title: An official American Thoracic Society policy statement: managing conscientious objections in intensive care medicine.
abstract: BACKGROUND
  Intensive care unit (ICU) clinicians sometimes have a conscientious objection (CO) to providing or disclosing information about a legal, professionally accepted, and otherwise available medical service. There is little guidance about how to manage COs in ICUs.
  
  
  OBJECTIVE
  To provide clinicians, hospital administrators, and policymakers with recommendations for managing COs in the critical care setting.
  
  
  METHODS
  This policy statement was developed by a multidisciplinary expert committee using an iterative process with a diverse working group representing adult medicine, pediatrics, nursing, patient advocacy, bioethics, philosophy, and law.
  
  
  RESULTS
  The policy recommendations are based on the dual goals of protecting patients' access to medical services and protecting the moral integrity of clinicians. Conceptually, accommodating COs should be considered a "shield" to protect individual clinicians' moral integrity rather than as a "sword" to impose clinicians' judgments on patients. The committee recommends that: (1) COs in ICUs be managed through institutional mechanisms, (2) institutions accommodate COs, provided doing so will not impede a patient's or surrogate's timely access to medical services or information or create excessive hardships for other clinicians or the institution, (3) a clinician's CO to providing potentially inappropriate or futile medical services should not be considered sufficient justification to forgo the treatment against the objections of the patient or surrogate, and (4) institutions promote open moral dialogue and foster a culture that respects diverse values in the critical care setting.
  
  
  CONCLUSIONS
  This American Thoracic Society statement provides guidance for clinicians, hospital administrators, and policymakers to address clinicians' COs in the critical care setting.
authors.forename: Mithya
authors.initials: M
authors.lastname: Lewis-Newby
authors.forename: Mark
authors.initials: M
authors.lastname: Wicclair
authors.forename: Thaddeus
authors.initials: T
authors.lastname: Pope
authors.forename: Cynda
authors.initials: C
authors.lastname: Rushton
authors.forename: Farr
authors.initials: F
authors.lastname: Curlin
authors.forename: Douglas
authors.initials: D
authors.lastname: Diekema
authors.forename: Debbie
authors.initials: D
authors.lastname: Durrer
authors.forename: William
authors.initials: W
authors.lastname: Ehlenbach
authors.forename: Wanda
authors.initials: W
authors.lastname: Gibson-Scipio
authors.forename: Bradford
authors.initials: B
authors.lastname: Glavan
authors.forename: Rabbi Levi
authors.initials: RL
authors.lastname: Langer
authors.forename: Constantine
authors.initials: C
authors.lastname: Manthous
authors.forename: Cecile
authors.initials: C
authors.lastname: Rose
authors.forename: Anthony
authors.initials: A
authors.lastname: Scardella
authors.forename: Hasan
authors.initials: H
authors.lastname: Shanawani
authors.forename: Mark D
authors.initials: MD
authors.lastname: Siegel
authors.forename: Scott D
authors.initials: SD
authors.lastname: Halpern
authors.forename: Robert D
authors.initials: RD
authors.lastname: Truog
authors.forename: Douglas B
authors.initials: DB
authors.lastname: White
mesh_terms: D022126:Access to Information / Q000941:ethics* / Q000331:legislation & jurisprudence; D000293:Adolescent; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D026688:Bioethical Issues; D002648:Child; D003242:Conscience; D030881:Disclosure / Q000941:ethics / Q000331:legislation & jurisprudence; D005260:Female; D017408:Guidelines as Topic; D006297:Health Services Accessibility / Q000941:ethics* / Q000331:legislation & jurisprudence; D006801:Humans; D007223:Infant; D007362:Intensive Care Units / Q000941:ethics* / Q000331:legislation & jurisprudence; D008297:Male; D008875:Middle Aged; D016134:Organizational Policy; D028701:Patient Rights / Q000941:ethics* / Q000331:legislation & jurisprudence; D011247:Pregnancy; D017009:Professional Autonomy; D012955:Societies, Medical / Q000941:ethics; D014481:United States; D000078329:Workforce