An Official American Thoracic Society Policy Statement: Managing Conscientious Objections in Intensive Care Medicine

Abstract

This American Thoracic Society statement provides guidance for clinicians, hospital administrators, and policymakers to address clinicians' COs in the critical care setting.

Moral Distress Amongst American Physician Trainees Regarding Futile Treatments at the End of Life: A Qualitative Study

“…50 An example of a policy-oriented intervention includes a statement issued by the American Thoracic Society that addresses situations to which a clinician might morally object and seeks to establish institutional norms that allow for practitioners to personally excuse themselves from morally problematic situations. 51 These strategies, likely underutilized at many institutions, could be used to mitigate moral distress and loss of empathy during medical residency and fellowship training. This study describes experiences of moral distress amongst physician trainees in response to treatments administered at the end of life that they perceive to be futile.…”

Rationing conscience

“…17 However, some have argued that judgements about the futility of medical treatment represent professional judgements, and should not count as CO. 13 , ( p 6) A recent professional guideline on COs set aside the source or quality of beliefs to focus instead on actions that would be contrary to either personal or professional beliefs: CO (broad definition): Objections to providing legal, professionally accepted, and otherwise available medical services based on a clinician's judgment that to do what is requested would be morally wrong. 18 All of the above cases involved physicians' moral disagreement with allocation decisions. Some of them, though (cases 3 and 4), led to positive actions rather than to withholding treatment.…”

“…18 All of these could straightforwardly be applied to instances of professional disagreement about resource allocation. For example, the clinicians who resigned in case 2 clearly felt that their personal moral integrity was threatened by continuing to provide treatment.…”

“…While controlled allocation of scarce resources ('rationing') appears to be inevitable in health systems, 1 2 , ( pp [14][15][16][17][18][19] health professionals do not always agree about the right way to allocate those resources. [3][4][5] Those disagreements can take different forms.…”

Why conscientious objection merits respect

“…Analogously, if one finds PAD similarly unethical, providing a referral for PAD is highly objectionable and undermines one's moral integrity. Fifth, respect for conscientious objection upholds the moral integrity of physicians, 8,9 the foundation for society's confidence in the profession. Disregarding conscientious objection prioritizes moral conformity over moral integrity, undermining the trustworthiness of the profession.…”