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1.
Acta Biomed ; 93(4): e2022279, 2022 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-36043952

RESUMO

The Italian Supreme Court ruling no. 18901 of May 13, 2021 has determined that doctors who are opposed to abortion can refuse to perform it on grounds of conscience, but such a refusal does not exempt them from providing assistance to the woman before and after the procedure itself. The legalization of abortion should be considered within a broader strategy to put an end to underground and unsafe abortions, to raise awareness and enhance reproductive education and accessibility to contraceptive methods. The authors have set out to briefly analyze the legal and ethical complexities inherent in the effort to reconcile women's reproductive autonomy and freedom of choice with conscience-based refusal on the part of numerous healthcare professionals. Such an apparent conflict highlights the need for an ethically tenable solution that takes into account the dignity of unborn children, based on the conviction of many healthcare professionals primarily based on moral and religious tenets, that life begins at conception as well as the reproductive freedom and autonomy of women.


Assuntos
Consciência , Recusa do Médico a Tratar , Feminino , Pessoal de Saúde , Humanos , Itália , Princípios Morais , Gravidez
2.
BMJ Open ; 12(7): e053880, 2022 07 27.
Artigo em Inglês | MEDLINE | ID: mdl-35896293

RESUMO

INTRODUCTION: Conscience is central to moral decision making. In the context of morally pluralistic workplaces today, healthcare professionals' conscience may prompt them to make moral decisions to refrain from providing services they morally disagree with. However, such decisions are largely viewed as contentious, giving rise to polarising arguments for and against healthcare professionals' freedom of conscience. Yet, little work has been done to understand and support healthcare professionals' conscience. Instead, the rising polarity related to healthcare professionals' freedom of conscience stems from a central lack of understanding of what conscience is and the relevance it holds for healthcare professionals' clinical practice. Therefore, the degree and extent to which healthcare professionals are supported to understand and use their conscience is unknown. The objective of this review is to critically analyse the scholarly evidence available to ascertain the effectiveness of interventions that support healthcare professionals to understand and use their conscience in care practice. METHODS AND ANALYSES: At least two reviewers will systematically review 10 interdisciplinary, scholarly databases to examine qualitative, quantitative and mixed-methods studies including clinical trials pertaining to interventions related to conscience for healthcare professionals. Databases to be searched include: the Cochrane Controlled Register of Trials, Medline, EMBASE, PsycINFO, Cumulative Index for Nursing and Allied Health Literature (CINAHL), Academic Search Complete, ATLA Religion Database, Religion and Philosophy Collection, PhilPapers and Scopus. Databases were searched in May 2021. Study screening, selection, extraction and risk of bias assessments on each study using the Mixed Methods Appraisal Tool will be independently conducted by independent reviewers. Descriptive data synthesis will be carried out. Statistical analysis and meta-analysis will be conducted as relevant, based on homogeneity of findings. The quality of the aggregate evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluations criteria. ETHICS AND DISSEMINATION: Ethical approval is not required for this review. This protocol will not involve individual patient information endangering participant rights. The results will be reported in a peer-reviewed journal and disseminated at conferences. PROSPERO REGISTRATION NUMBER: CRD42021256943.


Assuntos
Consciência , Pessoal de Saúde , Atenção à Saúde , Humanos , Metanálise como Assunto , Prática Profissional , Literatura de Revisão como Assunto , Local de Trabalho
3.
J Int Bioethique Ethique Sci ; 33(1): 107-118, 2022.
Artigo em Francês | MEDLINE | ID: mdl-35723992

RESUMO

From the problem of the increase in the price of diesel by a few cents (cf. the movement of the Yellow Vests), we have moved on to the political question of the economic impact of the ecological transition on the middle and especially vulnerable social classes. In this same national debate in 2018, among the 32 questions asked was that of secularism. The environmental question is resolutely bioethical coupled with other concepts including freedom of conscience. It recalls the Rawlsian question of “how to live together?”. It is an integral part of the ongoing political programs for the 2022 presidential elections. How to debate and engage the citizen in bioethical and sustainable development discussions?


Assuntos
Consciência , Secularismo , Liberdade , Humanos , Política
5.
J Med Philos ; 47(1): 54-71, 2022 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-35137174

RESUMO

"Intervention" is not synonymous with "care." For an intervention to constitute care-which patients should have a right to access-it must be technically feasible and licit. Now these criteria do not prove sufficient; numerous archaic interventions remain feasible and legally permissible, yet are now bywords for spurious care. Therefore, we propound another necessary condition for an intervention to become care: the physician must rationally judge the intervention to be conducive to the patient's good. Consequently, the right of access-to-care relies on physicians being free to practice medicine in accord with their consciences, conscience being the rational faculty with which they judge the reasonableness of even mundane medical decisions. Since physicians operate as part of a community, it is further necessary to consider when central bodies may reasonably compel physicians to engage in interventions that the physician believes are not consistent with the patient's good and/or are not congruent with the purposes of medicine.


Assuntos
Consciência , Médicos , Humanos
6.
J Bioeth Inq ; 19(2): 255-264, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35103900

RESUMO

In complex, pluralistic societies, different views concerning the moral duties of healthcare professionals inevitably exist: according to some accounts, doctors can and should cooperate in performing abortion or physician-assisted suicide, while according to others they should always defend human life and protect their patients' health. It is argued that the very plurality of responses presently given to questions such as these provides a liberal argument in favour of conscientious objection (CO), as an attempt to deal with moral diversity by protecting both the professionals' claim to moral integrity and the patients' claim to receive lawful and safe medical treatments. A moderate view on CO is defended, according to which none of these claims can be credited with unconditional value. Claims to CO by healthcare professionals can be justified but must be subjected to a reasonableness standard. Both the incompatibility of CO with the medical profession and its unconditional sanctioning by conscience absolutism are therefore rejected. The paper contributes to the definition of the conditions of such reasonableness, particularly by stressing the role played by conceptions of good medicine in discriminating claims to CO; it is argued that respecting these conditions prevents from having the negative consequences dreaded by critics. The objection according to which accepting the physician's duty to inform and refer is inconsistent with the professed value of moral integrity is also discussed.


Assuntos
Consciência , Recusa do Médico a Tratar , Atenção à Saúde , Feminino , Humanos , Obrigações Morais , Princípios Morais , Gravidez
7.
Nurs Health Sci ; 24(1): 265-273, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35061324

RESUMO

The study aimed to explore the conditions that accompany conflict of conscience experienced by nurses in intensive care units. A qualitative approach guided the study, which was undertaken between April 2020 and April 2021. A total of 15 registered nurses working in intensive care units were recruited through purposive sampling. Individual semistructured interviews were conducted. The data were analyzed using a qualitative content analysis. The analysis revealed two themes: "conflict of conscience in relation to the structure" and "conflict of conscience based on context." Conflict of conscience in relation to the structure consisted of two categories: conflict of interest and conflict of conscience and law. Conflict of conscience based on context consisted of two categories: care dilemmas and arbitrary behaviors with end-stage patients. A variety of factors were accompanied by a conflict of conscience for nurses in intensive care units. Given that conflict of conscience has negative consequences for the health and quality of nursing care, health care managers need to tailor strategies to reduce the negative consequences considering the findings of the study.


Assuntos
Enfermeiras e Enfermeiros , Cuidados de Enfermagem , Consciência , Humanos , Unidades de Terapia Intensiva , Pesquisa Qualitativa , Caminhada
8.
Appl Nurs Res ; 63: 151554, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35034704

RESUMO

BACKGROUND: Healthcare workers experience morally stressful situations during delivery of care which may trouble their conscience. Literature emerging in the context of global pandemics suggest increased frequency of morally stressful situations in healthcare and a link with negative outcomes such as attrition and burnout. Little is known about the emerging concept of stress of conscience which could provide a meaningful way to highlight and address these morally stressful situations in healthcare. AIM: The aim of this scoping review was to provide an overview of the literature on, (i) the extent, (ii) the factors associated, and (iii) the interventions to prevent or mitigate stress of conscience among healthcare workers. DESIGN: The study was guided by the framework provided by Arksey and O'Malley in 2005 and the PRISMA Guidelines. Relevant healthcare databases were searched in November 2020 to identify relevant studies. RESULTS: The search identified 24 studies for inclusion in the analysis, 19 of these were from Nordic countries, particularly Sweden. Across those studies, stress of conscience was prevalent among healthcare workers and the levels varied with demographic factors, individual personalities, perceptions of belonging and the workplace culture and environment. Stress of conscience was associated with negative outcomes such as burnout, moral burden, workplace stress, and low quality of care. Although there were few quality interventions studies, facilitating healthcare workers to provide person-centred care appears to be a promising intervention. CONCLUSIONS: The concept of stress of conscience provides a contemporary framework to assess, highlight and discuss the degree of the negative impact of perceived violations of professional and personal values in healthcare. However, the limited studies suggest that exploring stress of conscience, including trials of potential interventions, particularly beyond Nordic countries is essential to fill the gaps in the literature.


Assuntos
Esgotamento Profissional , Consciência , Atitude do Pessoal de Saúde , Pessoal de Saúde , Humanos , Suécia
9.
Bioethics ; 36(4): 374-380, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35080778

RESUMO

The deliverances of our conscience are heartfelt, but not necessarily reason-based, moral convictions that concern our own behaviour. The fact that conscientious objections to a regulation, like a prohibition or obligation, express a heartfelt conviction that it is morally wrong to comply or morally permissible not to comply with the regulation provides a moral reason to respect the conviction because failing to do so is likely to cause objectors considerable suffering. But for conscientious objections to succeed in justifying exempting objectors from complying with the regulation, the suffering caused by forcing compliance must outweigh the suffering produced by exempting them from compliance. In the case of obligations, this necessitates that others with a similar competence are available to replace them. Conscientious objectors can never justifiably demand to be granted exemptions. This takes acts of generosity made feasible by favourable circumstances, such as the availability of replacements.


Assuntos
Consciência , Princípios Morais , Humanos , Recusa do Médico a Tratar
10.
Rev. chil. neuropsicol. (En línea) ; 16(1): 28-36, ene. 2022.
Artigo em Espanhol | LILACS | ID: biblio-1362112

RESUMO

La craneotomía con paciente despierto (CPD) demanda un manejo multidisciplinario particular debido al componente de conciencia transoperatoria que aporta beneficios en la resección tumoral y preservación neurológica, pero también implica el manejo de los riesgos asociados a la necesidad de cooperación del paciente durante el procedimiento. En este trabajo se describen los beneficios y las complicaciones en pacientes operados bajo la modalidad de CPD. Además, se abordan los retos documentados tanto para el equipo profesional a cargo, como para los pacientes, los cuales tienen un rol activo durante la cirugía. En ese sentido, se exponen los criterios para la selección, preparación psicológica y neuropsicológica tanto previo como durante la cirugía. A su vez, se proponen las consideraciones para lograr un procedimiento exitoso y evitar las posibles secuelas psicológicas a largo plazo, como insumos para la protocolización de este tipo de procedimientos con base en nuestra experiencia.


Awake craniotomy (AC) requires a multidisciplinary management due to trans operative awareness, which benefits the tumor resection and neurologic preservation, but it also implies risks for the patient cooperation during the procedure. This article describes the benefits and complications in patients operated under AC. Besides, it approaches the documented challenges for both the professional team and patients, who have an active role during surgery. In this regard, the criteria for selection and psychological and neuropsychological preparation before and during surgery are set out. It suggests considerations to achieve a successful procedure and to avoid possible long- term psychological sequelae, as a resource for the protocol of this type of procedures based on our experience.


Assuntos
Humanos , Vigília , Procedimentos Neurocirúrgicos/métodos , Craniotomia/métodos , Período Pós-Operatório , Cooperação do Paciente , Consciência
11.
Psychol Health Med ; 27(2): 496-502, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35000512

RESUMO

This study sought to determine the effect of health anxiety levels experienced by Turkish nurses upon their perceptions of conscience during COVID-19. The study was a cross-sectional study involving nurses working in X Hospital (n:207). The study data were collected using Personal Information Form, Health Anxiety Inventory, and Perception of Conscience Scale. The average total Health Anxiety Inventory score was 15.34 ± 5.93 (low). The mean total Perception of Conscience Scale score was 65.67 ± 10.27 (high). The independent variables were effective on perception of conscience at an effect size of 0.11.


Assuntos
COVID-19 , Enfermeiras e Enfermeiros , Ansiedade/epidemiologia , Consciência , Estudos Transversais , Humanos , SARS-CoV-2 , Inquéritos e Questionários
12.
J Med Ethics ; 48(8): 547-550, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34233957

RESUMO

In this paper, we argue that providers who conscientiously refuse to provide legal and professionally accepted medical care are not always morally required to refer their patients to willing providers. Indeed, we will argue that refusing to refer is morally admirable in certain instances. In making the case, we show that belief in a sweeping moral duty to refer depends on an implicit assumption that the procedures sanctioned by legal and professional norms are ethically permissible. Focusing on examples of female genital cutting, clitoridectomy and 'normalizing' surgery for children with intersex traits, we argue that this assumption is untenable and that providers are not morally required to refer when refusing to perform genuinely unethical procedures. The fact that acceptance of our thesis would force us to face the challenge of distinguishing between ethical and unethical medical practices is a virtue. This is the central task of medical ethics, and we must confront it rather than evade it.


Assuntos
Consciência , Recusa do Médico a Tratar , Criança , Ética Médica , Feminino , Humanos , Masculino , Obrigações Morais , Princípios Morais
13.
J Pediatr ; 240: 272-279, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34547338

RESUMO

Within pediatric graduate medical education, the care of transgender youth presents opportunities for deepening learners' understanding of equity, access, the role of the physician as an advocate, and health disparities caused by stigma and minority stress. However, when a pediatric resident objects to providing health care to this uniquely vulnerable population owing to their personal beliefs and values, how should pediatrician-educators respond? Important reasons to respect healthcare professionals' conscience have been described in the scholarly literature; however, equally important concerns have also been raised about the extent to which conscientious objection should be permitted in a pluralistic society, particularly given power differentials that favor healthcare professionals and grants them a monopoly over certain services. In the context of medical education, however, residents are in a unique position: they are simultaneously learners and employees, and although privileged relative to their patients, they are also vulnerable in relation to the hierarchy of healthcare and of institutions. We must find a compassionate balance between nurturing the evolving conscience of students and trainees and protecting the health and well-being of our most vulnerable patients. Educators have an obligation to foster empathy, mitigate bias, and mentor their learners, regardless of beliefs, but in some cases, they may recognize that there are limits: patients' welfare ultimately takes precedence and trainees should be guided toward alternative career paths. We explore the limits of conscientious objection in medical training and propose a framework for pediatrician-educators to support learners and patients in challenging circumstances.


Assuntos
Atitude do Pessoal de Saúde , Pediatria/educação , Recusa do Médico a Tratar , Pessoas Transgênero , Consciência , Humanos , Internato e Residência , Populações Vulneráveis
14.
J Med Ethics ; 48(8): 517-521, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34127526

RESUMO

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.


Assuntos
Consciência , Suicídio Assistido , Austrália , Humanos , Corpo Clínico Hospitalar , Princípios Morais , Recusa do Médico a Tratar
15.
J Clin Nurs ; 31(5-6): 612-622, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34145671

RESUMO

AIM: To determine the associations between person-centred care (PCC) and job strain, stress of conscience and intent to leave among healthcare professionals in Swedish hospital departments. BACKGROUND: Hospitals have experienced difficulty in retaining qualified healthcare personnel. Previous studies have shown that working in a person-centred environment could offset this challenge, but research is scarce. DESIGN: A cross-sectional survey design using the STROBE checklist. METHODS: Healthcare professionals (n = 94) in six hospital departments in Sweden completed a survey measuring perceived PCC, job strain, stress of conscience and intent to leave. Data were collected from April 2019 to April 2020. Bivariate analysis was used to describe the sample and correlations between the explanatory variables and perceived PCC and its subscales. Regression analyses were performed to explore the associations between perceived PCC and job strain, stress of conscience and intent to leave. RESULTS: The organisational and environmental support subscale of perceived PCC showed significant correlations with all explanatory variables, while the extent of personalising care subscale only correlated with job strain and intent to leave. The regression analyses showed that higher perceived PCC was associated with higher job strain, less stress of conscience and less intent to leave. CONCLUSION: Higher perceived PCC is associated with work-related factors in hospital departments. There is scope for further research in this area.


Assuntos
Consciência , Satisfação no Emprego , Estudos Transversais , Humanos , Assistência Centrada no Paciente , Reorganização de Recursos Humanos , Recursos Humanos em Hospital , Inquéritos e Questionários
16.
J Med Ethics ; 48(8): 530-533, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34103367

RESUMO

One of the many problems posed by the collective effort to tackle COVID-19 is non-compliance with restrictions. Some people would like to obey restrictions but cannot due to their job or other life circumstances; others are not good at following rules that restrict their liberty, even if the potential consequences of doing so are repeatedly made very clear to them. Among this group are a minority who simply do not care about the consequences of their actions. But many others fail to accurately perceive the harms that they might be causing. One of the main reasons for this is that the harms done by transmitting COVID-19 to someone else are morally distant from the agent, particularly in cases where infection is asymptomatic. In this paper, I describe seven different aspects of moral distance in the context of COVID-19, explore how they affect (lack of) motivation to obey restrictions, and suggest several ways in which such moral distance can be reduced - primarily through enhanced-contact tracing that makes it clear to individuals and the public precisely who they could be harming and how.


Assuntos
COVID-19 , Consciência , Busca de Comunicante , Liberdade , Humanos , Princípios Morais
17.
Bioethics ; 36(1): 63-70, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34464461

RESUMO

The debate over whether the medical profession should accommodate its members' conscientious objections (COs) has raged on in the bioethics literature and on legislative floors for decades. Unfortunately, participants on all sides of the debate fail to distinguish among different types of CO, a failure that obstructs the view of which cases warrant accommodation and why. In this paper, we identify one type of CO that warrants consideration for accommodation, called Nature of Medicine COs (NoMCOs). NoMCOs involve the refusal of physicians to perform actions they reasonably judge to be contrary to the nature of medicine and their professional obligations. We argue that accommodating NoMCOs can be justified based on the profession's need to preserve reformability. Importantly, this previously underdeveloped position evades some of the concerns commonly raised by opponents of CO accommodations.


Assuntos
Consciência , Médicos , Humanos , Recusa do Médico a Tratar
18.
Scand J Caring Sci ; 36(1): 131-141, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33734472

RESUMO

BACKGROUND: Studies points to that levels of stress of conscience and burnout among staff in healthcare contexts may seriously affect their health. AIM: To compare assessments and associations of stress of conscience, perceptions of conscience, social support and burnout amongst care providers working in home care respectively residential care for older people. METHODS: This cross-sectional descriptive comparative study was performed among all care providers working in home care (n = 227) and residential care of older people (n = 354) in a municipality in northern Sweden. Data was collected using four different questionnaires. Analysis were performed using partial least square regression, descriptive statistics, statistical tests and effect size measures. RESULTS: Care providers in residential care of older people assessed higher levels of stress of conscience compared to those working in home care. Exhaustion was an important predictor for belonging to the group of care providers working in residential care of older people. The most important predictor for belonging to the group of care providers working in home care were social support from one's immediate superior and co-workers. Women assessed significantly higher levels of stress of conscience and exhaustion compared to men. CONCLUSION: Further research seems needed to investigate what the high levels of stress of conscience is caused by. A combined intervention consisting of work-directed measures against burnout and measures aiming at reducing stress of conscience is suggested.


Assuntos
Esgotamento Profissional , Serviços de Assistência Domiciliar , Idoso , Consciência , Estudos Transversais , Feminino , Humanos , Masculino , Apoio Social , Inquéritos e Questionários
19.
J Gerontol B Psychol Sci Soc Sci ; 77(2): 300-311, 2022 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-33959767

RESUMO

OBJECTIVES: The current study examined within-person associations of self-reports of impaired current memory functioning and perceived decline with depressive symptoms in older adults without cognitive impairment, and whether these associations were moderated by individuals' levels of neuroticism, conscientiousness, and extraversion. METHODS: Samples were drawn from the Einstein Aging Study, Rush Memory and Aging Project (MAP), Minority Aging Research Study (MARS), Health and Retirement Study (HRS), and National Health and Aging Trends Study (NHATS), with over 8,000 participants (65+ years) included across data sets. In a series of coordinated analyses, multilevel linear models tested within-person relationships over periods of up to 22 years. RESULTS: Across HRS and NHATS samples, self-reports of impaired current memory functioning covaried with depressive symptoms over time. This association was moderated by neuroticism, such that the association was stronger for individuals with higher levels of neuroticism. Across all samples, perceived memory decline covaried with depressive symptoms over time. This association was moderated by neuroticism in MAP/MARS, HRS, and NHATS, such that the association was stronger for individuals with higher levels of neuroticism. DISCUSSION: Self-reports of impaired current memory functioning and perceived memory decline are important determinants of older adults' psychological well-being. In our results, at times when older adults perceive poorer memory functioning or decline, they also tend to report more depressive symptoms. Further, results from two larger data sets suggest that individuals' level of neuroticism may determine the extent to which self-reports of memory impairment and depressive symptoms covary over time.


Assuntos
Depressão , Autoavaliação Diagnóstica , Transtornos da Memória , Determinação da Personalidade , Idoso , Variação Biológica Individual , Cognição , Consciência , Correlação de Dados , Depressão/diagnóstico , Depressão/psicologia , Extroversão Psicológica , Feminino , Humanos , Masculino , Transtornos da Memória/diagnóstico , Transtornos da Memória/psicologia , Neuroticismo , Autoimagem
20.
Bioethics ; 36(1): 54-62, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34599825

RESUMO

Schuklenk, Smalling, and Savulescu put forth four conditions that delineate when conscientious objection is impermissible. Roughly, they argue for the following claim: if some practice is legal, standard, expected of a profession, and in the patient's interest, then medical professionals cannot refuse to perform the practice. In this essay, I argue that these conditions are not jointly sufficient to deny medical professionals the ability to refuse to perform procedures that detract from a patient's health. They are insufficient to bar medical refusals to perform certain practices because, even when these conditions are met, non-health conducive practices would not be open to refusal by the physician. I provide an example of a non-health conducive practice female genital mutilation, which meets all of the proposed conditions but, intuitively, should be open to medical refusals. As a result, I conclude that the proposed conditions are insufficient to determine when conscientious objection is impermissible. I then offer an amendment to their position by suggesting that a practice, in addition to the other four conditions, must also be health conducive in order to remove the medical professional's ability to refuse to perform the practice.


Assuntos
Consciência , Médicos , Feminino , Humanos , Recusa do Médico a Tratar
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