Cannold L
Monash University, Melbourne, Australia.
J Med Ethics. 1994 Jun;20(2):80-6. doi: 10.1136/jme.20.2.80.
The legitimacy of the refusal of South Australian nurses to care for second trimester abortion patients on grounds of conscience is examined as a test case for a theory of permissible limits on the autonomy of health care professionals. In cases of health care professional (HCP) conscientious refusal, it is argued that a balance be struck between the HCPs' claims to autonomous action and the consequences to them of having their autonomous action restricted, and the entitlement of patients to care and the consequences for them of being refused such care. Conscientious action that results in the disruption or termination of health care services, however, is always impermissible on two grounds. Firstly, because it is at this point that the action '... invades a patient's autonomy, puts a patient at serious risk ... [and] treats a patient unjustly' (1) Secondly, because the consequences of such refusals turn them into political acts--acts of civil disobedience. It is arguable that in order for acts of civil disobedience to be legitimate, certain obligations are required of the dissenter by the community. It is concluded that the actions of the South Australian nurses, which have over the last few years both terminated and disrupted second trimester services, are morally impermissible.
南澳大利亚护士基于良心拒绝护理中期堕胎患者的合法性，作为检验医疗保健专业人员自主权可允许限度理论的一个案例进行了审视。在医疗保健专业人员出于良心拒绝的情况下，有人认为，应在医疗保健专业人员自主行动的主张与其自主行动受限对其造成的后果，以及患者获得护理的权利和被拒绝护理对其造成的后果之间达成平衡。然而，导致医疗保健服务中断或终止的出于良心的行为，基于两个理由始终是不允许的。其一，因为此时该行为“……侵犯了患者的自主权，使患者面临严重风险……[且]不公正地对待患者”(1)。其二，因为此类拒绝的后果使其变成了政治行为——公民抗命行为。可以说，为使公民抗命行为合法，社会对持不同意见者有某些要求。结论是，南澳大利亚护士的行为在过去几年里既终止又扰乱了中期服务，在道德上是不允许的。
