Baergen Ralph Neil, Skidmore James
Department of Philosophy, Idaho State University, Pocatello, ID 83209, USA.
Nurs Rep. 2024 Dec 19;14(4):4091-4108. doi: 10.3390/nursrep14040298.
BACKGROUND/OBJECTIVES: Caring for patients at the end of life can involve issues that are ethically and legally fraught: withholding or withdrawing artificial nutrition and hydration, pain control that could hasten death, aggressive treatment that is continued when it seems only to be prolonging suffering, patients who request medical assistance in dying, and so forth. Clinicians may find that their deeply held ethical principles conflict with law, institutional policy, or patients' choices. In these situations, they may consider either refusing to participate in procedures that they find morally abhorrent (conscientious refusal) or providing care that they believe to be ethically obligatory despite being contrary to law or policy (conscientious commitment).
This paper reviews the ethical issues involved.
Each of the usual policies for handling conscientious refusals faces serious challenges.
Healthcare providers who refuse to provide medical services should be expected to explain their reasons, make prompt referrals, and bear some of the resulting costs or burdens.
背景/目的：临终关怀患者可能涉及充满伦理和法律问题的情况：停止或撤除人工营养和水分、可能加速死亡的疼痛控制、在似乎只是延长痛苦时仍继续的积极治疗、请求医疗协助死亡的患者等等。临床医生可能会发现他们根深蒂固的伦理原则与法律、机构政策或患者的选择相冲突。在这些情况下，他们可能会考虑要么拒绝参与他们认为在道德上令人厌恶的程序（良心拒绝），要么提供他们认为在伦理上是义务性的护理，尽管这与法律或政策相悖（良心承诺）。
本文回顾了所涉及的伦理问题。
处理良心拒绝的每种常见政策都面临严峻挑战。
拒绝提供医疗服务的医疗保健提供者应被要求解释其原因，迅速进行转诊，并承担一些由此产生的费用或负担。
