Wilkinson Dominic
Camb Q Healthc Ethics. 2017 Jan;26(1):132-142. doi: 10.1017/S0963180116000700.
Discussions of conscientious objection (CO) in healthcare often concentrate on objections to interventions that relate to reproduction, such as termination of pregnancy or contraception. Nevertheless, questions of conscience can arise in other areas of medicine. For example, the intensive care unit is a locus of ethically complex and contested decisions. Ethical debate about CO usually concentrates on the issue of whether physicians should be permitted to object to particular courses of treatment; whether CO should be accommodated. In this article, I focus on the question of how clinicians ought to act: should they provide or support a course of action that is contrary to their deeply held moral beliefs? I discuss two secular examples of potential CO in intensive care, and propose that clinicians should adopt a norm of conscientious non-objection (CNO). In the face of divergent values and practice, physicians should set aside their personal moral beliefs and not object to treatment that is legally and professionally accepted and provided by their peers. Although there may be reason to permit conscientious objections in healthcare, conscientious non-objection should be encouraged, taught, and supported.
医疗保健领域中关于良心拒斥（CO）的讨论往往集中在对与生殖相关干预措施的拒斥上，比如终止妊娠或避孕。然而，良心问题也可能出现在医学的其他领域。例如，重症监护病房是伦理复杂且存在争议的决策场所。关于良心拒斥的伦理辩论通常集中在医生是否应被允许拒斥特定治疗方案这一问题上；良心拒斥是否应得到迁就。在本文中，我关注的问题是临床医生应该如何行动：他们应该提供或支持与他们根深蒂固的道德信念相悖的行动方案吗？我讨论了重症监护中两个潜在良心拒斥的世俗例子，并提议临床医生应采用良心非拒斥（CNO）规范。面对不同的价值观和做法，医生应搁置个人道德信念，不拒斥由同行合法且专业地提供并被接受的治疗。尽管在医疗保健领域可能有理由允许良心拒斥，但良心非拒斥应得到鼓励、传授和支持。
