An Official American Thoracic Society Policy Statement: Managing Conscientious Objections in Intensive Care Medicine

Am J Respir Crit Care Med. 2015 Jan 15;191(2):219-27

9 Pages Posted: 26 Mar 2015 Last revised: 10 Dec 2015

See all articles by Mithya Lewis-Newby

Mithya Lewis-Newby

Seattle Children's Hospital

Mark R. Wicclair

West Virginia University - Department of Philosophy; University of Pittsburgh - Department of Medicine & Center for Bioethics and Health Law

Thaddeus Mason Pope

Mitchell Hamline School of Law; Queensland University of Technology - Australian Health Law Research Center; Saint Georges University; Alden March Bioethics Institute

Cynda Rushton

Johns Hopkins University - Berman Institute of Bioethics

Farr Curlin

Duke University - School of Medicine

Douglas S. Diekema

University of Washington - School of Medicine

Debbie Durrer

Independent

William Ehlenbach

University of Wisconsin - Milwaukee

Wanda Gibson-Scipio

Wayne State University

Bradford Glavan

Independent

Levi Langer

Independent

Constantine Manthous

Yale University

Cecile Rose

Independent

Anthony Scardella

University of Medicine & Dentistry of New Jersey (UMDNJ) - Robert Wood Johnson Medical School

Hasan Shanawani

Wayne State University

Mark Siegel

Yale University

Scott D. Halpern

University of Pennsylvania - Perelman School of Medicine

Robert D. Truog

Harvard University - Harvard Medical School

Douglas White

University of Pittsburgh

Date Written: February 1, 2015

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.

Keywords: conscience, intensive care, ICU

JEL Classification: K32, I18

Suggested Citation

Lewis-Newby, Mithya and Wicclair, Mark R. and Pope, Thaddeus Mason and Rushton, Cynda and Curlin, Farr and Diekema, Douglas S. and Durrer, Debbie and Ehlenbach, William and Gibson-Scipio, Wanda and Glavan, Bradford and Langer, Levi and Manthous, Constantine and Rose, Cecile and Scardella, Anthony and Shanawani, Hasan and Siegel, Mark and Halpern, Scott D. and Truog, Robert D. and White, Douglas, An Official American Thoracic Society Policy Statement: Managing Conscientious Objections in Intensive Care Medicine (February 1, 2015). Am J Respir Crit Care Med. 2015 Jan 15;191(2):219-27. Available at SSRN: https://ssrn.com/abstract=2003473

Mithya Lewis-Newby

Seattle Children's Hospital ( email )

4800 Sand Point Way NE
Seattle, WA 98105
United States

Mark R. Wicclair

West Virginia University - Department of Philosophy ( email )

Morgantown, WV 26506
United States
304-293-3611 (Phone)

University of Pittsburgh - Department of Medicine & Center for Bioethics and Health Law ( email )

3708 Fifth Avenue
Medical Arts Building, Suite 300
Pittsburgh, PA 15260
United States

HOME PAGE: http://www.pitt.edu/~bioethic/facWicclair.htm

Thaddeus Mason Pope (Contact Author)

Mitchell Hamline School of Law ( email )

875 Summit Avenue
Room 320
Saint Paul, MN 55105
United States
651-695-7661 (Phone)

HOME PAGE: http://www.thaddeuspope.com

Queensland University of Technology - Australian Health Law Research Center ( email )

2 George Street
Brisbane, Queensland 4000
Australia

Saint Georges University ( email )

West Indies
Grenada

HOME PAGE: http://www.thaddeuspope.com

Alden March Bioethics Institute ( email )

47 New Scotland Ave
MC 153
Albany, NY 12208
United States

HOME PAGE: http://www.thaddeuspope.com

Cynda Rushton

Johns Hopkins University - Berman Institute of Bioethics ( email )

United States

Farr Curlin

Duke University - School of Medicine ( email )

United States

Douglas S. Diekema

University of Washington - School of Medicine ( email )

Box 356340
1925 N.E. Pacific Street
Seattle, WA 98195-6340
United States

Debbie Durrer

Independent ( email )

No Address Available

William Ehlenbach

University of Wisconsin - Milwaukee ( email )

Department of Africology
3203 N Downer Ave.
Milwaukee, WI 53202
United States

Wanda Gibson-Scipio

Wayne State University ( email )

Detroit, MI 48202
United States

Bradford Glavan

Independent ( email )

No Address Available

Levi Langer

Independent ( email )

No Address Available

Constantine Manthous

Yale University ( email )

New Haven, CT 06520
United States

Cecile Rose

Independent ( email )

No Address Available

Anthony Scardella

University of Medicine & Dentistry of New Jersey (UMDNJ) - Robert Wood Johnson Medical School ( email )

97 Paterson Street
New Brunswick, NJ 08903
United States

Hasan Shanawani

Wayne State University ( email )

Detroit, MI 48202
United States

Mark Siegel

Yale University ( email )

New Haven, CT 06520
United States

Scott D. Halpern

University of Pennsylvania - Perelman School of Medicine ( email )

423 Guardian Drive
Philadelphia, PA 19104
United States

Robert D. Truog

Harvard University - Harvard Medical School ( email )

25 Shattuck St
Boston, MA 02115
United States
617-355-7327 (Phone)

Douglas White

University of Pittsburgh ( email )

135 N Bellefield Ave
Pittsburgh, PA 15260
United States

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