PDF(Pubmed)
Abstract：
Healthcare professionals often face ethical conflicts and challenges related to decision-making that have necessitated consideration of the use of conscientious objection (CO). No current guidelines exist within Spain\'s healthcare system regarding acceptable rationales for CO, the appropriate application of CO, or practical means to support healthcare professionals who wish to become conscientious objectors. As such, a procedural framework is needed that not only assures the appropriate use of CO by healthcare professionals but also demonstrates its ethical validity, legislative compliance through protection of moral freedoms and patients\' rights to receive health care. Our proposal consists of prerequisites of eligibility for CO (individual reference, specific clinical context, ethical justification, assurance of non-discrimination, professional consistency, attitude of mutual respect, assurance of patient rights and safety) and a procedural process (notification and preparation, documentation and confidentiality, evaluation of prerequisites, non-abandonment, transparency, allowance for unforeseen objection, compensatory responsibilities, access to guidance and/or consultative advice, and organizational guarantee of professional substitution). We illustrate the real-world utility of the proposed framework through a case discussion in which our guidelines are applied.
摘要：
医疗保健专业人员经常面临道德冲突和与决策相关的挑战，这些挑战需要考虑使用依良心拒服兵役（CO）。西班牙的医疗保健系统中没有关于可接受的CO，CO的适当应用，或支持希望成为良心反对者的医疗保健专业人员的实际手段。因此，需要一个程序框架，不仅确保医疗保健专业人员适当使用CO，而且证明其道德有效性，通过保护道德自由和患者接受医疗保健的权利来遵守立法。我们的建议包括获得CO资格的先决条件(个人参考，特定的临床背景，道德理由，保证不歧视，专业一致性,相互尊重的态度,保证患者权利和安全)和程序过程(通知和准备，文档和保密性，先决条件的评估，不放弃,透明度，意外反对津贴，补偿性责任，获得指导和/或咨询意见，和专业替代的组织保证)。我们通过应用我们的准则的案例讨论来说明拟议框架的实际实用性。
