Civaner M Murat, Yalçinkaya Eylül, Macdonald Arlene
Department of Medical Ethics, Bursa Uludag University School of Medicine, Bursa, Turkey.
Department of Neurology, Bursa City Hospital, Bursa, Turkey.
BMC Med Educ. 2025 Jan 2;25(1):5. doi: 10.1186/s12909-024-06599-1.
Physicians' refusal to perform medical procedures that they deem contrary to their conscience may threaten basic human rights and public health. This study aims to investigate the thoughts and attitudes of future physicians on conscientious objection (CO) and thus contribute to the discussions from a country more heavily influenced by Eastern values.
A cross-sectional multi-center study was conducted among medical students country-wide, where 2,188 medical students participated via an online survey. The methodology was in accordance with the CHERRIES.
Nearly half of the students think that CO should be a right. If a medical intervention that conflicts with their personal values is requested, two-thirds would request an assignment to take another action if possible, and 8.2% stated that they would refuse to participate at all costs. If CO is recognized as a right, one-third of the participants would not refer the patient. Male participants, the ones who are more religious, and who have chosen medicine for pragmatic reasons, were more supportive of the right to refuse medical interventions that may contradict their moral values, culture, or beliefs (p = 0.000, 0.000, 0.021, respectively). Also, students who thought that conscience is a voice within us that has existed since we were born and who believed everyone must pay for all healthcare services were statistically more likely to agree that CO should be a right (p = 0.000, 0.008, respectively). The participants stated that they would most frequently object to requests for extreme aesthetic interventions (splitting the tongue in half - 39.1%, changing eye color - 28.2%, removing the lowest rib - 26.8%), euthanasia (23.2%), hymen restoration (17.3%), gender change (16.5%), and optional pregnancy termination (14.0%).
Developing undergraduate and post-graduate education that integrates CO as a specific topic, clarifying the conceptual definitions, and improving/developing protocols for exercising CO seem crucial to prevent possible violations of rights and to protect health professionals' integrity. These interventions should be carried out with the participation of all parties to come together in open communication and respectful dialogue in this delicate matter.
医生拒绝实施他们认为违背自己良知的医疗程序可能会威胁基本人权和公众健康。本研究旨在调查未来医生对良心拒斥（CO）的想法和态度，从而为来自一个受东方价值观影响更大的国家的相关讨论做出贡献。
在全国范围内的医学生中开展了一项横断面多中心研究，2188名医学生通过在线调查参与。该方法符合CHERRIES标准。
近一半的学生认为良心拒斥应是一项权利。如果被要求实施与他们个人价值观相冲突的医疗干预，三分之二的人会要求调配去采取其他行动（如果可能的话），8.2%的人表示他们会不惜一切代价拒绝参与。如果良心拒斥被承认为一项权利，三分之一的参与者不会转诊患者。男性参与者、更虔诚的人以及出于务实原因选择医学的人，更支持拒绝可能与他们的道德价值观、文化或信仰相矛盾的医疗干预的权利（分别为p = 0.000、0.000、0.021）。此外，那些认为良知是我们内心自出生就存在的声音的学生以及那些相信每个人都必须为所有医疗服务付费的学生，在统计学上更有可能同意良心拒斥应是一项权利（分别为p = 0.000、0.008）。参与者表示，他们最常反对的请求包括极端美容干预（将舌头一分为二——39.1%、改变眼睛颜色——28.2%、切除最下面一根肋骨——26.8%）、安乐死（23.2%）、处女膜修复（17.3%）、性别改变（16.5%）以及选择性终止妊娠（14.0%）。
开展将良心拒斥作为一个特定主题纳入其中的本科和研究生教育，阐明概念定义，并改进/制定行使良心拒斥的方案，对于防止可能的权利侵犯以及保护卫生专业人员正直性而言似乎至关重要。在这个微妙的问题上，这些干预措施应在所有各方的参与下，通过公开沟通和尊重的对话共同开展。
