La objeción de conciencia en el ámbito clínico. Propuesta para un uso apropiado (I)

Abstract

Social changes and new technologies have brought new problems in doctor-patient relationships. In many clinical contexts conscientious objection is misused, with negative effects for patients, healthcare professionals and institutions. The paper aims to clarify what conscientious objection means in a plural society based on a deliberative democracy and to show the different ways of understanding this society in order to respect both the ethical reasons of individuals and the compulsory normative framework of the Rule of Law. Furthermore, the paper identifies some clinical settings where conscientious objection is often invoked by healthcare professionals, and points out and analyses the arguments that explain why this appeal for conscientious objection is neither legitimate nor correct. Finally, it provides examples of the legal basis and Spanish jurisprudence, as well as the relevant clinical and ethical literature on this topic.

Guidelines for conscientious objection in Spain: a proposal involving prerequisites and protocolized procedure

“…CO starts and ends with the specific clinical situation to which objection is raised. Furthermore, medical professionals should exercise CO without being influenced by decisions made in the past [ 2 , 11 ]. The professional may revoke status as an objector at any point at which the specific situation no longer leads to a true internal and moral conflict.…”

“…Conscientious objection (CO) is the refusal to perform acts or services on ethical or religious grounds [ 1 ]. Therefore, in medicine CO occurs when a healthcare worker refuses to fulfill a professional duty required by law, regulations, institutional protocols, and/or court orders, citing a conflict with personal values, ideas, and/or beliefs [ 2 – 11 ]. In CO, the objector acknowledges the requirement imposed by the authority (and that this obligation is binding) but believes that his or her individual values should prevail in the specific case presented [ 11 ].…”

“…On the other hand, in the use of CO in health care began in 1985, when abortion was decriminalized [ 19 , 20 ]. Since that time, steadily increasing complexity of clinical practice [ 2 ] and technological advancements have generated interest in applying CO to a broader range of clinical situations, such as the limitation of therapeutic efforts, facilitated palliation during end-of-life care, rejection of life-sustaining therapies by patients, proper handling of human embryos and stem cells and others. As a result, CO in Spain is gaining acceptance among healthcare professionals as an ethical and legal right.…”

“…From a legislative standpoint, CO is regulated in two Spanish laws: national law that governs CO for healthcare workers is in the Spanish Public Act 2/2010 on Sexual and Reproductive Health and Voluntary Interruption of Pregnancy [ 26 ] and Organic Law 3/2021 for the Regulation of Euthanasia [ 21 ]. On the other hand, several regional governments in Spain include CO in legislation pertaining to advance directives: Madrid, Valencia, Extremadura, the Balearic Islands, Murcia and La Rioja [ 2 , 27 ] (see Table 1 ).…”

Objeción de conciencia: entre libertades y derechos

“…La Objeción de Conciencia Individual en la legislación de Chile se interpreta como el esfuerzo realizado en búsqueda de la "armonización y garantía de ambos bienes: conciencia individual y leyes democráticas" categoría propuesta por Couseiro y col. 8 , frente a la constatación de las diversas visiones valóricas que deben convivir en un estado de derecho.…”