Competing World Views, Professional Norms, and Conscience

Sometimes patients or their legally authorized representatives/surrogate decision makers request interventions that clinicians believe ought not to be provided because, for example, they will merely prolong the life of a patient whose quality of life clinicians deem poor. When such disagreements cannot be resolved, clinicians may request a clinical ethics consultation. Some institutions have policies and some jurisdictions have laws addressing such conflicts, many of which involve procedures that ultimately allow for unilaterally withholding life-sustaining interventions. Autumn Fiester has argued that a radically new approach for addressing such conflicts is needed. I argue that Fiester's analysis relates closely to and has implications for other debates and key topics in the bioethics literature and raises important questions that merit further exploration. These include the concept of professional values or professional ethics and of values imposition, both of which are important in the literature on conscientious objection.