Conscientious Objection in Euthanasia and Voluntary Assisted Dying From the Perspective of Stakeholders: A Meta-Synthesis

Abstract

Aim: Analyse the meaning of conscientious objection to euthanasia and/or physician-assisted suicide from the perspective of health professionals, students, patients, family members and regulations.

Design: Qualitative systematic review. This review was informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Methods: The Joanna Briggs Institute Critical Appraisal Checklist was used to evaluate the included articles. Data were extracted and analysed using meta-aggregation.

Data Source: The CINAHL, PubMed, PsycINFO, Web of Science and Scopus databases were consulted between January and April 2024. The protocol was registered in PROSPERO (ID: 1007658).

Results: We analysed 15 articles, mainly published between 2019 and 2023, from Canada, Australia, the United States, Spain, and the Netherlands. Two main findings were identified: non-moral motivations (perceived competence, social context, and emotional reactions) and moral motivations (ethical principles, moral consciousness, and religious beliefs).

Conclusions: Conscientious objection is a complex phenomenon in which moral, emotional, and organisational factors converge. Differentiating between moral and non-moral motivations is essential to understanding this diversity of reasons for conscientious objection and avoiding oversimplifications. Clear institutional frameworks are needed to facilitate the handling of objections, balance the rights of professionals and patients, and foster a culture of ethical dialogue.

Implications: Healthcare professionals, patients, and families need clear tools and criteria to manage conscientious objection related to euthanasia and physician-assisted suicide. The findings can contribute to the creation of precise institutional guidelines on the referral procedure and mechanisms that ensure a balance between rights and duties.

Impact: This meta-synthesis provides an integrated view of conscientious objection from multiple perspectives. The results contribute to a better understanding of the ethical complexity of conscientious objection and the practical implications for health systems that are in the process of implementing euthanasia and medically assisted dying laws.