Conscientious Objection Research Articles

Data discrepancies: Italian ministry reports on abortion, contextualised

The Italian Ministry of Health reports annually on activities related to abortion and fertility, providing quantitative data that looks ripe for analysis. Actors ranging from activists to medical providers to...

Rural healthcare professionals’ participation in Medical Assistance in Dying (MAiD): beyond a binary decision

BackgroundMedical Assistance in Dying (MAiD) was legalized in Canada in 2016 and amended in 2021. At the time that this study was conducted, the federal government was considering expanding the eligibility criteria to include patients whose death was not reasonably foreseeable. The purpose of this study was to better understand rural healthcare professionals’ experiences with assisted dying set against the backdrop of legislative expansion.MethodsA qualitative exploratory study was undertaken with general rural practice physicians, nurse practitioners, registered nurses, ethicists, patients, and patient families in rural Southern Alberta, Canada. For this paper, data from 18 audio-recorded and transcribed semi-structured interviews with healthcare professionals were analyzed using thematic analysis. Categories and patterns of shared meaning that linked to an overarching theme were identified.ResultsBetween the binary positions of full support for and conscientious objection to assisted dying, rural healthcare professionals’ decisions to participate in MAiD was based on their moral convictions, various contextual factors, and their participation thresholds. Factors including patient suffering; personal and professional values and beliefs; relationships with colleagues, patients and family, and community; and changing MAiD policy and legislation created nuances that informed their decision-making.ConclusionsThe interplay of multiple factors and their degree of influence on healthcare professionals’ decision-making create multiple decision points between full support for and participation in MAiD processes and complete opposition and/or abstention. Moreover, our findings suggest evolving policy and legislation have the potential to increase rural healthcare professionals’ uncertainty and level of discomfort in providing services. We propose that the binary language typically used in the MAiD discourse be reframed to reflect that decision-making processes and actions are often fluid and situational.

Guidelines for conscientious objection in Spain: a proposal involving prerequisites and protocolized procedure

Healthcare professionals often face ethical conflicts and challenges related to decision-making that have necessitated consideration of the use of conscientious objection (CO). No current guidelines exist within Spain’s healthcare system regarding acceptable rationales for CO, the appropriate application of CO, or practical means to support healthcare professionals who wish to become conscientious objectors. As such, a procedural framework is needed that not only assures the appropriate use of CO by healthcare professionals but also demonstrates its ethical validity, legislative compliance through protection of moral freedoms and patients’ rights to receive health care. Our proposal consists of prerequisites of eligibility for CO (individual reference, specific clinical context, ethical justification, assurance of non-discrimination, professional consistency, attitude of mutual respect, assurance of patient rights and safety) and a procedural process (notification and preparation, documentation and confidentiality, evaluation of prerequisites, non-abandonment, transparency, allowance for unforeseen objection, compensatory responsibilities, access to guidance and/or consultative advice, and organizational guarantee of professional substitution). We illustrate the real-world utility of the proposed framework through a case discussion in which our guidelines are applied.

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.

Conscientious objection - a cross-sectional, vignette-based, mixed methods exploration of Australian pharmacists' perspectives.

Background: Conscientious objection (CO) in healthcare is a controversial topic. Some perceive CO as freedom of conscience, others believe their professional duty-of-care overrides personal-perspectives. There is a paucity of literature pertaining to pharmacists' perspectives on CO. Aim: To explore Australian pharmacists' decision-making in complex scenarios around CO and reasons for their choices. Method: A cross-sectional, qualitative questionnaire of pharmacists' perspectives on CO. Vignette-based questions were about scenarios related to medical termination, emergency contraception, IVF surrogacy for a same-sex couple and Voluntary Assisted Dying (VAD) Results: Approximately half of participants (n = 223) believed pharmacists have the right to CO and most agreed to supply prescriptions across all vignettes. However, those who chose not to supply (n = 20.9%), believed it justifiable, even at the risk of patients failing to access treatment. Strong self-reported religiosity had a statistically significant relationship with decisions not to supply for 3 of 4 vignettes. Three emergent themes included: ethical considerations, the role of the pharmacist and training and guidance. Conclusion: This exploratory study revealed perspectives of Australian pharmacists about a lack of guidance around CO in pharmacy. Findings highlighted the need for future research to investigate and develop further training and professional frameworks articulating steps to guide pharmacists around CO.

Conscientious objection to enforcing living wills: A conflict between beneficence and autonomy and a solution from Indian philosophy

Living wills document how patients wish to be treated in the event of becoming incompetent to make their medical decisions. Living wills are legally enforceable in India, nonetheless, doctors can claim conscientious objection to implementing any aspect of such directives; however, the buck stops with the hospital to ensure that the patient’s wishes are carried out. In enforcing advance care directives, beneficence and autonomy usually come into conflict. In a paternalistic model of medicine, beneficence and nonmaleficence take precedence over autonomy, and there is a danger that the patient’s wishes are ignored. Even if a physician is not trained to give equal importance to autonomy, beneficence, and nonmaleficence, they can rationalize the enforcement of an advance care directive under the principle of nonmaleficence rather than under autonomy. The ethical principles of ahimsa—the principle of not being the cause of physical or mental injury of others—and raja dharma—the principle where a person in a position of power puts the wishes of the person whom they have power over ahead of their own wishes—which are derived from Hindu, Buddhist, and Jain philosophical traditions, can help physicians who practice Indic faiths resolve their moral dilemma when faced with a possibility of enforcing a patient’s wishes that are not in line with their personal views. Such moralizing is especially important during public health emergencies when a patient may not be able to transfer to the care of another doctor who does not have an objection to enforcing their living will.

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.

The establishment of conscientious monopolies in rural communities.

In the United States, healthcare providers have the federally protected right to conscientiously refuse to provide treatments or services that they feel violate their moral or religious values. This refusal of services is colloquially known as "conscientious objection," which has become a polarizing topic in today's medical and ethical landscape. Typically, physicians exercising their right to conscientious objection do not represent a barrier in access to care for most patient populations. This dynamic shifts, however, in rural America, where there are relatively few providers. In this commentary, we discuss some of the unique ramifications that are likely to occur when rural providers invoke conscientious objection in their medical practice and how this can in turn establish conscientious monopolies for the members of their communities.

The Reasonable Content of Conscience in Public Bioethics.

Bioethicists aim to provide moral guidance in policy, research, and clinical contexts using methods of moral analysis (e.g., principlism, casuistry, and narrative ethics) that aim to satisfy the constraints of public reason. Among other objections, some critics have argued that public reason lacks the moral content needed to resolve bioethical controversies because discursive reason simply cannot justify any substantive moral claims in a pluralistic society. In this paper, the authors defend public reason from this criticism by showing that it contains sufficient content to address one of the perennial controversies in bioethics-the permissibility and limits of clinician conscientious objection. They develop a "reasonability view" grounded in public reason and apply it to some recent examples of conscientious objection.

Implementación de la Guía la Interrupción Voluntaria del Embarazo

The Diploma in Gender Equity of the Hospital Interzonal General de Agudos Prof. Dr. Ramón Carrillo seeks to approach health from a feminist and transfeminist perspective, especially in relation to National Law No. 25929, which guarantees the right to the Voluntary Interruption of Pregnancy (VTP). The hospital management faced challenges such as the conscientious objection of some obstetrics professionals. To overcome these obstacles, several actions were proposed, including training professionals in gender equity, expanding care services and improving communication with the community. An interdisciplinary Nurse Liaison team was established to facilitate access to abortion care and a registry system was implemented to monitor outcomes. These measures are expected to reduce barriers to access to sexual and reproductive health, empowering women and pregnant women to make informed decisions about their health. This intersectoral approach and specialized training in gender equity aims to close access gaps and improve the quality of care

A Common Good-Based Justification for Non-Compliance with the Political Obligation of Homeland Defence

Non-compliance with compulsory military service as a form of homeland defence (i.e. conscription) is typically justified by various types of conscientious objections. However, in this article, I offer an alternative type of justification that is based on the common good. To achieve this, I present the concept of the common good and its relationship to the political obligation of homeland defence from the perspective of different traditions of political thought. Subsequently, I outline two types of exceptions to this political obligation: the liberal type of exceptions and the membership-based ones.

Mapping Dissent: Conscientious Objectors in Northern England during the First World War

The men who refused to fight for King and Country in the First World War have now been identified and placed in their home communities by a Register of British Conscientious Objectors. Doing that has exposed the geography of that dissent and has helped map popular attitudes to the war more closely than hitherto. With an explanatory text are tables of Conscientious Objectors (COs) in the eight counties of Northern England—Cumberland, Durham, Lancashire, Northumberland, Westmorland and the Yorkshire Ridings. Each table sets out the numbers of COs listed in the Register arranged by local government areas and calculates a CO Index to indicate the proportion of COs among those eligible to serve. Interpreting and comparing that data helps create new insights into the hugely diverse wartime politics of the Northern Counties.

Imagining national security through the body’s organisation: conscientious objectors in South Korea

ABSTRACT This article studies how reimagining the body’s organisation can also lead to reimagining national security in the context of conscientious objectors to military conscription in South Korea. Despite decades of persecution, they have ceaselessly opposed the almost sacred belief that the military is vital for securing lives. I discuss national security through the body’s organisation because both focus on which interests are vital or redundant. To expose a dominant mode of imagining security and provide an alternative, I read and juxtapose the state’s and the objectors’ texts while considering competing imageries of the organic organisation and the Body without Organs. The juxtaposition shows that while the South Korean state advances the state-centric and militaristic imagery of national security that moulds the individual into the subject of the state, conscientious objectors propose less state-centric and more dynamic national security that preserves human potential to become something else.

Understanding the extent of and limitations to conscientious objection to abortion by health care practitioners: A hermeneutic study.

The United Kingdom's Abortion Act 1967 has attracted substantial controversy, which has centred not only on the regulation of abortion itself, but also on the extent to which conscientious objection should be permitted. The aim of this study was to examine a range of healthcare professionals' views on conscientious objection and identify the appropriate parameters of conscientious objection to abortion. Gadamer's hermeneutic was utilised to frame this study. We conducted semi-structured interviews in two UK locations with 18 pharmacists, 17 midwives, 12 nurses and nine doctors, encompassing a mix of conscientious objectors and non-objectors to abortion. A multi-faceted in-depth data analysis led to the development of a hermeneutic of "respecting self and others". Four major themes of "doing the job", "entrusting to others", "acknowledging institutional power" and "being selective" and 18 subthemes contributed to this overarching theme. The complexity of the responses indicates that there is little consistency within and between each profession. They show that participants who were conscientious objectors were accepted by their colleagues and accommodated without detriment to the service, and that in larger hospitals, such as those where our work was carried out, it is possible to be employed in the service areas that include abortion while still being a conscientious objector. Finally, our results indicate that, by respecting of self and others, each profession should be able to accommodate conscience-based objections where individual practitioners seek to exercise them. Conscientious objectors as well as non-objectors have something to contribute to the ongoing development of the maternity and gynaecological services as abortion is only a small part of the work of these services.

Chapitre 4. Subventions discriminatoires de soins medicaux à l’épreuve du principe éthique de la justice : cas d’un service d’orl au burkina faso

A legal exception to the principle of equal health rights, discriminatory subsidies often pose an ethical dilemma in the field of application. To analyze discriminatory subsidies for healthcare in the light of the ethical principle of justice and to propose alternatives to any inherent legal and ethical conflicts. This was a qualitative, descriptive and analytical study based on semi-structured interviews with caregivers. Participants felt that the application of discriminatory subsidies has a negative impact on substantial distributive justice. The infringements of the award conditions were exclusively for the benefit of the patients concerned. Their impact was considered positive on distributive justice and negative on formal justice. Discriminatory care subsidies generally stem from a legal requirement whose application should not be ambiguous. It is apparent that the infringements of the conditions for attribution were in favour of substantial distributive justice. This opposition is a potential source of decision-making difficulties for caregivers who often choose to violate conditions for the benefit of their indigent patients. There are therefore violations of ethically understandable standards, which must be admitted. This could be done through the provision of exceptions for the application of standards for ”noble causes” and conscientious objection clauses in health policy texts. The legitimacy of health policy norms is essential for their effective application, hence the interest of taking distributive justice into account in the genesis of formal norms.

Conscientious objection and barriers to abortion within a specific regional context - an expert interview study.

While most countries that allow abortion on women's request also grant physicians a right to conscientious objection (CO), this has proven to constitute a potential barrier to abortion access. Conscientious objection is regarded as an understudied phenomenon the effects of which have not yet been examined in Germany. Based on expert interviews, this study aims to exemplarily reconstruct the processes of abortion in a mid-sized city in Germany, and to identify potential effects of conscientious objection. Five semi-structured interviews with experts from all instances involved have been conducted in April 2020. The experts gave an insight into the medical care structures with regard to abortion procedures, the application and manifestations of conscientious objection in medical practice, and its impact on the care of pregnant women. A content analysis of the transcribed interviews was performed. Both the procedural processes and the effects of conscientious objection are reported to differ significantly between early abortions performed before the 12th week of pregnancy and late abortions performed at the second and third trimester. Conscientious objection shows structural consequences as it is experienced to further reduce the number of possible providers, especially for early abortions. On the individual level of the doctor-patient relationship, the experts confirmed the neutrality and patient-orientation of the vast majority of doctors. Still, it is especially late abortions that seem to be vulnerable to barriers imposed by conscientious objection in individual medical encounters. Our findings indicate that conscientious objection possibly imposes barriers to both early and late abortion provision and especially in the last procedural steps, which from an ethical point of view is especially problematic. To oblige hospitals to partake in abortion provision in Germany has the potential to prevent negative impacts of conscientious objection on women's rights on an individual as well as on a structural level.

Conscientious objection to canine pregnancy termination among veterinary surgeons.

Conscientious objection to canine pregnancy termination among veterinary surgeons.

Barriers and facilitators for engaging in the practice of medical assistance in dying among providers in Canada: a scoping review protocol.

This review will explore the perceived barriers and facilitators for engaging in the practice of medical assistance in dying (MAiD) from the perspective of physicians, nurse practitioners, and medical residents in Canada. The number of MAiD requests in Canada is growing steadily and is predicted to continue to grow with the passing of Bill C-7 in 2021, which expands access to individuals whose deaths are not reasonably foreseeable. Under federal law, physicians and nurse practitioners are the only health care professionals permitted to assess for and administer MAiD. Providers are not obligated to engage in the practice of MAiD; therefore, patient access relies on providers' readiness to engage in the practice. More information is needed to understand the barriers and facilitators for engaging in MAiD care from the perspective of providers. This review will consider studies that identify physicians, nurse practitioners, and medical residents' perceived barriers and facilitators for engaging in the practice of MAiD in Canada. Physicians, nurse practitioners, and medical residents who do not directly administer MAiD, including those who identify as conscientious objectors or non-participants, will be included. Studies looking at barriers and facilitators for providing MAiD care to individuals with dementia, mental illness, or for individuals under the age of 18 years will be excluded. MEDLINE, Embase, CINAHL with Full-text, and APA PsycINFO will be searched. Studies will be screened and data extracted by 2 independent reviewers using a tool created for this review. The scoping review findings will be presented in a narrative format and mapped in tables to address the review aims.

HHS Issues Final Rule to Protect Conscientious Objection

HHS Issues Final Rule to Protect Conscientious Objection

Duty to Serve, Duty to Conscience: The story of two conscientious objector combat medics during the Vietnam War. By James C.Kearney, William H.Clamurro. Denton, TX: University of North Texas Press. 2023. 288 pp.

Duty to Serve, Duty to Conscience: The story of two conscientious objector combat medics during the Vietnam War. By James C.Kearney, William H.Clamurro. Denton, TX: University of North Texas Press. 2023. 288 pp.