Conscientious objection in the healthcare domain: A balance between rights and responsibilities

Authors

  • Rosa Maria Pérez-Capellades Universitat de Barcelona. Programa de doctorado Enfermería y Salud https://orcid.org/0009-0005-6348-6129
  • Anna Falcó-Pegueroles Departamento de Enfermería Fundamental y Clínica. Facultad de Enfermería. Grupo de Investigación Consolidado SGR 325 Bioética, Derecho y Sociedad (BIOELSi). Universidad de Barcelona https://orcid.org/0000-0002-3702-3009
  • Sergio Ramos Pozón Departamento de Enfermería Fundamental y Clínica, Facultad de Enfermería. Grupo de Investigación Consolidado SGR 325 Bioética, Derecho y Sociedad (BIOELSi), U. de Barcelona https://orcid.org/0000-0002-5772-6676

DOI:

https://doi.org/10.1344/rbd2024.60.43672

Keywords:

bioethics, implications, barriers, conscientious objection, institutional conscientious objection

Abstract

The enactment of Organic Law 3/2021 on euthanasia in Spain has sparked a significant debate in the field of bioethics, namely the issue of conscientious objection (CO) among healthcare professionals. However, despite the scientific literature addressing this matter, the understanding of the underlying reasons that drive professionals to object is not entirely clear. Several authors have highlighted that CO is rooted in personal beliefs, professional ethics, emotional aspects, and dynamics within the healthcare system. Simultaneously, there have been varying stances on the legitimacy of CO, leading to debates regarding its validity.

The objectives of this article are to review the concept of conscientious objection in the healthcare context, analyze the factors motivating this right, examine the consequences of CO on the workload of non-objecting professionals, and explore its potential ethical conflict with distributive justice in healthcare. Finally, we will reflect on the possibility of institutional CO and its potential implications for the rights of patients and healthcare workers.

Author Biographies

Rosa Maria Pérez-Capellades , Universitat de Barcelona. Programa de doctorado Enfermería y Salud

University of Barcelona. Doctoral Program in Nursing and Health Nurse. Pallars Hospital

Anna Falcó-Pegueroles , Departamento de Enfermería Fundamental y Clínica. Facultad de Enfermería. Grupo de Investigación Consolidado SGR 325 Bioética, Derecho y Sociedad (BIOELSi). Universidad de Barcelona

Department of Fundamental and Clinical Nursing. Faculty of Nursing. Consolidated Research Group SGR 325 Bioethics, Law, and Society (BIOELSi). University of Barcelona

References

Altisent, R., de Lorenzo, R., Gónzalez, R., Gracia, D., Monzon, J. L., Rodríguez, J., et al. (2008). Ética de la objeción de conciencia. En: Guías de ética en la práctica médica. https://www.fcs.es/images/Publipdf/Guia_etica_objecion_conciencia.pdf.

Autorino, T., Mattioli, F., & Mencarini, L. (2020). The impact of gynecologists' conscientious objection on abortion access. Soc Sci Res, 87, 102403. doi: 10.1016/j.ssresearch.2020.102403.

Bo, M., Zoti, C., & Charrier, L. (2015). Conscientious objection and waiting time for voluntary abortion in Italy. Eur J Contracept Reprod Health Care, 20(4), 272-282. doi: 10.3109/13625187.2014.990089.

Brown, J., Goodridge, D., Thorpe, L., Hodson, A., & Chipanshi, M. (2021). Factors influencing practitioners who do not participate in ethically complex, legally available care: scoping review. BMC Med Ethics, 22(1), 134. doi: 10.1186/s12910-021-00703-6.

Byrnes, J. (2021). The Problem of “Core Moral Beliefs” as the Ground of Conscientious Objection. HEC Forum, 33, 291-305. doi: 10.1007/s10730-020-09425-5.

Cabello, J., & Núñez, A. (2018). Objeción de conciencia institucional y regulación en salud: ¿existe una excusa legítima frente al aborto en Chile? Rev. Bioética y Derecho, 43, 161-177.

Card, R. (2017). The Inevitability of Assessing Reasons in Debates about Conscientious Objection in Medicine. Camb Q Healthc Ethics, 26(1), 82-96. doi: 10.1017/S0963180116000669.

Casado, M., & Corcoy, M. (coords). (2007). Documento sobre objeción de conciencia en Sanidad. Observatori de Bioètica i Dret. Disponible en: http://www.publicacions.ub.edu/refs/observatoriBioEticaDret/documents/07898.pdf.

Comité de Bioética de España. (2021a). Opinión del comité de bioética de España sobre la objeción de conciencia en sanidad. Available: http://assets.comitedebioetica.es/files/documentacion/es/La%20objecion%20de%20conciencia%20en%20sanidad.pdf.

Comité de Bioética de España. (2021b). Informe del comité de bioética de España sobre la objeción de conciencia en relación con la prestación de la ayuda para morir de la ley orgánica reguladora de la eutanasia. Available: http://assets.comitedebioetica.es/files/documentacion/Informe%20CBE%20sobre%20la%20Objecion%20de%20Conciencia.pdf.

Comité de Bioètica de Catalunya. (2021). Reflexions del Comitè de Bioètica de Catalunya i el Comitè d’Ètica de Serveis Socials de Catalunya sobre una possible negativa, en nom de l’ideari institucional, a l’aplicació de la Llei reguladora de l’Eutanàsia. Available: https://canalsalut.gencat.cat/web/.content/_Sistema_de_salut/CBC/recursos/documents_tematica/reflexions-possible-negativa-a-laplicacio-de-la-llei-reguladora-de-leutanasia.pdf.

Díez, J. (2022). ¿Tiene cabida en nuestro ordenamiento la objeción institucional para las entidades sanitarias? Anuario de Derecho Eclesiástico del Estado, 38, 321-340.

Dobrowolska, B., McGonagle, I., Kozak, A., & Kane, R. (2020). Conscientious object in nursing: Regulations and practice in two European countries. Nursing Ethics, 27(1), 168–183.

Eberl, J. (2019). Protecting reasonable conscientious refusals in health care. Theor Med Bioeth, 40(6), 565-581. doi: 10.1007/s11017-019-09512-w.

Finegan, T. (2019). Conscientious objection to referrals. J Med Ethics, 45(4), 277-279. doi: 10.1136/medethics-2018-105067.

Fovargue, S., & Neal, M. (2022). UK pharmacists' experiences and perceptions of conflict between personal ethical commitments and professional obligations, as set out in professional guidance. Int J Pharm Pract, 30(3), 241-246. doi: 10.1093/ijpp/riac022Kantymir, L., & McLeod, C. (2014). Justification for conscience exemptions in health care. Bioethics, 28(1), 16-23.

Kottow, M. (2021). Conscientious objection in medicine: Experience in Chile. Dev World Bioeth, 21(2), 63-67. doi: 10.1111/dewb.12294.

Hempton, C. (2021). Voluntary assisted dying in the Australian state of Victoria: an overview of challenges for clinical implementation. Ann Palliat Med, 10(3), 3575-3585.

Lamb, C., Evans, M., Babenko, Y., Wong, C., & Kirkwood, K. (2019). Nurses’ use of conscientious objection and the implications for conscience. Journal of Advanced Nursing, 75(3), 594–602. doi: 10.1111/jan.13869.

Lamb, C., & Pesut, B. (2021). Conscience and conscientious objection in nursing: A personalist bioethics approach. Nursing Ethics. doi: 10.1177/0969733021996037.

Ley Orgánica 3/2021, de 24 de marzo, de regulación de la eutanasia. «BOE» núm. 72, de 25 de marzo de 2021, páginas 34037 a 34049 (13 págs.).

McDougall, R., White, B., Ko, D., Keogh, L., & Willmott, L. (2022). Junior doctors and conscientious objection to voluntary assisted dying: ethical complexity in practice. J Med Ethics, 48(8), 517-521. doi: 10.1136/medethics-2020-107125.

Meyers, C., & Woods, R. (2007). Conscientious objection? Yes, but make sure it is genuine. American Journal of Bioethics, 7(6), 19-20. doi: 10.1080/15265160701347270.

Myskja, B., & Magelssen, M. (2018). Conscientious objection to intentional killing: an argument for toleration. BMC Med Ethics, 19(1), 82. doi: 10.1186/s12910-018-0323-0.

Navarro, S. (2021). La objeción de conciencia en sanidad: contraprestación y registro de objetores. Tesis doctoral. Available: https://www.tdx.cat/handle/10803/672651?locale-attribute=es#page=1.

Nuttall, C. (2007). Conscientious objection: justified or just refusal to care? J Perioper Pract, 17(5), 210-215.

Panchuk, J., & Thirsk, L. (2021). Conscientious objection to medical assistance in dying in rural/remote nursing. Nurs Ethics, 28(5), 766-775. doi: 10.1177/0969733020976185.

Rawls, J. (1971). A theory of justice. USA: Belknap Press.

Resolución 2215 (2020) del Parlamento Europeo sobre situación de la salud y los derechos sexuales y reproductivos en la Unión. Available: https://www.europarl.europa.eu/doceo/document/FEMM-PR-648429_ES.pdf.

Savulescu, J. (2006). Conscientious objection in medicine. BMJ, 332(7536), 294-297.

Savulescu, J., & Schuklenk, U. (2017). Doctors Have no Right to Refuse Medical Assistance in Dying, Abortion or Contraception. Bioethics, 31(3), 162-170. doi: 10.1111/bioe.12288.

Seoane, JA. (2021). Lex artis como estándar de la práctica clínica. Folia Humanística, 2(6), 1–23. doi: 10.30860/0081.

Shadd, P., & Shadd, J. (2019). Institutional non-participation in assisted dying: Changing the conversation. Bioethics, 33(1), 207-214. doi: 10.1111/bioe.12528.

Schuklenk, U. (2018). Conscientious objection in medicine: accommodation versus professionalism and the public good. British Medical Bulletin, 126, 47–56. doi: 10.1093/bmb/ldy007.

Shanawan, H. (2016). The Challenges of Conscientious Objection in Health Care. J Relig Health, 55, 384–393. doi: 10.1007/s10943-016-0200-4.

Schiller, C. (2017). Medical Assistance in Dying in Canada: Focus on Rural Communities. The Journal for Nurse Practitioners, 13(9), 628-634.

Symons, X. (2022). Conscientious Objection in Health Care: Why the Professional Duty Argument is Unconvincing. The Journal of Medicine and Philosophy, 47, 549–557. doi: 10.1093/jmp/jhac013.

Terribas, N. (2010). Objeción de conciencia del profesional y derechos del paciente. Formación Médica Continuada En Atención Primaria, 17(10), 664–670. doi: 10.1016/S1134-2072(10)70268-1.

Waller, R. (2005). Conscientious objection. Do nurses have the right to refuse to provide care? AWHONN Lifelines, 9(4), 283–286.

Weinstock, D. (2014). Conscientious Refusal and Health Professionals: Does Religion Make a Difference? Bioethics, 28(1), 8–15.

Wester, W. (2015). Conscientious Objection by Health Care Professionals. Philosophy Compass, 10(7), 427–437. doi: 10.1111/phc3.12235.

Wicclair, M. R. (2011). Conscientious objection in health care: An ethical analysis. Cambridge: Cambridge University Press.

- Wicclair, M. (2014). Managing Conscientious Objection in Health Care Institutions. HEC Forum, 26, 267–283. doi: 10.1007/s10730-014-9241-9.

Wicclair, M. (2019). Conscientious Objection, Moral Integrity, and Professional Obligations. Perspectives in Biology and Medicine, 62(3), 543-559.

Zolf, B. (2019). No conscientious objection without normative justification: Against conscientious objection in medicine. Bioethics, 33(1), 146–153. doi: 10.1111/bioe.12521.

Published

2024-02-13

How to Cite

Pérez-Capellades , R. M. . ., Falcó-Pegueroles , A. ., & Ramos Pozón, S. (2024). Conscientious objection in the healthcare domain: A balance between rights and responsibilities . Revista De Bioética Y Derecho, (60), 3–18. https://doi.org/10.1344/rbd2024.60.43672

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Section

General section