Figure 1. An approach to managing conscientious objections
(CO) based on a clinician's belief that a requested
medical service is medically inappropriate or futile.
An lCU clinician invokes a CO to withhold or
withdraw a medical service against patient/surrogate
wishes based on a belief that a requested treatment is
medically inappropriate or futile.
Pursue a fair process of dispute resolution to
determine if the requested medical service is consistent
with accepted medical practice.
There is no obligation to provide the
requested medical service. The case
should be handled according to the
relevant institutional policies (out of
the scope of this document).
NO YES
Is the requested
medical service
within the boundaries
of accepted medical
practice?
The institution should ensure that the
requested medical service is provided.
NO YES
The clinician should
reconsider but not
necessarily abandon the
CO based on the outcome of
the case review. Does the clinician
continue to have a CO to
providing the requested
medical service?
The clinician should
provide the medical
service.
The objecting ICU clinician should seek
an accommodation through the CO
management process to be personally
removed from the case.
