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How do I know if I have a conscientious objection?

Case study about balancing conscientious objection with duty to provide care

Jamie’s new job is in a practice setting where medical assistance in dying is provided. Until now, he’s not really thought about participating in a client’s medically assisted death.

He’s not sure how he feels and realizes he needs to sort it out. Does he have a conscientious objection to medical assistance in dying? What is a conscientious objection? He wonders where to start.

Conscientious objection: what does it mean?

Natalie, a close friend and mentor, helps Jamie sort out his thoughts. She explains conscientious objection as feeling that an action, practice or policy is contrary to the kind of person you want to be and the kind of society and community you want to foster.

“Conscientious objection is driven by moral concerns that are based on your world view—your basic beliefs and values,” she explains. “These may be personal, ethical or religious.”

She explains that conscientious objection is not based on fear, prejudice, bias, convenience or distaste but rather on a conflict with one’s basic beliefs and values. Natalie encourages Jamie to reflect on medical assistance in dying and determine whether it is compatible with his beliefs and values.

What could Jamie ask himself?

He reflects on the following questions:

  • Does medical assistance in dying conflict with the type of person I want to be?
  • Is it contrary to what I value and believe in?
  • Would participating in it mean a loss of integrity and wholeness of myself?
  • Would it bring me guilt and shame?
  • Or, is this conflict based on fear, uncertainty, bias, preference or distaste?

What does Jamie decide?

After much thought, Jamie determines that medical assistance in dying goes against his basic values and beliefs. He wonders how he can conscientiously object in a way that respects his values and beliefs—while still meeting his professional and legal obligation to provide clients with safe, competent and ethical care.

How can Jamie balance personal values with professional obligations?

Jamie wants to avoid participating in an action that goes against his basic beliefs and values.  He wonders however, what is appropriate to avoid and what is unavoidable.

He knows he can take steps to avoid immediate and direct involvement in medical assistance in dying, such as starting the IV or providing information about medical assistance in dying to the client. But avoiding all indirect involvement—such as working on the ward where clients may request and receive a medically assisted death—may be not be possible without serious consequences such as leaving his job.

Jamie understands his objection is to the action and not the person(s) requesting or performing the action. He decides to make sure there is a plan outlining how he will avoid being in a situation with direct involvement, and how, if necessary,  he will hand over care for the activities for which he will not perform. This will ensure continuity of care for the client. In this way, he will demonstrate respect for the person or persons, care for them, and transfer care to others when needed—but will not participate in or support the action.

What are Jamie’s responsibilities?

Nothing in the Criminal Code compels nurses to aid in the provision of medical assistance in dying. However, nurses with a conscientious objection must take all reasonable steps to ensure that the quality and continuity of care for clients are not compromised.

Jamie needs to formally make his manager aware of his conscientious objection and have a plan in place, preferably in writing, well before a client would require care. Should an unexpected situation arise, Jamie will involve his supervisor and other team members as appropriate to safely hand over the care of the client.

Reflection and questions

  • What is your experience with conflicts between client care needs and the personal values and beliefs of others?
  • How have you determined whether certain actions or practices are compatible with your basic beliefs and values?

Resources

You’ll find more information and guidance in the Duty to Provide Care practice standard, and Medical Assistance in Dying resource centre and FAQs.

If you have questions about medical assistance in dying, scope of practice or other standards, contact Practice Support:

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