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Conscientious objection and moral distress: a relational ethics case study of MAiD in Canada
  1. Mary Kathleen Deutscher Heilman1,
  2. Tracy J Trothen2
  1. 1 Ethics, St. Paul’s Hospital, Saskatoon, Saskatchewan, Canada
  2. 2 School of Religion and School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
  1. Correspondence to Dr Mary Kathleen Deutscher Heilman, Ethics, St. Paul’s Hospital, Saskatoon, Canada; mary.heilman{at}


Conscientious objection has become a divisive topic in recent bioethics publications. Discussion has tended to frame the issue in terms of the rights of the healthcare professional versus the rights of the patient. However, a rights-based approach neglects the relational nature of conscience, and the impact that violating one’s conscience has on the care one provides. Using medical assistance in dying as a case study, we suggest that what has been lacking in the discussion of conscientious objection thus far is a recognition and prioritising of the relational nature of ethical decision-making in healthcare and the negative consequences of moral distress that occur when healthcare professionals find themselves in situations in which they feel they cannot provide what they consider to be excellent care. We propose that policies that respect the relational conscience could benefit our healthcare institutions by minimising the negative impact of moral distress, improving communication among team members and fostering a culture of ethical awareness. Constructive responses to moral distress including relational cultivation of moral resilience are urged.

  • conscientious objection
  • euthanasia
  • moral psychology

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  • Contributors Both authors contributed equally to this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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