The right to refuse.. on what basis??

Nurses General Nursing

Published

Hi guys,

I had a very interesting discussion with a work colleague today based on a topic he saw on another forum. It turned into a very heated argument amoungst staff members and so I would be interested to see what anyone else thinks.

The question posed was: 'Could a health professional refuse to treat a patient?' The answer to this was of course: yes a health professional does have that right.. especially in cases where treatment options can be unsafe for the nurse or the client.

However.... could a health professional refuse to treat on the basis of religious or cultural beleifs??

For example.. lets say a catholic pharmacist refuses to fill a prescription for an oral contraceptive based on the fact that this is against the pharmacist's beleifs?? The pharmacist has the right to refuse.. but by doing so is he infringing on the cultural beleifs of the client?? Or should he deny his own beleifs between the hours of nine to five to appease others??

Or another example: a surgeon in an emergency department refusing to give a patient a blood transfusion due to the surgeons religious beleifs??

My workplace was split in two by this argument. On one hand some people think that the right to refuse should be irrespective of the type of reason, or simply you should not enter a job in which you have obvious personal dilemmas.

On the other hand, some believe that letting your own personal beleifs affect the health of your clients is unprofessional, and that refusal of treatment should not be for personal cultural or religious beleifs but instead should be for safety or precautionary reasons.

There is alot of talk about cultural safety when a nurse is dealing with a client.. but how about the respect of our own cultures in our nursing practice?

It poses some interesting questions.. Id be glad to know what you all think

Specializes in Critical Care.

If I believe that abortion is murder, then assisting in abortions or providing morning after pill is an OVERT act on my part that allows the act to occur: I would be accountable to my Higher Power for participating in the act. My refusal to participate isn't about imposing my beliefs on someone else in this case; it's about imposing my beliefs upon myself and not doing something that would call MY actions into question w/ MY beliefs.

Since abortions and morning after pills are legal (and I use that term loosely since the Supreme Cabal is a Court and not a legislature), I have no problem with someone availing themselves of a legal treatment so long as they respect my right to not participate.

In these cases, there really has to be a mutual respect for beliefs.

And I believe that the examples that bear the most scrutiny on these issues are examples that display the differences of opinion regarding issues of life and death (i.e. abortion, euthanasia, etc.) - and therein explains why they are such difficult issues to address.

But in the end, I feel like we are big enough people to respect each other's belief systems: If a pharmacist has an ethical problem dispensing BCPs, there are other pharmacists out there, you know?

It is a problem if the pharm doesn't release the script back, but that's theft and a completely different moral issue.

Y'all just wait: Roe is going to be overturned in the next 10 yrs, and these issues are going to be exacerbated when the individual States have to, once again, decide these issues for themselves. . .in that case, the shoe will be on the other foot: is it ethical to participate in an 'illegal' procedure in order to prevent what you believe to be 'immoral' outcomes if abortions aren't safe?

(btw, I belief abortion to be a moral crime, however, I have a tendency to believe that the government shouldn't be in the business of legislating morality - and most States, I believe, will have some form of abortion available after Roe, even if some severely restrict it. I think, in the near future, the legislative mandate for abortion is going to be: legal but rare.)

I want Roe to go away because it is bad 'law'. I'm not sure I want abortions to be illegal (because after all, legislating morality is also 'bad' law), but I sure would like it to be more rare.

~faith,

Timothy.

Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

(Please, please, please, let's not turn this into an abortion debate!!)

I can't imagine there was a written Morphine order for the purpose of hastening death....people, and more often than not, nurses, have a grand misconception about palliative care and symptom management. Morphine can be used for other things beside pain, and perhaps you were not aware of the implications of it's use in that case....I don't know, I wasn't there....but we must remember the ethical principle of double effect....sometimes death may be very briefly hastened in effort to make the person comfortable...but there are numerous studies to show that the use of narcotics in the closely terminal pt, usually does not hasten death.

Now, I do realize that this has nothing to do with the original post, but I had to reply.

As far as the OP, I hope when I need care in the hospital, the nurses know how to assess me, implement prescribed care, and evaulate for it's effectiveness. I do not need for them to pray for me or consult with the Bible to figure out if the prescribed treatment I NEED is good for them. And I would imagine this same principle would apply to those who are deeply religious....I would imagine that you would hope that if you get an agnostic nurse caring for you, that she would care for you appropriately and with all due respect for your beliefs despite that fact that he/she might think they are ridiculous.....there are 2 sides to this coin....ultimately, we have made a committment to care for the patients and respect their beliefs....and to be able to carry out care accordingly.....our beliefs are secondary at that point. If that is not ok with you, then you should find something else to do.

Kathryn

Its interesting that you put yourself in the pt's position. in the place of the pt I would agree with you that I wouldnt want my nurse to refuse me anything based on what HE or SHE beleives in

Its interesting that you put yourself in the pt's position. in the place of the pt I would agree with you that I wouldnt want my nurse to refuse me anything based on what HE or SHE beleives in

I think not putting ourselves in the patient's position is part of the problem with nursing today. Don't get me wrong....I don't particularly enjoy bedside care...and I'm not a hand holder. I was a hospice nurse for the last 2 years and I learned alot. For instances, I like my personal space to be my own...I do not enjoy receiving hugs from stangers. I saw alot of people when I worked hospice ASSUME everyone was like them...or should be like them....thus sometimes saying and doing things that may have been inappropriate to that family. I never assumed people wanted a hug when their loved one died...b/c I knew how I felt about that sort of intimacy from strangers...but some people DID want a hug when they were grieving...AND I HAD TO GET OVER IT. It was not about me at that point....I was the caregiver....and I let that family direct the type of care they wanted given. I would see this frequently also with some feeling like they needed to evangelize the dying....I'm sure they were generally worried about their poor dying souls...but give me a break, how completely disrespectful...to assume that you have some absolute answer to the afterlife that you should now burden the pt and family with....it's disgusting. Now, if the pt/fly asked....great....share with them what your philosophy may be...and this did often occur...sometimes people were looking for something...but often they weren't. It made me ill the arrrogance of healthcare professionals that we could not manage to put OUR NEEDS and OUR IDEAS and OUR PHILOSOPHY down for 2 freakin seconds and consider what that life before us needs. And people can get mad all they want...but this argument applies to any that have been mentioned...abortion, birth control, blood,...whatever.....IT IS NOT ABOUT YOUR NEEDS OR YOUR FEELINGS...it is what is very real to that person at that moment, who other than out of desparation, I don't think would be paying a visit to the ER, hospital, or clinic....whatever happened to trying to walk a mile in someone else's shoes? I agree....at the same time, we do have a choice not to participate in things we feel so strongly against...but maybe then nursing is just not what you should do...I mean, things could come up daily that could make you feel compromised....and it's not like we didn't know that things existed in the healthcare arena that may be against your beliefs. I think the long and short of it is that though we need to find something that doesn't conflict with our belief system, ultimately, if you are there in that building being employed, and the prescribed care is prudent....whether it meshes with your beliefs or not...then that care should be carried out....

Kathryn

Specializes in Critical Care.
(Please, please, please, let's not turn this into an abortion debate!!)

you're right, but!

when you talk about pharmacists not wanting to give morning after pills, that is in fact the debate you are already having . . .

~faith,

Timothy.

Specializes in Geriatrics/Oncology/Psych/College Health.

I am asking this not to turn into an abortion thread/debate.

quoting from:

http://content.nejm.org/cgi/content/full/352/24/2471

new england j. of medicine

volume 352:2471-2473 spacer.gif june 16, 2005 spacer.gif number 24

"...as mahatma gandhi said, "in matters of conscience, the law of majority has no place," acts of conscience are usually accompanied by a willingness to pay some price. martin luther king, jr., argued, "an individual who breaks a law that conscience tells him is unjust, and who willingly accepts the penalty of imprisonment in order to arouse the conscience of the community over its injustice, is in reality expressing the highest respect for law."

what differentiates the latest round of battles about conscience clauses from those fought by gandhi and king is the claim of entitlement to what newspaper columnist ellen goodman has called "conscience without consequence."

and of course, the professionals involved seek to protect only themselves from the consequences of their actions-not their patients.

one is the emerging norm of patient autonomy, which has contributed to the erosion of the professional stature of medicine. insofar as they are reduced to mere purveyors of medical technology, doctors no longer have extraordinary privileges, and so their notions of extraordinary duty-house calls, midnight duties, and charity care-deteriorate as well. in addition, an emphasis on mutual responsibilities has been gradually supplanted by an emphasis on individual rights. with autonomy and rights as the preeminent social values comes a devaluing of relationships and a diminution of the difference between our personal lives and our professional duties.

for health care professionals, the question becomes: what does it mean to be a professional in the united states? does professionalism include the rather old-fashioned notion of putting others before oneself? should professionals avoid exploiting their positions to pursue an agenda separate from that of their profession? and perhaps most crucial, to what extent do professionals have a collective duty to ensure that their profession provides nondiscriminatory access to all professional services?

some health care providers would counter that they distinguish between medical care and nonmedical care that uses medical services. in this way, they justify their willingness to bind the wounds of the criminal before sending him back to the street or to set the bones of a battering husband that were broken when he struck his wife. birth control, abortion, and in vitro fertilization, they say, are lifestyle choices, not treatments for diseases.

and it is here that licensing systems complicate the equation: such a claim would be easier to make if the states did not give these professionals the exclusive right to offer such services. by granting a monopoly, they turn the profession into a kind of public utility, obligated to provide service to all who seek it. claiming an unfettered right to personal autonomy while holding monopolistic control over a public good constitutes an abuse of the public trust-all the worse if it is not in fact a personal act of conscience but, rather, an attempt at cultural conquest.

accepting a collective obligation does not mean that all members of the profession are forced to violate their own consciences. it does, however, necessitate ensuring that a genuine system for counseling and referring patients is in place, so that every patient can act according to his or her own conscience just as readily as the professional can."

so, believe whatever you want, but don't deny care (or at least a referral)

Specializes in Critical Care.
Gandhi said, "in matters of conscience, the law of majority has no place," acts of conscience are usually accompanied by a willingness to pay some price. Martin Luther King, Jr., argued, "An individual who breaks a law that conscience tells him is unjust, and who willingly accepts the penalty of imprisonment in order to arouse the conscience of the community over its injustice, is in reality expressing the highest respect for law."

I wasn't trying to start an abortion debate, as I probably wouldn't long participate in such a debate anyway.

I was trying to point out the thought above from two perspectives: 1. This is what the pharmacists refusing to provide morning after pills are doing at this moment: being willing to accept the penalties for expressing their conscience in order to arouse the conscience of the community over its injustice.

All I was really trying to do was create a comparison, not start an abortion debate: if you think it's wrong for the pharmacist to do this, isn't it on the same level as someone who would assist with abortions if they become illegal after Roe goes?

wouldn't that be an on-par 'being willing to accept the penalties for expressing their conscience in order to arouse the conscience of the community over its injustice.'

I guess what I'm trying to say is that, if you think someone should violate their beliefs because it doesn't violate yours, isn't your opinion convenient to a set of situations that favor your viewpoint? Would you hold the same viewpoint if it was your beliefs that you were expected to violate on behalf of society??

And the turnabout on the morning after pill had to do with the possibililty of abortion being illegal. In order to get to that hypothetical, I felt it necessary to point out that I didn't believe this would ever be possible, Roe or not.

sorry, wasn't trying to open a can of worms, I was trying to stick to this debate. And I was trying to find an example to highlight a position where the people saying that pharms must violate their beliefs would see a similar situation that related personally to them to see if their beliefs would be the same if it were their fundamental beliefs at issue. . .

~faith,

Timothy.

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