Reply: Conscientious objection to deceased organ donation by healthcare professionals

Abstract

We welcome the ongoing discussion regarding conscientious objection (CO) among those engaged in critical care, especially in light of Baroness O’Loan’s recent Bill. Nevertheless, certain points in Shaw et al.’s article need further consideration. Contrary to what is implied, there is in fact no consensus on CO in medicine. While there is opposition to CO from some (largely non-clinical) quarters, CO has also been defended in the literature. Additionally, CO is not always a by-product of religious opinion or personal feeling, but is often the fruit of the same reasoning upon which all clinical judgment about what is good is based, or of reflection upon the goals of medicine. Therefore, the utilitarian analysis concerning resource allocation is not sufficient to justify organ retrieval or the exclusion of CO. The ambivalence surrounding death and organ retrieval should not be dismissed lightly. The authors correctly state that most major religions accept the practice of organ retrieval from the deceased, and recognise that a religious group’s definition of death might vary from its current legal definition – hence the source of conflict (though the fact that one branch of a religion accepts a practice does not mean all do; no religion is monolithic). The crux of the issue is not organ donation per se, but that organ retrieval from ‘legally deceased’ persons could be precipitating death illicitly. In the UK, death can be pronounced based on the ‘brainstem death’ criteria, yet some might only accept ‘whole brain death, or ‘cardiorespiratory death’ as valid criteria. Acknowledging the discrepancy between legally and personally accepted definitions of death and the reasonable doubt involved is the reason for the existence of CO. It is a desideratum of a pluralistic society to have room for more than one point of view. Those who disagree with certain definitions will likely object to practices that presuppose them – though, of course, they will have no grounds for calling on law enforcement to implement their ethical viewpoint, like the authors imply they should if their CO were authentic. Finally, there is no mention of the real benefits of CO. CO is a mechanism which highlights flaws in a system (e.g. when a clinical situation is unsafe or unjust), while also protecting individual integrity and autonomy. Since top-level decision makers do not always write policy reflective of the views of all stakeholders, giving those who must follow such guidance the permission to exercise their professional judgment is surely good. When such conflicts arise, CO can force a reasoned debate. Banning CO implies that the views of decision makers or certain parties are not up for debate, either because these parties are utterly certain of the goodness of their instruction, or because they believe they are not accountable to those beneath them. It seems to us, then, that CO still has a place in medicine, including in the intensive care unit.