Protection of Conscience Project, Powell River, Canada,
J Bioeth Inq. 2013 Oct;10(3):347-54. doi: 10.1007/s11673-013-9451-x. Epub 2013 Jun 21.
The widespread emergence of innumerable technologies within health care has complicated the choices facing caregivers and their patients. The escalation of knowledge and technical innovation has been accompanied by an erosion of moral and ethical consensus among health providers that is reflected in the abandonment of the Hippocratic Oath as the immutable bedrock of medical ethics. Ethical conflicts arise when the values of health professionals collide with the expressed wishes of patients or the dictates of regulatory bodies and administrators. Increasing attempts by groups outside of the medical profession to limit freedom of conscience for health providers has raised concern and consternation among some health professionals. The personal and professional impact of health professionals surrendering freedom of conscience and participating in actions they deem malevolent or unethical has not been adequately studied and may not be inconsequential when considering the recognized impact of other circumstances of coerced complicity. We argue that the distinction between the two ways that freedom of conscience is exercised (avoiding a perceived evil and seeking a perceived good) provides a rational basis for a principled limitation of this fundamental freedom.
医疗保健领域无数技术的广泛出现，使护理人员及其患者面临的选择更加复杂。知识和技术创新的不断升级，伴随着医疗服务提供者之间道德和伦理共识的侵蚀，体现在放弃希波克拉底誓言作为医学伦理不可动摇的基石。当卫生专业人员的价值观与患者的明确意愿或监管机构和行政人员的规定发生冲突时，就会出现伦理冲突。越来越多的医疗行业以外的团体试图限制卫生提供者的良心自由，这引起了一些卫生专业人员的关注和惊愕。卫生专业人员放弃良心自由并参与他们认为恶意或不道德的行动所产生的个人和职业影响尚未得到充分研究，在考虑到其他强迫共谋情况下的公认影响时，可能并非微不足道。我们认为，行使良心自由的两种方式（避免被认为是邪恶的行为和寻求被认为是好的行为）之间的区别为这种基本自由的有原则限制提供了合理的依据。
