Conscientious objection and other motivations for refusal to treat in hastened death: A systematic review

Abstract

Conscientious objection (CO) in the context of health care arises when a health care professional (HCP) refuses to participate in a certain procedure because it is not compatible with their ethical or moral principles. Refusal to treat in health care includes, in addition to CO, other factors that may lead the HCP not to want to participate in a certain procedure. Therefore, we can say that CO is a form of refusal of treatment based on conscience. Hastened death has become an increasingly reality around the world, being a procedure in which not all HCP are willing to participate. There are several factors that can condition the HCP' refusal to treat in this scenario. With aim of identifying these factors, we performed a systematic review, following de PRISMA guidelines. On 1 October 2022, we searched for relevant articles on Pubmed, Web of Science and Scopus databases. From an initial search of 693 articles, 12 were included in the final analysis. Several motivations that condition refusal to treat were identified, including legal, technical, social, and CO. Three main motivations for CO were also identified, namely religious, moral/secular, and emotional/psychological motivations. We must have an understanding behaviour, respecting the position of each HCP, and avoiding judgmental and discriminatory positions, although, we must ensure that patients have access to care. The identification of these motivations may permit to find solutions that, while protecting HCP' position, may also mitigate the potential problems for patients' access to this type of procedure.