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Presenter: Mark, Wicclair, Morgantown, United States
Authors: Mark Wicclair
Conscience-based refusal to participate in donation after cardiac death (DCD)
Mark Wicclair1,2
1Philosophy, West Virginia University, Morgantown, WV, United States, 2Center for Bioethics and Health Law, University of Pittsburgh, Pittsburgh, PA, United States
While conscientious objection has its historical roots in objections to military service, a growing number of health professionals have refused to provide a broad range of goods and services that violate their ethical beliefs. Such actions, clearly, can have a major impact on organ donation. Some ICU clinicians, for instance, have objected to participating in donation after cardiac death (DCD) because it is against their conscience. In this presentation, two extreme approaches to managing conscience-based objections to participating in DCD are identified and rejected and a more nuanced middle-ground is proposed.
One extreme is “conscience absolutism,” the view that clinicians should be exempted from performing any action, including participating in DCD, that is contrary to their conscience. The second extreme is the “incompatibility thesis,” the view that practitioners have an obligation to provide any good or service, including participating in DCD, that is legal, professionally accepted, and within the scope of their professional competence.
Neither of these extreme approaches is defensible. Conscience absolutism is indefensible because it fails to consider that clinicians have obligations to patients and their families, other professionals, institutions, and society. The incompatibility thesis is untenable because it fails to acknowledge the value of moral integrity, and it presupposes an indefensible conception of clinicians’ professional obligations.
An alternative to both extreme approaches is presented. It features the following guidelines: a) Clinicians should provide advance notification of a conscience-based objection to participating in DCD; b) accommodation should not result in a failure to inform surrogates of the DCD option in a timely manner; c) accommodation should not impede or unduly delay DCD; d) accommodation should not impose excessive burdens on other clinicians, administrators, or institutions.
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