Conscience clause in brain death care: ethical and legal perspectives of young nurses and midwives in Poland
Justyna Czekajewska, Dariusz Walkowiak, Anna Jelińska, Jan Domaradzki
Abstract
Background The conscience clause allows healthcare professionals to refuse participation in procedures that conflict with their ethical or religious beliefs. While intended to protect moral autonomy, its application, particularly in the context of brain death and organ donation, raises complex ethical and legal challenges. This study aims to explore the attitudes of young nurses and midwives in Poland toward the conscience clause in relation to brain death, including their ethical concerns, perceived consequences, and views on legal regulations. Methods A cross-sectional survey was conducted among 269 master’s students of nursing and midwifery at the Medical University in Poznan, Poland. Participants completed a questionnaire covering ethical dilemmas, legal opinions, and potential consequences related to invoking the conscience clause. Descriptive statistics and logistic regression were used to analyze the data, with significance set at p < 0.05. Results Most respondents supported both respecting patients’ beliefs (90.3%) and the right to act according to their own conscience (68.4%). However, they expressed concerns about negative social and professional consequences, such as strained relationships (40.2%), job loss (43.9%), or legal action (56.9%). Attitudes were shaped by religiosity and political views. Religious participants were more likely to support conscientious objection in organ retrieval (OR = 2.08). At the same time, right-leaning students were less likely to support invoking the clause when mandated to disconnect a brain-dead patient. Respondents favored structured national regulations (81.8%) over institutional discretion or full abolition of the clause. Conclusion Young healthcare professionals report facing significant ethical and legal dilemmas related to brain death, and their views appear to be associated with personal values and societal context. The findings highlight the need for standardized guidelines, legal protections, ethics education, and further qualitative research to support ethically sound and patient-centered practice.