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Conscientious objection in euthanasia and assisted suicide: A systematic review.
Carlos Gomez-Virseda1, Chris Gastmans1
1Centre for Biomedical Ethics and Law, Department of Public Health & Primary Care, KU Leuven, Leuven, Belgium.
Plos One
|June 23, 2025
Summary
Conscientious objection (CO) in euthanasia and assisted suicide (EAS) is debated, with differing views on its meaning and application. Dialogue is crucial for balancing professional conscience and patient rights.
Area of Science:
- Bioethics
- Medical Law
- Professional Ethics
Background:
- Euthanasia and assisted suicide (EAS) legalization raises ethical concerns regarding healthcare professionals' conscientious objection (CO).
- CO is viewed as both a protection of moral integrity and a potential barrier to patient access to care.
- This review synthesizes ethical literature on CO in EAS, addressing its definition, ethical positions, and underlying presuppositions.
Purpose of the Study:
- To comprehensively synthesize the ethical literature concerning conscientious objection (CO) in euthanasia and assisted suicide (EAS).
- To clarify the meaning and application of CO within the context of EAS.
- To identify and analyze the ethical positions and presuppositions shaping the debate on CO in EAS.
Main Methods:
- Systematic review of argument-based publications using PRISMA, RESERVE, and TARCiS guidelines.
- Searched 13 major databases across biomedical, philosophical, and theological literature without date or language restrictions.
- Independent screening of titles and abstracts, followed by full-article selection based on predefined criteria.
Main Results:
- 58 pertinent articles were reviewed, with 51 published between 2015-2024, indicating recent focus on the topic.
- While the definition of CO is generally agreed upon, its interpretation and application in EAS remain contentious.
- Three main ethical positions emerged: conscience absolutism, the compromise approach, and the incompatibility thesis, each with distinct supporting arguments and presuppositions regarding conscience, morality, religion, medicine, and end-of-life care.
Conclusions:
- The debate on CO in EAS risks polarization, highlighting the need for dialogue between theoretical and context-sensitive perspectives.
- Effective implementation of CO requires clearer guidelines to balance respect for conscience, patient rights, and professional responsibilities.
- Further research and discussion are essential for navigating this complex ethical landscape.
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