Abstract
Rationale: Intensive care unit (ICU) clinicians sometimes have a conscientious objection (CO) to providing or disclosing information about a legal, professionally accepted, and otherwise available medical service. There is little guidance about how to manage COs in ICUs. Objectives: To provide clinicians, hospital administrators, and policymakers with recommendations for managing COs in the critical care setting. Methods: This policy statement was developed by a multidisciplinary expert committee using an iterative process with a diverse working group representing adult medicine, pediatrics, nursing, patient advocacy, bioethics, philosophy, and law. Main Results: The policy recommendations are based on the dual goals of protecting patients' access to medical services and protecting the moral integrity of clinicians. Conceptually, accommodating COs should be considered a "shield " to protect individual clinicians' moral integrity rather than as a "sword" to impose clinicians' judgments on patients. The committee recommends that: (1) COs in ICUs be managed through institutional mechanisms, (2) institutions accommodate COs, provided doing so will not impede a patient's or surrogate's timely access to medical services or information or create excessive hardships for other clinicians or the institution, (3) a clinician's CO to providing potentially inappropriate or futile medical services should not be considered sufficient justification to forgo the treatment against the objections of the patient or surrogate, and (4) institutions promote open moral dialogue and foster a culture that respects diverse values in the critical care setting. Conclusions: This American Thoracic Society statement provides guidance for clinicians, hospital administrators, and policymakers to address clinicians' COs in the critical care setting.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 219-227 |
| Number of pages | 9 |
| Journal | American Journal of Respiratory and Critical Care Medicine |
| Volume | 191 |
| Issue number | 2 |
| DOIs | |
| State | Published - Jan 15 2015 |
| Externally published | Yes |
Fingerprint
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
- Critical Care and Intensive Care Medicine
- Medicine(all)
Cite this
An official American Thoracic Society policy statement : Managing conscientious objections in intensive care medicine. / ATS Ethics and Conflict of Interest Committee.
In: American Journal of Respiratory and Critical Care Medicine, Vol. 191, No. 2, 15.01.2015, p. 219-227.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - An official American Thoracic Society policy statement
T2 - Managing conscientious objections in intensive care medicine
AU - ATS Ethics and Conflict of Interest Committee
AU - Lewis-Newby, Mithya
AU - Wicclair, Mark
AU - Pope, Thaddeus
AU - Rushton, Cynthia H
AU - Curlin, Farr
AU - Diekema, Douglas
AU - Durrer, Debbie
AU - Ehlenbach, William
AU - Gibson-Scipio, Wanda
AU - Glavan, Bradford
AU - Langer, Rabbi Levi
AU - Manthous, Constantine
AU - Rose, Cecile
AU - Scardella, Anthony
AU - Shanawani, Hasan
AU - Siegel, Mark D.
AU - Halpern, Scott D.
AU - Truog, Robert D.
AU - White, Douglas B.
PY - 2015/1/15
Y1 - 2015/1/15
N2 - Rationale: Intensive care unit (ICU) clinicians sometimes have a conscientious objection (CO) to providing or disclosing information about a legal, professionally accepted, and otherwise available medical service. There is little guidance about how to manage COs in ICUs. Objectives: To provide clinicians, hospital administrators, and policymakers with recommendations for managing COs in the critical care setting. Methods: This policy statement was developed by a multidisciplinary expert committee using an iterative process with a diverse working group representing adult medicine, pediatrics, nursing, patient advocacy, bioethics, philosophy, and law. Main Results: The policy recommendations are based on the dual goals of protecting patients' access to medical services and protecting the moral integrity of clinicians. Conceptually, accommodating COs should be considered a "shield " to protect individual clinicians' moral integrity rather than as a "sword" to impose clinicians' judgments on patients. The committee recommends that: (1) COs in ICUs be managed through institutional mechanisms, (2) institutions accommodate COs, provided doing so will not impede a patient's or surrogate's timely access to medical services or information or create excessive hardships for other clinicians or the institution, (3) a clinician's CO to providing potentially inappropriate or futile medical services should not be considered sufficient justification to forgo the treatment against the objections of the patient or surrogate, and (4) institutions promote open moral dialogue and foster a culture that respects diverse values in the critical care setting. Conclusions: This American Thoracic Society statement provides guidance for clinicians, hospital administrators, and policymakers to address clinicians' COs in the critical care setting.
AB - Rationale: Intensive care unit (ICU) clinicians sometimes have a conscientious objection (CO) to providing or disclosing information about a legal, professionally accepted, and otherwise available medical service. There is little guidance about how to manage COs in ICUs. Objectives: To provide clinicians, hospital administrators, and policymakers with recommendations for managing COs in the critical care setting. Methods: This policy statement was developed by a multidisciplinary expert committee using an iterative process with a diverse working group representing adult medicine, pediatrics, nursing, patient advocacy, bioethics, philosophy, and law. Main Results: The policy recommendations are based on the dual goals of protecting patients' access to medical services and protecting the moral integrity of clinicians. Conceptually, accommodating COs should be considered a "shield " to protect individual clinicians' moral integrity rather than as a "sword" to impose clinicians' judgments on patients. The committee recommends that: (1) COs in ICUs be managed through institutional mechanisms, (2) institutions accommodate COs, provided doing so will not impede a patient's or surrogate's timely access to medical services or information or create excessive hardships for other clinicians or the institution, (3) a clinician's CO to providing potentially inappropriate or futile medical services should not be considered sufficient justification to forgo the treatment against the objections of the patient or surrogate, and (4) institutions promote open moral dialogue and foster a culture that respects diverse values in the critical care setting. Conclusions: This American Thoracic Society statement provides guidance for clinicians, hospital administrators, and policymakers to address clinicians' COs in the critical care setting.
UR - http://www.scopus.com/inward/record.url?scp=84921414837&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84921414837&partnerID=8YFLogxK
U2 - 10.1164/rccm.201410-1916ST
DO - 10.1164/rccm.201410-1916ST
M3 - Article
VL - 191
SP - 219
EP - 227
JO - American Journal of Respiratory and Critical Care Medicine
JF - American Journal of Respiratory and Critical Care Medicine
SN - 1073-449X
IS - 2
ER -