Table 3 Guideline for CO: eligibility prerequisites and procedural process

Eligibility Prerequisites

Comments

1) Individual Reference

Conscience is individual; collective CO is not admissible.

2) Specific Clinical Context

Exercise CO is non-binding with regard to future actions, as each situation is handled as a new clinical context.

3) Ethical Justification

The ethical values of the norm and of the objecting professional must both be valid. The professional may invoke CO as a genuine exercise of individual freedom.

4) Assurance of Non-discrimination

CO cannot be based on discriminatory or prejudicial grounds (objection must be directed to an act, not a person per se).

5) Professional Consistency

Objection must be applicable and generalizable to similar ethical conflicts irrespective of physical, geographic, or other occupational characteristics.

6) Attitude of Mutual Respect

Respect must be shown to patients, coworkers, and authorities (both objectors and non-objectors).

7) Assurance of Patient Rights and Safety.

The ability of the patient to receive health care of the highest standards of quality must not be interrupted.

Procedural Process

Description

1) Notification and Preparation

CO declarations must be made with as much advance notice as possible to allow for appropriate arrangements to be made.

2) Documentation and Confidentiality

CO requests must be formally submitted (e.g. in writing) to appropriate institutional authorities and be subject to privacy-based norms therein, to be shared discreetly only as required for protection of rights of the medical professional, institution, and patient.

3) Evaluation of Prerequisites

Diligent review of the set of prerequisites to determine eligibility for CO is required

4) Non-abandonment

The professional must perform any and all medical interventions for which CO does not apply.

5) Transparency

Medical professional must explain his/her objector status to the patient in question.

6) Allowance for Unforeseen Objection

Unforeseen CO is acceptable depending on the urgency of the circumstances. In such situations, formal CO solicitations may be submitted post hoc.

7) Compensatory Responsibilities

Medical professionals who receive allowances for not performing a medical act due to CO should commensurately perform other duties in their stead such that primary or secondary gain(s) are avoided.

8) Access to Guidance and/or Consultative Advice

Medical professionals considering CO must have access to advice from the professional association and the CEC.

9) Organizational Guarantees of Professional Substitution

Assurances should be made to the patient that another professional will provide the necessary medical service(s) with the same quality standards in a reasonable timeframe such that no detriment to care is encountered.