CONSCIENTIOUS OBJECTION IN HEALTHCARE

Abstract

Background: Conscientious objection (CO) refers to the act of refusing to participate in a service on the grounds that doing so would violate one's deeply held morals and values. The aim of this thesis was to explore the implications of CO and develop an evaluated framework on managing CO in healthcare practice.

Methods: A series of qualitative and mixed methods studies were conducted to meet the aim of this thesis. This included a scoping literature review, a cost analysis and mapping review, a semi-structured interview study design with qualitative thematic analysis, a mixed methods, vignette-based survey and a modified Delphi study with expert panellists from various health professions.

Results: Semi-structured interviews of pharmacists revealed concerns regarding Voluntary-Assisted Dying (VAD) legislation, ethical challenges and the need for further training. Further exploring the pharmacoeconomic impact of VAD, a cost analysis mapping review identified a paucity in fiscal reporting on VAD laws in the literature and legislative reports. Mixed methods vignette-based survey studies on CO identified that a majority of participants did not conscientiously object, however of those who did, there was a statistically significant relationship with self-reported religious conviction and a justification of CO despite the risk of inequity or lack of access. Additionally, a modified Delphi study, based on advice from healthcare expert stakeholders, inaugurated a comprehensive proposed framework on how to manage CO in the healthcare setting.

Conclusions: CO is multifaceted with a variety of influencing factors. The proposed CO management framework can aid in managing situations of CO in the workplace. It can also be utilised by clinical educators in pedagogy and for future healthcare providers. Future work is necessary to assess its implementation in the workplace and adapting it to various services, as well as future research into patient and consumer consensus around CO.