Omfanget av helsepersonells reservasjonsrett har nylig vært gjenstand for debatt i Norge. Vi spør om leger bør ha reservasjonsrett ved utførelse og henvisning til assistert befruktning, og drøfter argumenter for og imot ved hjelp av et rammeverk med sju kriterier for vurdering av reservasjon. Reservasjonsrettens grunnleggende dilemma er hvordan to viktige hensyn, henholdsvis pasientens rett til behandling og hensynet til helsepersonellets moralske integritet, best kan ivaretas. Det argumenteres for at leger bør ha rett til å reservere seg mot å utføre, (...) assistere ved og henvise til assistert befruktning generelt hvis begrunnelsen er hensynet til befruktede eggs moralske verdi. Videre finner vi at leger også kan ha en moralsk rett til reservasjon mot å utføre, assistere ved og henvise til assistert befruktning for likekjønnede, men da på nærmere spesifiserte vilkår.Nøkkelord: reservasjonsrett, assistert befruktning, samvittighet, moralsk integritetEnglish summary: Should physicians have the right to conscientiously object to assisted reproduction?The extent of the healthcare worker's right to conscientious objection has recently been debated in Norway. This article asks whether physicians should have a right to conscientious objection to the performance of, and referral for, assisted reproduction, and discusses arguments for and against the same, utilizing a framework of seven criteria for the evaluation of conscientious objection. The fundamental dilemma of conscientious objection is how two important considerations can be reconciled: the patient's right to treatment, and the protection of the healthcare worker's moral integrity. It is argued that physicians should have the right to object to performing, assisting with, and referring for assisted reproduction generally when the objection is grounded in the moral value of the embryo. Furthermore, physicians may also have a moral right to object to performing, assisting with, and referring for assisted reproduction for same-sex couples, but only on conditions that are further specified. (shrink)

Background:Ideas of patient involvement are related to notions of self-determination and autonomy, which are not always in alignment with complex interactions and communication in clinical practice.Aim:To illuminate and discuss patient involvement in routine clinical care situations in nursing practice from an ethical perspective.Method:A case study based on an anthropological field study among patients with advanced cancer in Denmark.Ethical considerations:Followed the principles of the Helsinki Declaration.Findings:Two cases illustrated situations where nurses refused patient involvement in their own case.Discussion:Focus on two ethical issues, (...) namely ‘including patients’ experiences in palliative nursing care’ and ‘relational distribution of power and knowledge’, inspired primarily by Hannah Arendt’s concept of thoughtlessness and a Foucauldian perspective on the medical clinic and power. The article discusses how patients’ palliative care needs and preferences, knowledge and statements become part of the less significant background of nursing practice, when nurses have a predefined agenda for acting with and involvement of patients. Both structurally conditioned ‘thoughtlessness’ of the nurses and distribution of power and knowledge between patients and nurses condition nurses to set the agenda and assess when and at what level it is relevant to take up patients’ invitations to involve them in their own case.Conclusion:The medical and institutional logic of the healthcare service sets the framework for the exchange between professional and patient, which has an embedded risk that ‘thoughtlessness’ appears among nurses. The consequences of neglecting the spontaneous nature of human action and refusing the invitations of the patients to be involved in their life situation call for ethical and practical reflection among nurses. The conditions for interaction with humans as unpredictable and variable challenge nurses’ ways of being ethically attentive to ensure that patients receive good palliative care, despite the structurally conditioned logic of healthcare. (shrink)

Background:The concept of conscientious objection is well described; however, because of its nature, little is known about real experiences of nursing professionals who apply objections in their practice. Extended roles in nursing indicate that clinical and value-based dilemmas are becoming increasingly common. In addition, the migration trends of the nursing workforce have increased the need for the mutual understanding of culturally based assumptions on aspects of health care delivery.Aim:To present (a) the arguments for and against conscientious objection in nursing practice, (...) (b) a description of current regulations and practice regarding conscientious objection in nursing in Poland and the United Kingdom, and (c) to offer a balanced view regarding the application of conscientious objection in clinical nursing practice.Design:Discussion paper.Ethical considerations:Ethical guidelines has been followed at each stage of this study.Findings:Strong arguments exist both for and against conscientious objection in nursing which are underpinned by empirical research from across Europe. Arguments against conscientious objection relate less to it as a concept, but rather in regard to organisational aspects of its application and different mechanisms which could be introduced in order to reach the balance between professional and patient’s rights.Discussion and conclusion:Debate regarding conscientious objection is vivid, and there is consensus that the right to objection among nurses is an important, acknowledged part of nursing practice. Regulation in the United Kingdom is limited to reproductive health, while in Poland, there are no specific procedures to which nurses can apply an objection. The same obligations of those who express conscientious objection apply in both countries, including the requirement to share information with a line manager, the patient, documentation of the objection and necessity to indicate the possibility of receiving care from other nurses. Using Poland and the United Kingdom as case study countries, this article offers a balanced view regarding the application of conscientious objection in clinical nursing practice. (shrink)

This study explored identity conflict dynamics in interpersonal interactions in professionals facing ethically charged situations. Through semi-structured interviews, we conducted a qualitative study among doctors and nurses working for the English National Healthcare Service and analyzed the data with grounded theory approaches. Our findings reveal that identity conflict is triggered by three micro processes, namely cognitive and emotional perspective taking, as well as identifying with the other. In these processes, identity conflict is signaled by emotions and recognized as a clash (...) not only between identities and their values, but also within one identity and its multiple values. Behavioral and psychological outcomes of identity conflict involve seeking peer support, doing reflective practices and identity growth. This article contributes to identity literature by providing a multilevel approach of identity conflict dynamics able to account for both interpersonal and intrapsychic processes, deeply hold values and emotions, as well as crucial behavioral and psychological consequences. (shrink)