Is it Ethical to Refuse to Treat a Patient due to Sexual Identity?

Lynda Lampert, RN

Patients come in all sorts of flavors. You have your frequent flyers, your noncompliants, your criminals, and your sweet little senior citizens. All patients are different, and this is part of the joy of nursing. Everyone has their own story, and we get to listen to them, help them, and see them flourish. While not everyone agrees with it, patients come in all kinds of sexual orientations, too. You can have those who are gay, bisexual, transexual, or transvestites. Just a normal day on the job for a nurse, right?

Sexual identity is a hot button issue, and it is becoming hotter. The internet almost blew up a few weeks ago about a Michigan law that purported to allow EMS personnel to deny treatment to patients who identified with a particular sexual identity. Supposedly, this bill allowed medical personnel to refuse based on religious beliefs. You can't believe everything you read on the internet, folks, and there is more to this story than meets the eye. It still brings up the ethical question: can medical workers refuse to treat those who violate a strongly held religious belief?

What the Michigan Bill Says

The bill currently under consideration in Michigan is called the Religious Freedom and Restoration Act, or RFRA. It is currently in the Michigan house, where it was proposed, and still has to work through the system and be signed by the government before it is law. Therefore, the RFRA is not a law in Michigan, despite what the internet says. It is a long, long way from that, and it could change drastically as the politicians get their hands on it. No need to worry, really. It's just an idea at this point.

Another crucial bit to understand is that the bill does not specifically give medical personnel the right to refuse treatment to gay people. The bill doesn't mention medicine or homosexuals at all. Instead, the bill suggests that a person who is by law required to act can choose not to act due to a strongly held religious belief. This means that it could be used as a defense in court if the one who should act is sued by the one not acted upon. Mostly, this would entail civil cases, but this isn't where the story ends.

Possible Scenarios Arising from the Bill

As most lawyers do, far more has been read into this bill than originally intended. Opponents of the bill have suggested that this law could be applied to medical personnel, from doctors to nurses to EMTs. In fact, it could affect any person required by law to act, and they would be in their rights to refuse. Please note, this is not what the bill says, but it is merely a possibility that could be read into the law to protect a medical professional who didn't act when they were required to.

It also brings up the idea of religious freedom. If you know that someone is gay and you disagree with that, do you have to act? The proposed law technically says no. When you hold a sincere and strong religious belief about something, the state cannot force you to act against those beliefs -- even if it means that someone else suffers because of it. This is a bit about the separation of church and state in addition to medicine. How far do religious beliefs go? Can you refuse someone anything because they don't agree with your religious point of view? For instance, should you be forced to rent your property to someone who is gay? According to this law, you wouldn't have to, and that would get you out of a discrimination suit.

Should Healthcare Workers have the Right to Refuse Treatment?

Despite the fact that this bill is far from a law and despite the fact that it doesn't directly affect medical workers, it does bring up a disturbing question: do nurses have the right to refuse to treat patients who are gay? Look at it this way: Do we have the right to refuse treatment of someone with HIV or Ebola? Do we have the right to refuse treatment of a patient whose religion is different than ours? Do we have the right to refuse treatment to those who have a violent criminal past? I have taken care of child molesters, rapists, and murders. I certainly don't agree with their actions, but I took care of them to the best of my ability.

Why is it different for someone of a different sexual orientation? It all boils down to the patient. Here is someone sick in front of you. Does it matter how they have sex? Does it matter what they believe? Do you have the right to play God and decide who lives and who dies? No matter who our patients are, I believe that we have the legal and ethical responsibility to care for them to their last breath. We didn't come into nursing to pick and choose those that we will care for, and politics does not belong at the patient's bedside. Instead, nurses should care for who they are charged with -- criminal, homosexual, black, white, Islamic, or whatever. No one should be denied care, and that includes the modern day lepers, those with a different sexual identity.

References

Michigan House Bill No. 5958; Accessed January 9, 2015

http://www.legislature.mi.gov/documents/2013-2014/billengrossed/House/pdf/2014-HEBH-5958.pdf

Snopes; Slake Michigan; Accessed January 9, 2015

snopes.com: Michigan Exempts Emergency Medical Personnel from Treating Gay People?