Background: While conscientious objection is a well-known phenomenon in normative and bioethical literature, there is a lack of evidence to support an understanding of what it is like for nurses to make a conscientious objection in clinical practice including the meaning this holds for them and the nursing profession. Research question: The question guiding this research was: what is the lived experience of conscientious objection for Registered Nurses in Ontario? Research design: Interpretive phenomenological methodology was used to gain an in-depth (...) understanding of what it means to be a nurse making a conscientious objection. Purposive sampling with in-depth interview methods was used to collect and then analyze data through an iterative process. Participants and research context: Eight nurse participants were interviewed from across practice settings in Ontario, Canada. Each participant was interviewed twice over 9 months. Ethical considerations: This study was conducted in accordance with Health Science Research Ethics Board approval and all participants gave consent. Findings: Six themes emerged from data analysis: encountering the problem, knowing oneself, taking a stand, alone and uncertain, caring for others, and perceptions of support. Discussion: This study offers an initial understanding of what it is like to be a nurse making a conscientious objection in clinical practice. Implications for nursing practice, education, policy, and further research are discussed. Conclusion: Addressing ethical issues in nursing practice is complex. The need for education across nursing, healthcare disciplines and socio-political sectors is essential to respond to nurses’ ethical concerns giving rise to objections. Conscience emerged as an informant to nurses’ conscientious objections. The need for morally inclusive environments and addressing challenging ethical questions as well as the concept of conscience are relevant to advancing nursing ethics and ethical nursing practice. (shrink)

In this paper, I argue that the conscience clause around abortion provision in England, Scotland and Wales is inadequate for two reasons. First, the patient and doctor are differently situated with respect to social power. Doctors occupy a position of significant moral and epistemic authority with respect to their patients, who are vulnerable and relatively disempowered. Doctors are rightly required to disclose their conscientious objection, but given the positioning of the patient and doctor, the act of doing so exploits the (...) authority of the medical establishment in asserting the legitimacy of a particular moral view. Second, the conscientious objector plays an unusual and self-defeating moral role. Since she must immediately refer the patient on to another doctor who does not hold a conscientious objection, she becomes complicit, via her necessary causal role, in the implementation of the procedure. This means that doctors are not able to prevent abortions, rather, they are required to ensure that they... (shrink)

The vigorous legal and ethical debates over conscientious objection have taken place largely within the domain of health care. Is this because conscience in medicine is of a special kind, or are th...

Omfanget av helsepersonells reservasjonsrett har nylig vært gjenstand for debatt i Norge. Vi spør om leger bør ha reservasjonsrett ved utførelse og henvisning til assistert befruktning, og drøfter argumenter for og imot ved hjelp av et rammeverk med sju kriterier for vurdering av reservasjon. Reservasjonsrettens grunnleggende dilemma er hvordan to viktige hensyn, henholdsvis pasientens rett til behandling og hensynet til helsepersonellets moralske integritet, best kan ivaretas. Det argumenteres for at leger bør ha rett til å reservere seg mot å utføre, (...) assistere ved og henvise til assistert befruktning generelt hvis begrunnelsen er hensynet til befruktede eggs moralske verdi. Videre finner vi at leger også kan ha en moralsk rett til reservasjon mot å utføre, assistere ved og henvise til assistert befruktning for likekjønnede, men da på nærmere spesifiserte vilkår.Nøkkelord: reservasjonsrett, assistert befruktning, samvittighet, moralsk integritetEnglish summary: Should physicians have the right to conscientiously object to assisted reproduction?The extent of the healthcare worker's right to conscientious objection has recently been debated in Norway. This article asks whether physicians should have a right to conscientious objection to the performance of, and referral for, assisted reproduction, and discusses arguments for and against the same, utilizing a framework of seven criteria for the evaluation of conscientious objection. The fundamental dilemma of conscientious objection is how two important considerations can be reconciled: the patient's right to treatment, and the protection of the healthcare worker's moral integrity. It is argued that physicians should have the right to object to performing, assisting with, and referring for assisted reproduction generally when the objection is grounded in the moral value of the embryo. Furthermore, physicians may also have a moral right to object to performing, assisting with, and referring for assisted reproduction for same-sex couples, but only on conditions that are further specified. (shrink)

This study explored identity conflict dynamics in interpersonal interactions in professionals facing ethically charged situations. Through semi-structured interviews, we conducted a qualitative study among doctors and nurses working for the English National Healthcare Service and analyzed the data with grounded theory approaches. Our findings reveal that identity conflict is triggered by three micro processes, namely cognitive and emotional perspective taking, as well as identifying with the other. In these processes, identity conflict is signaled by emotions and recognized as a clash (...) not only between identities and their values, but also within one identity and its multiple values. Behavioral and psychological outcomes of identity conflict involve seeking peer support, doing reflective practices and identity growth. This article contributes to identity literature by providing a multilevel approach of identity conflict dynamics able to account for both interpersonal and intrapsychic processes, deeply hold values and emotions, as well as crucial behavioral and psychological consequences. (shrink)

Background: Ideas of patient involvement are related to notions of self-determination and autonomy, which are not always in alignment with complex interactions and communication in clinical practice. Aim: To illuminate and discuss patient involvement in routine clinical care situations in nursing practice from an ethical perspective. Method: A case study based on an anthropological field study among patients with advanced cancer in Denmark. Ethical considerations: Followed the principles of the Helsinki Declaration. Findings: Two cases illustrated situations where nurses refused patient (...) involvement in their own case. Discussion: Focus on two ethical issues, namely ‘including patients’ experiences in palliative nursing care’ and ‘relational distribution of power and knowledge’, inspired primarily by Hannah Arendt’s concept of thoughtlessness and a Foucauldian perspective on the medical clinic and power. The article discusses how patients’ palliative care needs and preferences, knowledge and statements become part of the less significant background of nursing practice, when nurses have a predefined agenda for acting with and involvement of patients. Both structurally conditioned ‘thoughtlessness’ of the nurses and distribution of power and knowledge between patients and nurses condition nurses to set the agenda and assess when and at what level it is relevant to take up patients’ invitations to involve them in their own case. Conclusion: The medical and institutional logic of the healthcare service sets the framework for the exchange between professional and patient, which has an embedded risk that ‘thoughtlessness’ appears among nurses. The consequences of neglecting the spontaneous nature of human action and refusing the invitations of the patients to be involved in their life situation call for ethical and practical reflection among nurses. The conditions for interaction with humans as unpredictable and variable challenge nurses’ ways of being ethically attentive to ensure that patients receive good palliative care, despite the structurally conditioned logic of healthcare. (shrink)