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.

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.

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 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.

Common dedication to facilitating good dying experiences: Qualitative study of end-of-life care professionals’ attitudes towards voluntary assisted dying

2019 ◽  
Vol 33 (6) ◽  
pp. 562-569 ◽  
Author(s):  
Sarah-May Blaschke ◽  
Penelope Schofield ◽  
Keryn Taylor ◽  
Anna Ugalde
Keyword(s):  
Qualitative Study ◽  
End Of Life ◽  
Health Professionals ◽  
End Of Life Care ◽  
Policy Development ◽  
Sampling Strategy ◽  
Assisted Dying ◽  
Life Care ◽  
Structured Interviews ◽  
Moral Philosophies

Background: Debate about appropriate and ethically acceptable end-of-life choices is ongoing, which includes discussion about the legalization of voluntary assisted dying. Given health professionals’ role in caring for patients at the end life, their stance towards assisting a person with dying can have implications for policy development and implementation in jurisdictions where law changes are being considered. Aim: To explore end-of-life care professionals’ attitudes towards voluntary assisted dying 6 months prior to vote on legalization. Design: Qualitative study using textual data collected through semi-structured interviews. Purposive sampling strategy used to collect a broad representation of perspectives. Audio-recorded interviews were transcribed verbatim and subjected to qualitative descriptive analysis techniques. Participants: A total of 16 health professionals with experience in caring for people with life-limiting illness. Results: Participants reported two overarching positions grounded in differing moral philosophies with compelling arguments both for and against legalization of voluntary assisted dying. A third and common line of argument emerged from areas of shared concern and uncertainty about the practical consequences of introducing voluntary assisted dying. While a diversity of opinion was evident, all participants advocated for more public education and funding into end-of-life care services to make high-quality care equitable and widely available. Conclusion: Common dedication to reducing suffering and facilitating good dying experiences exists among experts despite their divergent views on voluntary assisted dying. Ongoing engagement with stakeholders is needed for practical resolution in the interest of developing health policy for best patient care.

Conscientious Objection, Complicity in Wrongdoing, and a Not-So-Moderate Approach

2016 ◽  
Vol 26 (1) ◽  
pp. 109-119 ◽  
Author(s):  
FRANCESCA MINERVA
Keyword(s):  
Well Being ◽  
Geographic Area ◽  
Roman Catholic ◽  
Conscientious Objection ◽  
Moral Integrity ◽  
Conscientious Objectors

Abstract:This article analyzes the problem of complicity in wrongdoing in the case of healthcare practitioners (and in particular Roman Catholic ones) who refuse to perform abortions, but who are nonetheless required to facilitate abortions by informing their patients about this option and by referring them to a willing colleague. Although this solution is widely supported in the literature and is also widely represented in much legislation, the argument here is that it fails to both (1) safeguard the well-being of the patients, and (2) protect the moral integrity of healthcare practitioners. Finally, the article proposes a new solution to this problem that is based on a desirable ratio of conscientious objectors to non-conscientious objectors in a hospital or in a given geographic area.

scholarly journals Medicalisation, suffering and control at the end of life: The interplay of deep continuous palliative sedation and assisted dying

2020 ◽  
pp. 136345932097674
Author(s):  
Gitte Hanssen Koksvik ◽  
Naomi Richards ◽  
Sheri Mila Gerson ◽  
Lars Johan Materstvedt ◽  
David Clark
Keyword(s):  
End Of Life ◽  
Health Professionals ◽  
Western Europe ◽  
Palliative Sedation ◽  
Good Death ◽  
Assisted Dying ◽  
Qualitative Interview Study ◽  
Continuous Palliative Sedation ◽  
And Control ◽  
The Relationship

Medicalisation is a pervasive feature of contemporary end of life and dying in Western Europe and North America. In this article, we focus on the relationship between two specific aspects of the medicalisation of dying: deep continuous palliative sedation until death and assisted dying. We draw upon a qualitative interview study with 29 health professionals from three jurisdictions where assisted dying is lawful: Flanders, Belgium; Oregon, USA; and Quebec, Canada. Our findings demonstrate that the relationship between palliative sedation and assisted dying is often perceived as fluid and complex. This is inconsistent with current laws as well as with ethical and clinical guidelines according to which the two are categorically distinct. The article contributes to the literature examining health professionals’ opinions and experiences. Moreover, our findings inform a discussion about emergent themes: suffering, timing, autonomy and control – which appear central in the wider discourse in which both palliative sedation and assisted dying are situated, and which in turn relate to the wider ideas about what constitutes a ‘good death’.

Conscientious Objection (European and American approaches)

Law and World ◽  
2020 ◽  
Vol 6 (2) ◽  
pp. 115-144
Keyword(s):  
Deep Understanding ◽  
Legal Protection ◽  
Legal Aspects ◽  
Conscientious Objection ◽  
State Regulation ◽  
Legal Responsibility ◽  
State Regulations ◽  
Conscientious Objectors ◽  
The Law ◽  
The Individual

The Article concerns the legal issues, connected with the situation, when a person (or group of people) disobey requirements of the Law or other State regulations on the basis of religious or nonreligious belief. The Author analyses almost all related issues – whether imposing certain obligation on individuals, to which the individual has a conscientious objection based on his/her religious beliefs, always represents interference with his/her religion rights, and if it does, then what is subject of the interference – forum integrum or forum externum; whether neutral regulation, which does not refer to religion issues at all, could ever be regarded as interference into someone’s religious rights; whether opinion or belief, on which the individual’s objection and the corresponding conduct is based, must necesserily represent the clear “manifest” of the same religion or belief in order to gain legal protection; what is regarded as “manifest” of the religion or other belief in general and whether a close and direct link must exist between personal conduct and requirements of the religious or nonreligious belief; what are the criteria of the “legitimacy” of the belief; to what extent the following factors should be taken into consideration : whether the personal conduct of the individual represents the official requirements of corresponding religion or belief, what is the burden which was imposed on the believer’s religious or moral feelings by the State regulation, also, proportionality and degree of sincerity of the individual who thinks that his disobidience to the Law is required by his/her religious of philosofical belief. The effects (direct or non direct) of the nonfulfilment of the law requirement (legal responsibility, lost of the job, certain discomfort, etc..) are relevant factors as well. By the Author, all these circumstances and factors are essencial while estimating, whether it arises, actually, a real necessity and relevant obligation before a state for making some exemptions from the law to the benefi t of the conscientious objectors, in cases, if to predict such an objection was possible at all. So, the issues are discussed in the prism of the negative and positive obligations of a State. Corresponding precedents of the US Supreme Court and European Human Rights Court have been presented and analysed comparatively by the Author in the Article. The Article contains an important resume, in which the main points, principal issues and conclusion remarks are delivered. The Author shows, that due analysis of the legal aspects typical to “Conscientious objection” is very important for deep understanding religious rights, not absolute ones, and facilitates finding a correct answer on the question – how far do their boundaries go?

Testing Consultation Recordings in a Clinical Setting With the SecondEars Smartphone App: Mixed Methods Implementation Study (Preprint)

2019 ◽  
Author(s):  
Amelia Hyatt ◽  
Ruby Lipson-Smith ◽  
Bryce Morkunas ◽  
Meinir Krishnasamy ◽  
Michael Jefford ◽  
...  
Keyword(s):  
Health Care ◽  
Mixed Methods ◽  
Health Professional ◽  
Clinical Setting ◽  
Health Professionals ◽  
Implementation Strategy ◽  
Smartphone App ◽  
Implementation Study ◽  
Pilot Testing ◽  
Effective Implementation

BACKGROUND Health care systems are increasingly looking to mobile device technologies (mobile health) to improve patient experience and health outcomes. SecondEars is a smartphone app designed to allow patients to audio-record medical consultations to improve recall, understanding, and health care self-management. Novel health interventions such as SecondEars often fail to be implemented post pilot-testing owing to inadequate user experience (UX) assessment, a key component of a comprehensive implementation strategy. OBJECTIVE This study aimed to pilot the SecondEars app within an active clinical setting to identify factors necessary for optimal implementation. Objectives were to (1) investigate patient UX and acceptability, utility, and satisfaction with the SecondEars app, and (2) understand health professional perspectives on issues, solutions, and strategies for effective implementation of SecondEars. METHODS A mixed methods implementation study was employed. Patients were invited to test the app to record consultations with participating oncology health professionals. Follow-up interviews were conducted with all participating patients (or carers) and health professionals, regarding uptake and extent of app use. Responses to the Mobile App Rating Scale (MARS) were also collected. Interviews were analyzed using interpretive descriptive methodology; all quantitative data were analyzed descriptively. RESULTS A total of 24 patients used SecondEars to record consultations with 10 multidisciplinary health professionals. In all, 22 of these patients used SecondEars to listen to all or part of the recording, either alone or with family. All 100% of patient participants reported in the MARS that they would use SecondEars again and recommend it to others. A total of 3 themes were identified from the patient interviews relating to the UX of SecondEars: empowerment, facilitating support in cancer care, and usability. Further, 5 themes were identified from the health professional interviews relating to implementation of SecondEars: changing hospital culture, mitigating medico-legal concerns, improving patient care, communication, and practical implementation solutions. CONCLUSIONS Data collected during pilot testing regarding recording use, UX, and health professional and patient perspectives will be important for designing an effective implementation strategy for SecondEars. Those testing the app found it useful and felt that it could facilitate the benefits of consultation recordings, along with providing patient empowerment and support. Potential issues regarding implementation were discussed, and solutions were generated. CLINICALTRIAL Australia and New Zealand Clinical Trials Registry ACTRN12618000730202; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373915&isClinicalTrial=False

scholarly journals ‘Living in parallel worlds’ – bereaved parents’ experience of family life when a parent with dependent children is at end of life from cancer: A qualitative study

2021 ◽  
pp. 026921632110017
Author(s):  
Cherith J Semple ◽  
Eilís McCaughan ◽  
Esther R Beck ◽  
Jeffrey R Hanna
Keyword(s):  
End Of Life ◽  
Psychosocial Adjustment ◽  
Family Life ◽  
Life Experience ◽  
Qualitative Interviews ◽  
Later Life ◽  
Support Service ◽  
Dependent Children ◽  
Bereaved Parents ◽  
Death Of A Parent

Background: When a parent of dependent children (<18 years old) is at end of life from cancer, this has a profound impact on the family. Children less prepared for the death of a parent are more susceptive to poorer psychosocial adjustment in later life. There is a lack of understanding from the literature surrounding what support parents require, and how they navigate this end of life experience. Aim: To explore bereaved parents’ experience and needs for families when a parent is at end of life from cancer with dependent children. Design: In-depth, semi-structured qualitative interviews were conducted with 21 bereaved mothers and fathers, identified from the general public, a family support service and hospice. Data were analysed thematically. Results: Parents often live in ‘parallel worlds’ throughout the end of life period. In one world, ‘living in the moment’, cherishing the ordinariness of family life, remaining hopeful treatment will prolong life, whilst adapting as the illness unfolds. The other world presents as ‘intermitted glimpses that death is approaching’, shadowed with painful emotional concerns surrounding their children and the future. At the end, death rapidly approaches, characterised as suddenly ‘falling off the cliff’; placing significant demands on the well-parent. Conclusions: Amidst challenges, clinicians should provide parents with clear information surrounding a poor prognosis, so families can plan and prepare for parental death. There is a need for healthcare professionals to engage, encourage and equip parents, as they prepare their children throughout the end of life experience for the inevitable death of a parent.

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