This article is an exploratory effort meant to solicit and provoke dialog. Conscientious objection is proposed as a potential response to the moral distress experienced by neonatal nurses. The most commonly reported cause of distress for all nurses is following orders to support patients at the end of their lives with advanced technology when palliative or comfort care would be more humane. Nurses report that they feel they are harming patients or causing suffering when they could be comforting instead. We examined the literature on moral distress, futility, and the concept of conscientious objection from the perspective of the nurse's potential response to performing advanced technologic interventions for the dying patient. We created a small pilot study to engage in clinical verification of the use of our concept of conscientious objection. Data from 66 neonatal intensive care and pediatric intensive care unit nurses who responded in a one-month period are reported here. Interest in conscientious objection to care that causes harm or suffering was very high. This article reports the analysis of conscientious objection use in neonatal care.

Context. Economic decision models are seldom used in developing policies for the cost-effective control of invasive species that threaten natural ecosystems. However, their potential value is shown using an example of European rabbits damaging native vegetation in Australia.Aims. To better define the problem of rabbit damage, provide a sound theoretical basis for implementing cost-efficient strategies for rabbit control and show how resources available for ecosystem protection can be most effectively applied. Methods.A dynamic economic decision model was developed, incorporating the costs and effectiveness of three methods for controlling rabbits among native vegetation to consider alternative management strategies. A monetary value on native vegetation was set using the 'avoided' cost of replanting trees on roadsides and from field data we described how capacity of plant communities to regenerate improves if rabbit numbers are reduced.Key results. Model outputs indicated the best combinations of methods for cost-effective rabbit control and showed how the highest benefits could be gained in protecting natural vegetation.Conclusions. The model provided a framework for deciding how limited resources might be used to greatest benefit for protecting native vegetation.Implications. This methodology could apply to other invasive species, provided that natural assets can be given a justifiable monetary value, control costs and effectiveness can be determined and the impact of the pests on assets can be modelled as dynamic population processes.

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Biodiversity protection, Cost estimation, Economic surplus, Invasive animals, Pests, Valuation,