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1.
BMC Med Ethics ; 23(1): 107, 2022 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-36329466

RESUMO

BACKGROUND: While healthcare professionals' right to invoke the conscience clause has been recognised as a fundamental human right, it continues to provoke a heated debate in Polish society. Although public discourse is filled with ethical and legal considerations on the conscience clause, much less is known about the attitudes of healthcare professionals regarding that matter. The aim of this study was therefore to describe the attitudes of Polish physicians, nurses and pharmacists towards the ethical and legal aspects of the conscience clause. METHODS: We analysed a group of three hundred healthcare professionals: physicians, nurses and pharmacists in Poznan, Poland, using a standard questionnaire comprising of 29 questions about various ethical and legal aspects of the conscience clause and participants' personal experiences with the conscience clause. The study was conducted between January and March 2020. RESULTS: This research shows that although most Polish healthcare workers support the right to invoke the conscience clause they differ significantly in their opinions on to whom and to what medical procedures the conscience clause should apply to. It also demonstrated that while the conscience clause is rarely invoked in Poland, most healthcare professionals declare that the current legal regulations in that sphere are unclear and inaccurate. CONCLUSIONS: While there is an urgent need to raise the awareness regarding the conscience clause among medical students and healthcare professionals and educate them about such issues, it is even more important to improve the legal system in regard to the CC so that it protects both HCPs' right to the CC and safeguards patients' rights to medical services.


Assuntos
Consciência , Médicos , Humanos , Polônia , Farmacêuticos , Atitude , Recusa do Médico a Tratar
2.
Artigo em Espanhol | IBECS | ID: ibc-209997

RESUMO

A Replication Randomized Controlled Trial of an Awareness, Courage, and Love Intervention. The objective of this study was to evaluate the effectiveness of a one session online intervention based on the Awareness, Courage and Love Model from Functional Analytic Psychotherapy to promote intimacy in couples during the COVID-19 pandemic. A sample of seventeen couples (dyads) from Argentina, older than 18 years old that were cohabitating in a situation of social distancing during the COVID-19 were randomly allocated into either the intervention or control group for a single 2-hour online group session. Both groups responded to two instruments that assessed the studied variables in three moments (pre, post and follow up). For data analysis it was used Generalized Estimation Equations to compare the change scores over time between the groups. The experimental group obtained a higher score in the VDs and the differences were maintained at one week of follow-up. The preliminary findings support the efficacy of this short intervention to foster closeness and intimacy in couples during situations of social isolation (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Psicoterapia , Consciência , Coragem , Amor , Eficácia
4.
AMA J Ethics ; 24(9): E906-912, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-36170425

RESUMO

The US Supreme Court overturned Roe v Wade in June 2022, and now each state's legislature will decide if and when its citizens will have legal access to abortion care and if and when its physicians will be criminalized for providing what is considered to be the standard of care by multiple health-related organizations. This extraordinary change in the medico-legal landscape requires reevaluation of health profession codes of ethics related to clinician conscience. This article argues that these codes must now be expanded to address 2 newly critical areas: physician advocacy to make abortion illegal and affirmative protection for "conscientious provision" in hostile environments on par with protection of conscientious refusal.


Assuntos
Aborto Legal , Consciência , Atenção à Saúde , Feminino , Instalações de Saúde , Humanos , Gravidez , Recusa do Médico a Tratar
6.
J Med Philos ; 47(4): 549-557, 2022 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-35920746

RESUMO

The past decade has seen a burgeoning of scholarly interest in conscientious objection in health care. Specifically, several commentators have discussed the implications that conscientious objection has for the delivery of timely, efficient, and nondiscriminatory medical care. In this paper, I discuss the main argument put forward by the most prominent critics of conscientious objection-what I call the Professional Duty Argument or PDA. According to proponents of PDA, doctors should place patients' well-being and rights at the center of their professional practice. Doctors should be prepared to set their personal moral or religious beliefs aside where these beliefs conflict with what is legal and considered good medical practice by relevant professional associations. Conscientious objection, on this account, should be heavily restricted, if even allowed at all. I discuss two powerful objections against PDA. The first objection, which I call the fallibility objection, notes that law and professional codes of conduct are fallible guides for ethical conduct and that conscientious objection has in the past and continues today to provide a check on aberrations in law and professional convention. The second, which I call the professional discretion objection, states that restrictions on conscientious objection undermine one of the cornerstones of good medical practice, namely, a practitioner's right to independent professional judgment. I argue that these two objections give us reason to retain conscience clauses in professional codes of conduct.


Assuntos
Consciência , Recusa do Médico a Tratar , Humanos , Dissidências e Disputas , Atenção à Saúde , Princípios Morais
7.
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
8.
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
9.
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
10.
Nurs Ethics ; 29(7-8): 1615-1633, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35575202

RESUMO

BACKGROUND: Conscientious objection is a person's refusal to fulfill a legal duty due to their ethical values, religious beliefs, or ideological affiliations. In nursing, it refers to a nurse's refusal to perform an action or participate in a particular situation based on their conscience. Conscientious objection has become a highly contested topic in recent years. RESEARCH OBJECTIVES: This study had four objectives: (1) eliciting information on how Turkish nurses perceive conscientious objection, (2) revealing whether their moral beliefs affect the care they provide, (3) determining their experiences with conscientious objection, and (4) identifying existing or potential issues of conscientious objection. RESEARCH DESIGN: This qualitative study collected data through semi-structured interviews. The data were analyzed using thematic content analysis. PARTICIPANTS: The sample consisted of 21 nurses. ETHICAL CONSIDERATIONS: The study was approved by an ethics committee. Confidentiality and anonymity were guaranteed. Participation was voluntary. FINDINGS: The analysis revealed four themes: (1) universal values of nursing (professional values), (2) experiences with conscientious objection (refusing to provide care/not providing care), (3) possible effects of conscientious objection (positive and negative), and (4) scope of conscientious objection (grounded and groundless). CONCLUSION: Participants did not want to provide care due to (1) patient characteristics or (2) their own religious and moral beliefs. Participants stated that conscientious objection should be limited in the case of moral dilemmas and accepted only if the healthcare team agreed on it. Further research is warranted to define conscientious objection and determine its possible effects, feasibility, and scope in Turkey.


Assuntos
Consciência , Enfermeiras e Enfermeiros , Humanos , Princípios Morais , Pesquisa Qualitativa , Turquia
12.
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
13.
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
14.
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
15.
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
16.
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
17.
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
18.
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
19.
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
20.
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
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