Résumés
Abstract
In the light of current legislation on Medical Aid in Dying (MAiD; also known as euthanasia and assisted suicide) in different countries worldwide, there have been some arguments devoted to the right to conscientious objection for healthcare professionals in these specific practices. The goals of this scoping review are to provide an overview of the motivations and causes that lie behind conscientious objection identified by previous literature according to professionals’ experiences and to verify if these motives match with theoretical debates on conscientious objection. As the results show, there is a dissonance between the motivations included in the traditional and mainstream definition of conscientious objection used in theoretical and speculative frameworks and the actual factors that empirical studies note as reported motivations to object to MAiD. Hence, either we consider new factors to include as causes of “conscience”, or we accept that there are motivations that are not actually applicable to conscientious objection and should be addressed by other means. As conscientious objection to MAiD is multifaceted, there can be different kinds of motivations acting at the same time. It is thus pertinent to rebalance theoretical and empirical considerations to fully understand the complexity of the phenomenon and so provide insights on how to best deal with conscientious objection.
Keywords:
- conscientious objection,
- euthanasia,
- assisted suicide,
- medical aid in dying,
- causes
Résumé
À la lumière de la législation actuelle sur l’aide médicale à mourir (AMM; aussi appelée euthanasie et suicide assisté) dans différents pays du monde, certains arguments ont été consacrés au droit à l’objection de conscience pour les professionnels de la santé dans ces pratiques spécifiques. Les objectifs de cette étude exploratoire sont de fournir une vue d’ensemble des motivations et des causes qui se cachent derrière l’objection de conscience identifiée par la littérature précédente selon les expériences des professionnels et de vérifier si ces motivations correspondent aux débats théoriques sur l’objection de conscience. Comme le montrent les résultats, il existe une dissonance entre les motivations incluses dans la définition traditionnelle et courante de l’objection de conscience utilisée dans les cadre théoriques et spéculatifs et les facteurs réels que les études empiriques relèvent comme motivations déclarées pour s’opposer à l’AMM. Par conséquent, soit nous envisageons de nouveaux facteurs à inclure dans les causes de la “conscience”, soit nous acceptons qu’il existe des motivations qui ne sont pas réellement applicables à l’objection de conscience et qui devraient être traitées par d’autres moyens. L’objection de conscience à l’AMM étant multiforme, il peut y avoir différents types de motivations qui agissent en même temps. Il est donc pertinent de rééquilibrer les considérations théoriques et empiriques pour bien comprendre la complexité du phénomène et ainsi donner des pistes sur la meilleure façon de traiter l’objection de conscience.
Mots-clés :
- objection de conscience,
- euthanasie,
- suicide assisté,
- aide médicale à mourir,
- causes
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Parties annexes
Remerciements / Acknowledgements
Ce travail a été développé dans le cadre des projets de recherche suivants : CONFINES (code FD9/21_03), financé par le Programa de Ayudas a Proyectos de Investigación Científica 2021 (Fondation BBVA), et les projets INEDYTO (code PID2020-118729RB-I00), IEMYRhd (code PID2020-113413RB-C32), et INconRES (code PID2020 117219GB-I00), tous trois financés par le Ministère Espagnol de la Science et de l’Innovation. Iris Parra Jounou remercie l’Agence Espagnole de la Recherche pour son financement (code PID2019-105422GB-I00). Nous apprécions l’aide de Camila Higueras (Escuela Andaluza de Salud Pública) pour la stratégie de recherche, ainsi que le soutien du reste de l’équipe de recherche du projet CONFINES. Enfin, nous tenons à remercier les professeurs Amitabha Palmer et Michael Gordon pour leur perspicacité et leurs commentaires attentifs et le professeur Bryn Williams-Jones pour la correction.
This work was conducted in the context of the following research projects: CONFINES (code FD9/21_03), funded by the Programa de Ayudas a Proyectos de Investigación Científica 2021 (BBVA Foundation), and the projects INEDYTO (code PID2020-118729RB-I00), IEMYRhd (code PID2020-113413RB-C32), and INconRES (code PID2020 117219GB-I00), all three funded by the Spanish Ministry of Science and Innovation. Iris Parra Jounou thanks the Spanish Research Agency for her funding (code PID2019-105422GB-I00). We acknowledge the assistance of Camila Higueras (Escuela Andaluza de Salud Pública) with the research strategy, as well as the support of the rest of the research team of CONFINES Project. Finally, we want to thank Prof. Amitabha Palmer and Prof. Michael Gordon for their insights and careful comments, and Prof. Bryn Williams-Jones for the proofreading.
Bibliography
- 1. Lamb C, Evans M, Babenko-Mould Y, Wong C, Kirkwood K. Nurses’ use of conscientious objection and the implications for conscience. Journal of Advanced Nursing. 2019;75(3):594-602.
- 2. Haining CM, Keogh LA. ‘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. BMC Medical Ethics. 2021;22:149.
- 3. Koksvik G. Practical and ethical complexities of MAiD: Examples from Quebec. Wellcome Open Research. 2020;5:227.
- 4. Emanuel EJ. The history of euthanasia debates in the United States and Britain. Annals of Internal Medicine. 1994;121(10):793-802.
- 5. Dönhoff M, Jonas H, Merkel R, Hannum H, Hannum H. Not compassion alone: on euthanasia and ethics. Hastings Center Report. 1995;25(7):44-50.
- 6. Allert G, Blasszauer B, Boyd K, Callahan D. Special supplement: The goals of medicine: Setting new priorities. The Hastings Center Report. 1996;26(6):S1-27.
- 7. Emanuel EJ, Onwuteaka-Philipsen BD, Urwin JW, Cohen J. Attitudes and practices of euthanasia and physician-assisted suicide in the United States, Canada, and Europe. JAMA. 2016;316(1):79-90.
- 8. Sprung ChL, Somerville MA, Radbruch L, et al. Physician-assisted suicide and euthanasia: emerging issues from a global perspective. Journal of Palliative Care. 2018;33(4):197-203.
- 9. WMA [The World Medical Association]. 2019. Declaration on Euthanasia and Physician-Assisted Suicide. Adopted by the 70th WMA General Assembly.
- 10. Pellegrino E. Patient and physician autonomy: conflicting rights and obligations in the physician-patient Relationship. Journal of Contemporary Health, Law and Policy. 1994;10(1):47-68.
- 11. Pellegrino E. The physician’s conscience, conscience clauses, and religious belief: a catholic perspective. Fordham Urban Law Journal. 2002;30(1):221-44.
- 12. Fernandez Lynch H. Conflicts of Conscience in Health Care: An Institutional Compromise. Cambridge, Mass.: MIT Press; 2008.
- 13. Wicclair M. Conscientious Objection in Health Care. Cambridge: Cambridge University Press; 2011.
- 14. Triviño Caballero R. El peso de la conciencia. La objeción en el ejercicio de las profesiones sanitarias. Madrid: Plaza y Valdés-CSIC; 2014.
- 15. Childress JF. Appeals to conscience. Ethics. 1979;89(4):315-35.
- 16. Cowley C. A defence of conscientious objection in medicine: a reply to Schüklenk and Savulescu. Bioethics. 2017;30(5):358-64.
- 17. Savulescu J. Conscientious objection in medicine. British Medical Journal. 2006;332:294-97.
- 18. Savulescu J. The proper place of values in medicine. American Journal of Bioethics. 2007;7(12):21-2.
- 19. Sulmasy DP. What is conscience and why is respect for it so important? Theoretical Medicine and Bioethics. 2008;29:135-49.
- 20. Giubilini A. Objection to conscience: an argument against conscience exemptions in healthcare. Bioethics. 2016;31(5):400-8.
- 21. Hughes JA. Conscientious objection, professional duty and compromise: A response to Savulescu and Schüklenk. Bioethics. 2017;32(2):126-31.
- 22. Savulescu J, Schüklenk U. Doctors have no right to refuse medical assistance in dying, abortion or contraception. Bioethics. 2017;31:162-70.
- 23. Card RF. A New Theory of Conscientious Objection in Medicine. Justification and Reasonability. New York: Routledge; 2020.
- 24. Fleming V, Frith L, Luyben A, Ramsayer B. Conscientious objection to participation in abortion by midwives and nurses: a systematic review of reasons. BMC Medical Ethics. 2018;19:31.
- 25. Davis JM, Haining CM, Keogh LA. A narrative literature review of the impact of conscientious objection by health professionals on women’s access to abortion worldwide 2013-2021. Global Public Health. 2022;17(9):2190-205.
- 26. Shaw D, Gardiner D, Lewis P, et al. Conscientious objection to deceased organ donation by healthcare professionals. Journal of the Intensive Care Society. 2018;19(1):43-7.
- 27. Sethi A, Laha G, Raval R. Do physicians reserve the right to refuse treating patients on moral or personal beliefs? a scoping review, examining the extent of conscientious objection. Global Bioethics Enquiry. 2022;10(1):11-9.
- 28. Fujioka JK, Mirza MR, McDonald PL, Klinger CA. Implementation of medical assistance in dying: a scoping Review of health care providers’ perspectives. Journal of Pain and Symptom Management. 2018;55(6):1564-76.
- 29. Wernow JR, Gastmans C. A review and taxonomy of argument-based ethics literature regarding conscientious objections to end-of-life procedures. Christian Bioethics. 2010;16(3):274-95.
- 30. Arksey H, O’Malley L. Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology. 2005;8(1):19-32.
- 31. Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris A. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Medical Research Methodology. 2018;18:143.
- 32. Pham, MT, Rajić A, Greig JD, Sargeant JM, Papadopoulos A, McEwan SA. A scoping review of scoping reviews: Advancing the approach and enhancing the consistency. Research Synthesis Methods. 2014;5(4):371-85.
- 33. Tricco AC, Lillie E, Zarin W, et al. A scoping review on the conduct and reporting of scoping reviews. BMC Medical Research Methodology. 2016;16:15.
- 34. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:71
- 35. Van de Scheur A, van der Arend A. The role of nurses in euthanasia: a Dutch study. Nursing Ethics. 1998;5(6):497-508.
- 36. Bouthillier ME, Opatrny L. A qualitative study of physicians’ conscientious objections to medical aid in dying. Palliative Medicine. 2019;33(9):1212-20.
- 37. Dumont I, Maclure J. Objection de conscience et aide médicale à mourir: une étude qualitative auprès de médecins québécois / Conscientious objection to medical assistance in dying: a qualitative study with Quebec physicians. Canadian Journal of Bioethics / Revue canadienne de bioéthique. 2019;2(2):110-34.
- 38. Brown J, Goodridge D, Thorpe L, Crizzle A. ‘What is right for me, is not necessarily right for you’: The endogenous factors influencing nonparticipation in medical assistance in dying. Qualitative Health Research. 2021;31(10):1786-1800.
- 39. Haining CM, Keogh LA, Gillam LH. Understanding the reasons behind healthcare providers’ conscientious objection to voluntary assisted dying in Victoria, Australia. Journal of Bioethical Inquiry. 2021;18:277-89.
- 40. Attaran A. Commentary: The limits of conscientious and religious objection to physician-assisted dying after the Supreme Court’s decision in Carter v. Canada. Health Law in Canada. 2016;36(3):86-98.
- 41. Christie T, Sloan J, Dahlgren D, Koning F. Medical assistance in dying in Canada: An ethical analysis of conscientious and religious objections. BioéthiqueOnline. 2016;5:14.
- 42. Goligher EC. Six questions about physician-assisted death from a conscientious objector. The Linacre Quarterly, 2017;84(2):105-7.
- 43. Sumner LW. Conscientious refusal to provide medically assisted dying. University of Toronto Law Journal. 2020;71(1):1-31.
- 44. Leck E, Christie S, Barry T, Barry S. The preliminary opinion of Canadian spine surgeons on Medical Assistance in Dying (MAID); a cross-sectional survey of Canadian Spine Society (CSS) members. NASSJ. 2020;4:100037.
- 45. Caux C, Leclerc-Loiselle J, Lecomte J. L’objection de conscience des professionnels de la santé: une revue intégrative. Canadian Journal of Bioethics / Revue canadienne de bioéthique. 2021;4(2):25-35.
- 46. Morley G, Ives J, Bradbury-Jones C, Irvine F. What is ‘moral distress’? A narrative synthesis of the literature. Nursing Ethics. 2019;26(3):646-62.
- 47. Martins-Vale M, Pereira HP, Marina S, Ricou M. Conscientious objection and other motivations for refusal to treat in hastened death: a systematic review. Healthcare. 2023;11(15):2127.
- 48. Berlinger N. Conscience clauses, health care providers, and parents. Bioethics Briefings. 30 Jun 2023.
- 49. Giubilini A. Conscience. In: Zalta EN. The Stanford Encyclopedia of Philosophy; 2016/2022.
- 50. Dorff EN. End-of-life: Jewish perspectives. The Lancet. 2005;366(9490):862-65.
- 51. Engelhardt Jr HT. Smith Iltis A. End-of-life. The traditional Christian view. The Lancet. 2005;366(9490):1045-49.
- 52. Sachedina A. End-of-life: the Islamic view. The Lancet. 2005;366(9487):774-79.
- 53. Lauwers AS. Religion, secularity, culture? Investigating Christian privilege in Western Europe. Ethnicities. 2023;23(3):403-25.
- 54. Vallier K. The moral basis of religious exemptions. Law and Philosophy. 2016;35(1):1-28.
- 55. Corvino J. Is religion special?: Exemptions, conscience and the culture wars. In: Adenitire J, editor. Religious Beliefs and Conscientious Exemptions in a Liberal State. Cambridge: Hart Publishing; 2019. p. 13-29.
- 56. Walker MU. Moral Understandings. A Feminist Study in Ethics. New York: Routledge; 1998.
- 57. Macleod C. Taking a feminist relational perspective on conscience. In: Downie J, Llewellyn JJ, editors. Being Relational: Reflections on Relational Theory and Health Law. Vancouver: University of British Columbia Press; 2012. p.161-81.
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