- A conscientious objection (CO) is a moral objection to providing or disclosing information about a legal, professionally accepted, and otherwise available medical service.
- Four policy recommendations are made for managing conscientious objections in intensive care medicine (Table 2). The recommendations are designed to balance two ethical goals: (1) to protect patients’ access to legal, professionally accepted, and otherwise available medical services, and (2) to protect clinician’s moral integrity.
Table 1. Ethically Relevant Considerations in the Analysis of Conscientious Objections in Intensive Care Medicine
Reasons to accommodate COs
- Consideration 1: To protect clinicians’ moral integrity
- Accommodating clinicians’ COs allows them to protect their moral integrity and to avoid the moral harm associated with acting contrary to moral beliefs.
- Consideration 2: To respect clinicians’ autonomy
- Accommodating COs protects clinicians’ freedom to refrain from acting in ways that violate their personal beliefs and values.
- Consideration 3: To improve the quality of medical care
- Protecting the moral integrity of critical care clinicians may improve medical quality at the population level.
- Consideration 4: To identify needed changes in professional norms and practices
- The evaluation and accommodation of COs may be one effective way to promote critical reappraisal of the boundaries of accepted medical practice.
- Reasons Not to accommodate COs
- Consideration 5: To honor core professional commitments
- Clinicians voluntarily commit to promote the patient’s best medical interests, not to abandon the patient, and to make reasonable sacrifices for the benefit of their patient’s health.
- Consideration 6: To protect vulnerable patients
- Patients receiving critical care are particularly vulnerable due to incapacity, life-threatening illness, lack of choice of clinician, lack of potential to be notified in advance of the clinician’s CO, and a severely constrained opportunity to seek out a new clinician.
- Consideration 7: To prevent excessive hardships on other clinicians or the institution
- Accommodating CO can create excessive hardships on other clinicians and healthcare institutions.
- Consideration 8: To avoid invidious discrimination
- Invidious discrimination is prohibited by most healthcare professional codes of ethics and by law.