely, a practitioner's right to independent professional judgment. I argue that these two objections give us reason to retain conscience clauses in professional codes of conduct.

The Reasonableness Standard for Conscientious Objection in Healthcare.

In complex, pluralistic societies, different views concerning the moral duties of healthcare professionals inevitably exist: according to some accounts, doctors can and should cooperate in performing abortion or physician-assisted suicide, while according to others they should always defend human life and protect their patients' health. It is argued that the very plurality of responses presently given to questions such as these provides a liberal argument in favour of conscientious objection (CO), as an attempt to deal with moral diversity by protecting both the professionals' claim to moral integrity and the patients' claim to receive lawful and safe medical treatments. A moderate view on CO is defended, according to which none of these claims can be credited with unconditional value. Claims to CO by healthcare professionals can be justified but must be subjected to a reasonableness standard. Both the incompatibility of CO with the medical profession and its unconditional sanctioning by conscience absolutism are therefore rejected. The paper contributes to the definition of the conditions of such reasonableness, particularly by stressing the role played by conceptions of good medicine in discriminating claims to CO; it is argued that respecting these conditions prevents from having the negative consequences dreaded by critics. The objection according to which accepting the physician's duty to inform and refer is inconsistent with the professed value of moral integrity is also discussed.

Conscientious Objection in Australia: A Comparison Between Abortion and Voluntary Assisted Dying

Abortion and voluntary assisted dying (VAD) are areas of health care that elicit passionate and emotional responses. As a result of the diverse perspectives relating to these forms of medical care, Australian law allows for conscientious objection in both contexts. This article considers the role of conscientious objection in health care in Australia, with a particular focus on abortion and VAD. In begins by considering the legal position, highlighting some of the key differences in the way that conscientious objection is regulated in these two contexts and between Australian jurisdictions. It observes that jurisdictions which have legalised both abortion and VAD have not necessarily adopted the same approach to the question of conscientious objection as it pertains to abortion versus VAD. The article then turns to consider the reality of conscientious objection "on the ground" across these two domains in an effort to understand this distinction.

Voluntarily chosen roles and conscientious objection in health care

The longstanding dominant view is that health care practitioners should be permitted to refrain from participating in medical interventions when they have a conscientious objection to doing so in a...

A taxonomy of conscientious objection in healthcare

Conscientious Objection (CO) has become a highly contested topic in the bioethics literature and public policy. However, when CO is discussed, it is almost universally referred to as a single entity. Reality reveals a more nuanced picture. Healthcare professionals may object to a given action on numerous grounds. They may oppose an action because of its ends, its means, or because of factors that lay outside of both ends and means. Our paper develops a taxonomy of CO, which makes it possible to describe the refusals of healthcare professional with greater finesse. The application of this development will potentially allow for greater subtlety in public policy and academic discussions – some species of CO could be permitted while others could be prohibited.

Conscientious Objection, Conflicts of Interests, and Choosing the Right Analogies. A Reply to Pruski.

In this response paper, we respond to the criticisms that Michal Pruski raised against our article "Beyond Money: Conscientious Objection in Medicine as a Conflict of Interests." We defend our original position against conscientious objection in healthcare by suggesting that the analogies Pruski uses to criticize our paper miss the relevant point and that some of the analogies he uses and the implications he draws are misplaced.

Analysis and Evolution of European Case Law on Conscientious Objections in Healthcare: Grimmark v. Sweden and Steen v. Sweden

Abstract Conscientious objection is a fundamental right recognized in various national and international texts and is generally linked to the religious beliefs of the people who invoke it. In this article, an analysis is made of the content of this fundamental right at the level of comparative and European human right law, as well as a study of how it has evolved over the years in the judgments issued by the European Court of Human Rights. An analysis of the decisions in Grimmark v. Sweden and Steen v. Sweden particularly, allow us to establish a change of trend in the European jurisprudence that shifts from more Europeanist positions to other more national ones, based on the notion of the margin of appreciation.

Conscientious Objection in Health Care: Pinning down the Reasonability View.

Robert Card’s “Reasonability View” is a significant contribution to the debate over the place of conscientious objection in health care. In his view, conscientious objections can only be accommodated if the grounds for the objection meet a reasonability standard. I identify inconsistencies in Card’s description of the reasonability standard and argue that each version he specifies is unsatisfactory. The criteria for reasonability that Card sets out most frequently have no clear underpinning principle and are too permissive of immoral objections. Card has also claimed that petitioners must justify their positions with Rawlsian public reason. I argue that, although the resulting reasonability standard is principled, it is overly restrictive. I also show that a reasonability standard built on Rawls’ more lenient conception of reasonableness would be overly permissive of objections at odds with professional healthcare standards. Finally, I argue for my favored solution, which bases the reasonability standard on minimal professional standards.