ATS GUIDELINES Bundle

Conscientious Objections Pocket Guide

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Table 2. Policy Recommendations for Managing Conscientious Objections in Intensive Care Medicine Recommendation 1 • COs in ICUs should be managed through institutional mechanisms rather than ad hoc by clinicians. Healthcare institutions should develop and implement CO policies that encourage prospective management of foreseeable COs and that provide a clear process to manage unanticipated COs. Recommendation 2 • Institutions should accommodate COs in ICUs if the following criteria are met: 1. the accommodation will not impede a patient's or surrogate's timely access to medical services or information, 2. the accommodation will not create excessive hardships for other clinicians or the institution, and 3. the CO is not based on invidious discrimination. Recommendation 3 • A clinician's CO to providing potentially inappropriate or futile medical services should not be considered sufficient justification to unilaterally forgo the treatment against the objections of the patient or surrogate. Clinicians should instead use a fair process-based mechanism to resolve such disputes. A clinician may use the institutional CO management process to request a personal exemption from providing the medical service. Recommendation 4 • Institutions should promote open moral dialogue, advance measures to minimize moral distress, and generally foster a culture that respects diverse values in the critical care setting. Policy Recommendations

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