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