What do medical students think about conscientious objection? A cross-sectional study from Turkey.

backgroundPhysicians' refusal to perform medical procedures that they deem contrary to their conscience may threaten basic human rights and public health. This study aims to investigate the thoughts and attitudes of future physicians on conscientious objection (CO) and thus contribute to the discussions from a country more heavily influenced by Eastern values.

methodsA cross-sectional multi-center study was conducted among medical students country-wide, where 2,188 medical students participated via an online survey. The methodology was in accordance with the CHERRIES.

resultsNearly half of the students think that CO should be a right. If a medical intervention that conflicts with their personal values is requested, two-thirds would request an assignment to take another action if possible, and 8.2% stated that they would refuse to participate at all costs. If CO is recognized as a right, one-third of the participants would not refer the patient. Male participants, the ones who are more religious, and who have chosen medicine for pragmatic reasons, were more supportive of the right to refuse medical interventions that may contradict their moral values, culture, or beliefs (p = 0.000, 0.000, 0.021, respectively). Also, students who thought that conscience is a voice within us that has existed since we were born and who believed everyone must pay for all healthcare services were statistically more likely to agree that CO should be a right (p = 0.000, 0.008, respectively). The participants stated that they would most frequently object to requests for extreme aesthetic interventions (splitting the tongue in half - 39.1%, changing eye color - 28.2%, removing the lowest rib - 26.8%), euthanasia (23.2%), hymen restoration (17.3%), gender change (16.5%), and optional pregnancy termination (14.0%).

conclusionsDeveloping undergraduate and post-graduate education that integrates CO as a specific topic, clarifying the conceptual definitions, and improving/developing protocols for exercising CO seem crucial to prevent possible violations of rights and to protect health professionals' integrity. These interventions should be carried out with the participation of all parties to come together in open communication and respectful dialogue in this delicate matter.