Inclusion and exclusion criteria.

Introduction
As euthanasia and assisted suicide (EAS) become legal in more countries, conscientious objection (CO) of healthcare professionals is gaining increasing attention. While some argue that CO safeguards professionals’ moral integrity, others view it as a barrier to patients’ access to desired healthcare. This review provides a comprehensive synthesis of the ethical literature regarding CO to EAS and answers three key questions: What is the meaning of CO and how is it used in EAS? What ethical positions support or challenge it? What underlying presuppositions shape the debate?.
Methods
We used the PRISMA guidelines, RESERVE standards, and TARCiS statement to conduct a systematic review of argument-based publications retrieved from 13 major databases covering biomedical, philosophical, and theological literature. No date or language restrictions were applied. Titles and abstracts were independently screened by the two authors, and complete articles were selected based on predefined inclusion and exclusion criteria.
Results
We identified 58 pertinent articles that were included in our review. Of these, 51 were published in the last decade, from 2015 through 2024. Our findings highlight three key dimensions. First, while there is general agreement on the definition of CO, its interpretation and application in EAS remain highly contested. Second, the ethical debate revolves around three main positions: conscience absolutism, the compromise approach, and the incompatibility thesis. Each of these is supported by distinct ethical arguments. Third, the debate is shaped by several underlying presuppositions, including divergent views on conscience, morality, religion, medicine, and end-of-life care.
Conclusions
Our results highlight the risk of polarization in the debate on CO in EAS. It emphasizes the importance of dialogue between theoretical and context-sensitive perspectives to support more effective implementation of CO. Clearer guidelines are needed to balance respect for conscience, patient rights, and professional responsibilities in this complex issue.

引言
随着安乐死与辅助自杀（euthanasia and assisted suicide, EAS）在更多国家合法化，医疗保健从业者的良心拒服（conscientious objection, CO）正受到越来越多的关注。部分观点认为，良心拒服可维护从业者的道德操守，而另有观点则将其视为阻碍患者获取所需医疗服务的障碍。本综述对安乐死与辅助自杀相关的良心拒服伦理研究文献进行了全面梳理，并回应了三个核心问题：良心拒服的内涵为何，其在安乐死与辅助自杀场景中如何应用？哪些伦理立场支持或反对良心拒服？哪些潜在预设塑造了这场学术辩论？
方法
本研究遵循PRISMA指南、RESERVE标准及TARCiS声明，对来自13个涵盖生物医学、哲学与神学文献的主流数据库中检索到的基于论证的出版物开展系统综述。本研究未设置时间与语言限制。两名研究者独立筛选文献标题与摘要，并基于预先设定的纳入与排除标准遴选完整文献。
结果
本研究共纳入58篇相关文献，其中51篇发表于2015至2024年的近十年间。本研究结果凸显了三个核心维度：其一，尽管学界对良心拒服的定义已达成普遍共识，但其在安乐死与辅助自杀场景中的解读与应用仍存在极大争议；其二，相关伦理辩论主要围绕三大立场展开：良心绝对主义、折中方案与不相容论题，各立场均有独特的伦理论证支撑；其三，这场辩论受多项潜在预设影响，包括对良心、道德、宗教、医学与临终关怀的不同认知。
结论
本研究结果凸显了安乐死与辅助自杀相关良心拒服辩论的极化风险。研究强调，需搭建理论视角与情境敏感视角间的对话机制，以更有效地落实良心拒服相关规范。在这一复杂议题中，亟需更清晰的指南来平衡对良心的尊重、患者权利与从业者责任三者间的关系。