title: Conscientious objection: a potential neonatal nursing response to care orders that cause suffering at the end of life? Study of a concept.
abstract: This article is an exploratory effort meant to solicit and provoke dialog. Conscientious objection is proposed as a potential response to the moral distress experienced by neonatal nurses. The most commonly reported cause of distress for all nurses is following orders to support patients at the end of their lives with advanced technology when palliative or comfort care would be more humane. Nurses report that they feel they are harming patients or causing suffering when they could be comforting instead. We examined the literature on moral distress, futility, and the concept of conscientious objection from the perspective of the nurse's potential response to performing advanced technologic interventions for the dying patient. We created a small pilot study to engage in clinical verification of the use of our concept of conscientious objection. Data from 66 neonatal intensive care and pediatric intensive care unit nurses who responded in a one-month period are reported here. Interest in conscientious objection to care that causes harm or suffering was very high. This article reports the analysis of conscientious objection use in neonatal care.
authors.affiliation: Sonoma State University, Rohnert Park, CA 94928, USA. catlin@sonoma.edu
authors.forename: Anita
authors.initials: A
authors.lastname: Catlin
authors.forename: Christine
authors.initials: C
authors.lastname: Armigo
authors.forename: Deborah
authors.initials: D
authors.lastname: Volat
authors.forename: Elnora
authors.initials: E
authors.lastname: Vale
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Hadley
authors.forename: Wendy
authors.initials: W
authors.lastname: Gong
authors.forename: Ranginah
authors.initials: R
authors.lastname: Bassir
authors.forename: Kelly
authors.initials: K
authors.lastname: Anderson
mesh_terms: D001291:Attitude of Health Personnel; D003220:Conflict, Psychological; D003242:Conscience; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000941:ethics* / Q000458:organization & administration / Q000523:psychology; D018447:Medical Futility / Q000941:ethics / Q000523:psychology; D016294:Models, Nursing; D009014:Morals; D017283:Neonatal Nursing / Q000193:education / Q000941:ethics* / Q000458:organization & administration; D024802:Nurse's Role / Q000523:psychology*; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000193:education / Q000941:ethics / Q000523:psychology*; D010166:Palliative Care / Q000941:ethics / Q000458:organization & administration / Q000523:psychology; D010344:Patient Advocacy / Q000193:education / Q000941:ethics* / Q000523:psychology; D010865:Pilot Projects; D013315:Stress, Psychological / Q000209:etiology / Q000517:prevention & control / Q000523:psychology; D011795:Surveys and Questionnaires