The literature on conscience in medicine has paid little attention to what is meant by the word ‘conscience.’ This article distinguishes between retrospective and prospective conscience, distinguishes synderesis from conscience, and argues against intuitionist views of conscience. Conscience is defined as having two interrelated parts: (1) a commitment to morality itself; to acting and choosing morally according to the best of one’s ability, and (2) the activity of judging that an act one has done or about which one is deliberating (...) would violate that commitment. Tolerance is defined as mutual respect for conscience. A set of boundary conditions for justifiable respect for conscientious objection in medicine is proposed. (shrink)

This paper makes two main claims: first, that the need to protect health professionals' moral integrity is what grounds the right to conscientious objection in health care; and second, that for a given claim of conscientious objection to be acceptable to society, a certain set of criteria should be fulfilled. The importance of moral integrity for individuals and society, including its special role in health care, is advocated. Criteria for evaluating the acceptability of claims to conscientious objection are outlined. The (...) precise content of the criteria is dictated by the two main interests that are at stake in the dilemma of conscientious objection: the patient's interests and the health professional's moral integrity. Alternative criteria proposed by other authors are challenged. The bold claim is made that conscientious objection should be recognised by society as acceptable whenever the five main criteria of the proposed set are met. (shrink)

Objective: To explore the ways in which health care practitioners working within the morally contested area of prenatal screening balance their professional and private moral values.Design: Qualitative study incorporating semistructured interviews with health practitioners followed by multidisciplinary discussion groups led by a health care ethicist.Setting: Inner city teaching hospital and district general hospital situated in South East England.Participants: Seventy practitioners whose work relates directly or indirectly to perinatal care.Results: Practitioners managed the interface between their professional and private moral values in (...) a variety of ways. Two key categories emerged: “tolerators”, and “facilitators”. The majority of practitioners fell into the “facilitator” category. Many “facilitators” felt comfortable with the prevailing ethos within their unit, and appeared unlikely to feel challenged unless the ethos was radically challenged. For others, the separation of personal and professional moral values was a daily struggle. In the “tolerator” group, some practitioners sought to influence the service offered directly, whereas others placed limits on how they themselves would contribute to practices they considered immoral.Conclusions: The “official” commitment to non-directiveness does not encourage open debate between professionals working in morally contested fields. It is important that practical means can be found to support practitioners and encourage debate. Otherwise, it is argued, these fields may come to be staffed by people with homogeneous moral views. This lack of diversity could lead to a lack of critical analysis and debate among staff about the ethos and standards of care within their unit. (shrink)

Objective To examine medical students’ views on conscientious objection and controversial medical procedures.Methods Questionnaire study among Norwegian 5th and 6th year medical students.Results Five hundred and thirty-one of 893 students responded. Respondents object to a range of procedures not limited to abortion —notably euthanasia, ritual circumcision for boys, assisted reproduction for same-sex couples and ultrasound in the setting of prenatal diagnosis. A small minority would object to referrals for abortion. In the case of abortion, up to 55% would tolerate conscientious (...) refusals, whereas 42% would not. Higher proportions would tolerate refusals for euthanasia or ritual circumcision for boys.Discussion A majority of Norwegian medical students would object to participation in euthanasia or ritual circumcision for boys. However, in most settings, many medical students think doctors should not be able to refuse participation on grounds of conscience. A minority would accept conscientious refusals for procedures they themselves do not object to personally. Most students would not accept conscientious refusals for referrals.Conclusions Conscientious objection remains a live issue in the context of several medical procedures not limited to abortion. Although most would want a right to object to participation in euthanasia, tolerance towards conscientious objectors in general was moderate or low. (shrink)

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)