scholarly journals Should Institutional Conscientious Objection to Assisted Dying be Accommodated?

2021 ◽  
Vol 4 (1) ◽  
pp. 15
Author(s):  
Jeffrey Kirby
2021 ◽  
pp. medethics-2020-107125
Author(s):  
Rosalind J McDougall ◽  
Ben P White ◽  
Danielle Ko ◽  
Louise Keogh ◽  
Lindy Willmott

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.


2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Morten Magelssen ◽  
Nhat Quang Le ◽  
Magne Supphellen

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.


2021 ◽  
Author(s):  
Rosalind McDougall ◽  
Ben White ◽  
Danielle Ko ◽  
Louise Keogh ◽  
Lindy Willmott

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Casey Michelle Haining ◽  
Louise Anne Keogh

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.


2020 ◽  
pp. medethics-2020-106702
Author(s):  
Jodhi Rutherford

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.


Law and World ◽  
2020 ◽  
Vol 6 (2) ◽  
pp. 115-144

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?


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