scholarly journals Junior doctors and conscientious objection to voluntary assisted dying: ethical complexity in practice

2021 ◽  
pp. medethics-2020-107125
Author(s):  
Rosalind J McDougall ◽  
Ben P White ◽  
Danielle Ko ◽  
Louise Keogh ◽  
Lindy Willmott
Keyword(s):  
Health Professionals ◽  
Conscientious Objection ◽  
Career Progression ◽  
Junior Doctors ◽  
Assisted Dying ◽  
Moral Integrity ◽  
Institutional Policies ◽  
Australian State ◽  
Specific Support ◽  
Ethical Complexity

In jurisdictions where voluntary assisted dying (VAD) is legal, eligibility assessments, prescription and administration of a VAD substance are commonly performed by senior doctors. Junior doctors’ involvement is limited to a range of more peripheral aspects of patient care relating to VAD. In the Australian state of Victoria, where VAD has been legal since June 2019, all health professionals have a right under the legislation to conscientiously object to involvement in the VAD process, including provision of information about VAD. While this protection appears categorical and straightforward, conscientious objection to VAD-related care is ethically complex for junior doctors for reasons that are specific to this group of clinicians. For junior doctors wishing to exercise a conscientious objection to VAD, their dependence on their senior colleagues for career progression creates unique risks and burdens. In a context where senior colleagues are supportive of VAD, the junior doctor’s subordinate position in the medical hierarchy exposes them to potential significant harms: compromising their moral integrity by participating, or compromising their career progression by objecting. In jurisdictions intending to provide all health professionals with meaningful conscientious objection protection in relation to VAD, strong specific support for junior doctors is needed through local institutional policies and culture.

scholarly journals Junior Doctors and Conscientious Objection to Voluntary Assisted Dying: Ethical Complexity in Practice

2021 ◽  
Author(s):  
Rosalind McDougall ◽  
Ben White ◽  
Danielle Ko ◽  
Louise Keogh ◽  
Lindy Willmott
Keyword(s):  
Conscientious Objection ◽  
Junior Doctors ◽  
Assisted Dying ◽  
Ethical Complexity

scholarly journals “I haven’t had to bare my soul but now I kind of have to”: describing how voluntary assisted dying conscientious objectors anticipated approaching conversations with patients in Victoria, Australia

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Casey Michelle Haining ◽  
Louise Anne Keogh
Keyword(s):  
Health Professional ◽  
End Of Life ◽  
Health Professionals ◽  
Medical Service ◽  
Qualitative Interviews ◽  
Conscientious Objection ◽  
Assisted Dying ◽  
Moral Integrity ◽  
Conscientious Objectors ◽  
Education Needs

Abstract Background Dealing with end of life is challenging for patients and health professionals alike. The situation becomes even more challenging when a patient requests a legally permitted medical service that a health professional is unable to provide due to a conflict of conscience. Such a scenario arises when Victorian health professionals, with a conscientious objection (CO) to voluntary assisted dying (VAD), are presented with patients who request VAD or merely ask about VAD. The Voluntary Assisted Dying Act 2017 (Vic) recognizes the inherent conflict of conscience that may arise for some health professionals when asked to provide VAD and responds by affording broad protection to conscientious objectors who wish to refuse to take part in the VAD process. Methods Seventeen semi-structured qualitative interviews were conducted with Victorian health professionals with a self-identified CO to VAD in the lead-up to the implementation of VAD in Victoria. Interviews explored how participants anticipated they would manage their CO in practice. Interviews were transcribed verbatim and analyzed thematically. Results Our results reveal that the way in which health professionals claimed they would approach CO conversations is variable and was dependant on the strength of their opposition to VAD. We categorized conscientious objectors according to their approach as either dissuasive non-referrers, passive non-referrers, facilitators or negotiators. Our study also explores the perceived difficulties of exercising one’s CO as identified by our participants. Conclusion The broad protection offered by the Voluntary Assisted Dying Act 2017 (Vic) encourages a range of behaviors from conscientious objectors, due to the minimal obligations imposed. In order to assist conscientious objectors, more policy, institutional guidance, and education needs to be available to conscientious objectors explicitly addressing how to effectively manage one’s CO. Such guidance is imperative to ensuring that their moral integrity is preserved and that they are exercising their CO appropriately.

scholarly journals Conscientious Objection in Healthcare and Moral Integrity

2016 ◽  
Vol 26 (1) ◽  
pp. 7-17 ◽  
Author(s):  
MARK WICCLAIR
Keyword(s):  
Health Professionals ◽  
Conscientious Objection ◽  
Alternative Conceptions ◽  
Moral Integrity ◽  
Specific Context ◽  
Moral Space ◽  
Social Component ◽  
Intellectual Integrity ◽  
Moral Convictions

Abstract:There are several reasons for accommodating health professionals’ conscientious objections. However, several authors have argued that among the most important and compelling reasons is to enable health professionals to maintain their moral integrity. Accommodation is said to provide “moral space” in which health professionals can practice without compromising their moral integrity. There are, however, alternative conceptions of moral integrity and corresponding different criteria for moral-integrity-based claims. It is argued that one conception of moral integrity, the identity conception, is sound and suitable in the specific context of responding to health professionals’ conscientious objections and their requests for accommodation. According to the identity conception, one maintains one’s moral integrity if and only if one’s actions are consistent with one’s core moral convictions. The identity conception has been subject to a number of criticisms that might call into question its suitability as a standard for determining whether health professionals have genuine moral-integrity-based accommodation claims. The following five objections to the identity conception are critically examined: (1) it does not include a social component, (2) it is a conception of subjective rather than objective integrity, (3) it does not include a reasonableness condition, (4) it does not include any substantive moral constraints, and (5) it does not include any intellectual integrity requirement. In response to these objections, it is argued that none establishes the unsuitability of the identity conception in the specific context of responding to health professionals’ conscientious objections and their requests for accommodation.

scholarly journals Secularity, abortion, assisted dying and the future of conscientious objection: modelling the relationship between attitudes

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Morten Magelssen ◽  
Nhat Quang Le ◽  
Magne Supphellen
Keyword(s):  
Conscientious Objection ◽  
Structural Equations ◽  
Assisted Dying ◽  
Moral Integrity ◽  
Patient Trust ◽  
Web Based ◽  
Main Driver ◽  
Abortion Attitudes ◽  
Sound Policy ◽  
The Relationship

Abstract Background Controversies arise over abortion, assisted dying and conscientious objection (CO) in healthcare. The purpose of the study was to examine the relationship between attitudes towards these bioethical dilemmas, and secularity and religiosity. Method Data were drawn from a 2017 web-based survey of a representative sample of 1615 Norwegian adults. Latent moderated structural equations modelling was used to develop a model of the relationship between attitudes. Results The resulting model indicates that support for abortion rights is associated with pro-secular attitudes and is a main “driver” for support for assisted dying and opposition to conscientious objection. Conclusions This finding should be regarded as a hypothesis which ought to be tested in other populations. If the relationship is robust and reproduced elsewhere, there are important consequences for CO advocates who would then have an interest in disentangling the debate about CO from abortion; and for health systems who ought to consider carefully how a sound policy on CO can safeguard both patient trust in the services and the moral integrity of professionals. It is suggested that if religiosity wanes and pro-secular and pro-abortion attitudes become more widespread, support for CO might decline, putting into question whether present policies of toleration of conscientious refusals will remain acceptable to the majority.

Conscientious Objection

2014 ◽  
Author(s):  
Mark R. Wicclair
Keyword(s):  
End Of Life ◽  
Health Professionals ◽  
End Of Life Care ◽  
Medical Service ◽  
Conscientious Objection ◽  
Reasonable Accommodation ◽  
Life Care ◽  
Middle Ground ◽  
Moral Integrity ◽  
Legal Rules

This chapter examines conscientious objection in health care, with a specific focus on end-of-life care. It begins with a brief historical overview and identifies distinguishing characteristics of refusals to provide a medical service that are instances of conscientious objection (conscience-based refusals). Several reasons are presented for accommodating conscience-based refusals, and it is maintained that the primary reason is to enable health professionals to maintain their moral integrity. Two extreme approaches to managing conscience-based refusals are critically analyzed, and a middle-ground approach (reasonable accommodation) is explained and defended. Conscience clauses (i.e., legal rules and regulations that protect the exercise of conscience) are discussed, and it is argued that typical conscience clauses do not provide an appropriate model for public policy in relation to conscientious objection in end-of-life care.

Conscientious participants and the ethical dimensions of physician support for legalised voluntary assisted dying

2020 ◽  
pp. medethics-2020-106702
Author(s):  
Jodhi Rutherford
Keyword(s):  
Empirical Study ◽  
Empirical Research ◽  
Conscientious Objection ◽  
Assisted Dying ◽  
Patient Access ◽  
Australian State ◽  
Scant Attention ◽  
The Law ◽  
Physician Support ◽  
First Time

The Australian state of Victoria legalised voluntary assisted dying (VAD) in June 2019. Like most jurisdictions with legalised VAD, the Victorian law constructs physicians as the only legal providers of VAD. Physicians with conscientious objection to VAD are not compelled to participate in the practice, requiring colleagues who are willing to participate to transact the process for eligible applicants. Physicians who provide VAD because of their active, moral and purposeful support for the law are known as conscientious participants. Conscientious participation has received scant attention in the bioethics literature. Patient access to VAD is contingent on the development of a sufficient corpus of conscientious participants in permissive jurisdictions. This article reports the findings of a small empirical study into how some Victorian physicians with no in-principle opposition towards the legalisation of VAD, are ethically orientating themselves towards the law, in the first 8 months of the law’s operation. It finds that in-principle-supportive physicians employ bioethical principles to justify their position but struggle to reconcile that approach with the broader medical profession’s opposition. This study is part of the first tranche of empirical research emerging from Australia since the legalisation of VAD in that country for the first time in over 20 years.

scholarly journals Freedom of conscience in Europe? An analysis of three cases of midwives with conscientious objection to abortion

2017 ◽  
Vol 44 (2) ◽  
pp. 104-108 ◽  
Author(s):  
Valerie Fleming ◽  
Beate Ramsayer ◽  
Teja Škodič Zakšek
Keyword(s):  
European Union ◽  
Health Professionals ◽  
Developed Countries ◽  
Conscientious Objection ◽  
The European Union ◽  
European Level ◽  
Major Area ◽  
Documentary Analysis ◽  
Opt Out ◽  
Church Law

While abortion has been legal in most developed countries for many years, the topic remains controversial. A major area of controversy concerns women’s rights vis-a-vis the rights of health professionals to opt out of providing the service on conscience grounds. Although scholars from various disciplines have addressed this issue in the literature, there is a lack of empirical research on the topic. This paper provides a documentary analysis of three examples of conscientious objection on religious grounds to performing abortion-related care by midwives in different Member States of the European Union, two of which have resulted in legal action. These examples show that as well as the laws of the respective countries and the European Union, professional and church law each played a part in the decisions made. However, support from both professional and religious sources was inconsistent both within and between the examples. The authors conclude that there is a need for clear guidelines at both local and pan-European level for health professionals and recommend a European-wide forum to develop and test them.

‘To die, to sleep’ – assisted dying legislation in Victoria: A case study

2018 ◽  
Vol 26 (7-8) ◽  
pp. 1976-1982 ◽  
Author(s):  
Julia Gilbert ◽  
Jane Boag
Keyword(s):  
Terminal Illness ◽  
Assisted Dying ◽  
Contemporary Society ◽  
Ethical Considerations ◽  
Australian Society ◽  
Australian State ◽  
Pain And Suffering ◽  
To Come ◽  
The Impact

Background: Assisted dying remains an emotive topic globally with a number of countries initiating legislation to allow individuals access to assisted dying measures. Victoria will become the first Australian state in over 13 years to pass Assisted Dying Legislation, set to come into effect in 2019. Objectives: This article sought to evaluate the impact of Victorian Assisted Dying Legislation via narrative view and case study presentation. Research design: Narrative review and case study. Participants and research context: case study. Ethical considerations: This legislation will provide eligible Victorian residents with the option to request access to assisted dying measures as a viable alternative to a potentially painful, protracted death. Findings: This legislation, while conservative and inclusive of many safeguards at present, will form the basis for further discussion and debate on assisted dying across Australia in time to come. Discussion: The passing of this legislation by the Victorian parliament was prolonged, emotive and divided not only the parliament but Australian society. Conclusion: Many advocates for this legislation proclaimed it was well overdue and will finally meet the needs of contemporary society. Protagonists claim that medical treatment should not provide a means of ending life, despite palliative care reportedly often failing to relieve the pain and suffering of individuals living with a terminal illness.

Conscience, Abortion and Jurisdiction

2020 ◽  
Vol 40 (4) ◽  
pp. 819-845
Author(s):  
Sheelagh McGuinness ◽  
Michael Thomson
Keyword(s):  
Health Professionals ◽  
Theoretical Work ◽  
Conscientious Objection ◽  
Market Control ◽  
Professional Obligations ◽  
Abortion Care ◽  
Private Beliefs

Abstract Conscientious objection has achieved a particular place in contemporary law and culture. Lawyers, political theorists, ethicists, health professionals and others have debated how we best negotiate the tensions that can exist between professional obligations and private beliefs. Conscientious objection to abortion care has been a particular focus of these discussions. In this article, we draw on theoretical work on ‘jurisdiction’ to provide an account of what is embedded in claims to conscience and what the effects of such claims are. We focus specifically on refusals of abortion care enabled by section 4 of the Abortion Act 1967. We argue that legitimating narratives on conscience seek to achieve seemingly contradictory goals: entrenching abortion as morally ambiguous while securing it as part of medicine’s monopolistic practice. While section 4 provides the focus, our concerns extend to the wider landscape and impact of claims to conscience. Through our jurisdictional analysis, we seek to better understand such claims and dramatically reorient thinking by grounding the conscience clause squarely in the politics of ‘task areas’, professional domains, market control and claims of epistemological authority.

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