In a climate of plurality about the concept of what is “good,” one of the most daunting challenges facing contemporary medicine is the provision of medical care within the mosaic of ethical diversity. Juxtaposed with escalating scientific knowledge and clinical prowess has been the concomitant erosion of unity of thought in medical ethics. With innumerable technologies now available in the armamentarium of healthcare, combined with escalating realities of financial constraints, cultural differences, moral divergence, and ideological divides among stakeholders, medical professionals and their patients are increasingly faced with ethical quandaries when making medical decisions. Amidst the plurality of values, ethical collision arises when the values of individual health professionals are dissonant with the expressed requests of patients, the common practice amongst colleagues, or the directives from regulatory and political authorities. In addition, concern is increasing among some medical practitioners due to mounting attempts by certain groups to curtail freedom of independent conscience—by preventing medical professionals from doing what to them is apparently good, or by compelling practitioners to do what they, in conscience, deem to be evil. This paper and the case study presented will explore issues related to freedom of conscience and consider practical approaches to ethical collision in clinical medicine. “A judgement of conscience may be wrong, but it cannot be put right by setting it aside” FA Curlin 1. Introduction The practice of contemporary medicine is changing. With diverging views about what constitutes acceptable and professional behavior, one of the most formidable tasks facing the medical community is how to respond to ethical diversity within its membership. Issues of conscience are becoming increasingly problematic for healthcare personnel as nurses, physicians, and other members of the healthcare team endeavor to interact with the expanse of emerging medical technologies, and to respond to evolving expectations that involve more than just treating disease and alleviating suffering [1]. When making clinical decisions, physicians are now tasked with balancing diverse priorities such as promoting wellness, conserving resources, measuring up to continuously evolving standards, making decisions about quality-of-life, engaging in advocacy, and changing harmful patient behaviours [2]. Furthermore, juxtaposed with waning respect for the wisdom of individual conscience and personal ethical conviction, pressure from sources external to
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