Milionis Charalampos, Toska Aikaterini
Department of Endocrinology, Diabetes and Metabolism, 'Elena Venizelou' General Hospital, Athens, Greece.
School of Nursing, University of Thessaly, Larissa, Greece.
Int J Nurs Pract. 2023 Oct;29(5):e13180. doi: 10.1111/ijn.13180. Epub 2023 Jul 12.
In modern society, health professionals are often asked to use their technical skills to serve purposes other than treating illnesses. In such cases, some clinicians may express ethical reluctance to fulfill their patients' preferences. Conscientious objection in health care is the refusal by providers to perform a legally valid and scientifically approved clinical intervention because of moral concerns. Although health services and staff are obliged to respect gender identity and prohibit discrimination, some clinicians may exempt themselves from caring for transgender people, citing ethical reasons. The decision of health professionals to object to medical activities related to transgender care may collide with the interests of trans people and further marginalizes the already underprivileged gender-diverse population.
This discussion paper analyses the concept of 'conscientious objection' and its application in health care settings in relation to transgender-related care.
In general, the right of health professionals to abstain from contested duties on moral grounds must be protected. However, claims to conscience cannot be accepted within centers specialized in gender transitioning and for services unrelated to gender affirmation such as routine and urgent care. Personal responsibility and discretion on the part of clinicians is the most appropriate way to compromise between protecting the moral integrity of health professionals and shielding trans persons' access to care. Guidance is proffered on how to resolve the apparent impasse emerging from the denial of various types of health services to transgender people.
在现代社会,卫生专业人员常常被要求运用其技术技能去服务于治疗疾病以外的目的。在这种情况下,一些临床医生可能会在道德上不愿满足患者的偏好。医疗保健中的良心拒斥是指提供者由于道德顾虑而拒绝实施一项具有法律效力且经科学认可的临床干预措施。尽管卫生服务机构和工作人员有义务尊重性别认同并禁止歧视,但一些临床医生可能会以道德为由,拒绝为跨性别者提供护理。卫生专业人员反对与跨性别者护理相关医疗活动的决定,可能会与跨性别者的利益发生冲突,并进一步边缘化本就处于弱势的性别多样化群体。
本讨论文件分析了“良心拒斥”的概念及其在与跨性别者护理相关的医疗保健环境中的应用。
总体而言,必须保护卫生专业人员基于道德理由拒绝承担有争议职责这一权利。然而,在专门从事性别转换的中心以及对于与性别肯定无关的服务(如常规和紧急护理)而言,良心主张是不能被接受的。临床医生的个人责任和判断力是在保护卫生专业人员的道德完整性与保障跨性别者获得护理机会之间达成妥协的最合适方式。文中就如何解决因拒绝为跨性别者提供各类卫生服务而出现的明显僵局提供了指导意见。