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ethics lecture rant (sensitive topic)

Today our lecture was on ethics and values in nursing care. We were discussing abortions and our teacher was explaining to us that we can refuse to care for a patient if say they are in the hospital because of a serious medical problem due to an abortion. The discussion got a little heated (personally I wouldn't try and refuse to care for anyone unless I felt threatened in some way) but some of the students in my class explained they would never care for a patient who was in the hospital from a problem with an abortion unless obviously no one was available to take over that pt's care. I was surprised a few students felt so strongly about this. I thought a big part of nursing care is to not pass judgement and be as accepting as possible. I realize we're only human but personally I feel that if you have reservations about treating certain pt's because they believe in something you don't...or they have acted in a way that you feel is against your own morals, you're in the wrong profession.

Anyway...a little fired up from the lecture still and wondering how you guys feel about passing a pt on to another nurse and reasons that would make you refuse care to for someone.

(no abortion arguments please)

Ginyer

UM Review RN, ASN, RN

Specializes in Utilization Management.

There are some patients I like better than others, and some patients who have dx's that I excel at dealing with, but I don't think I'd refuse to take care of any patient.

Every now and then I see patients or family members who have "dollar signs in their eyes" and those I would LOVE to refuse to care for, but the best I have done so far is to just grit my teeth and get through the shift.

Seems to me that refusing to care for someone means you've played judge and jury to them. I have learned through experience that the judge and jury belong in the courtroom, not in the hospital room.

We had that same discussion in our last semester when we covered the ethics/value topic of nursing. Personally, I would have no problem taking care of someone who was sufferring complications after an abortion. It would be no different that taking care of the overdose that came in through the ER, or the prostitute that is being treated for some sexual disease. They still need care.

However, I personally feel that I would not work with a patient going through an abortion. To me there is a difference. During or after an abortion...neither is judging the person. Afterwards, they are a patient in need of care. Going through the abortion goes against my own personal values. And though each person is an individual with their own values, each individual has the right to their own values, and everyone needs to respect that. To me its not a matter of judging others, but respecting each others values.

RedSox33RN

Specializes in Emergency Dept, M/S.

I agree, because if you refuse to care for one person for something, where would it stop? Refuse to treat someone with high cholesterol because they eat meat, and you don't? Refuse to treat a drug addict? An alcoholic? Someone that bungee-jumped because YOU would never do it?

I agree that all of us have our own morals - as we should, it makes us individuals, but there will always be aspects of our job we find distasteful. But I agree with what Angie said - WE are not the ones to play judge and jury. If someone did come in from having a procedure or overdose or whatever - WE were not the ones that were there, we don't know the reasons.

I don't believe treating the patient means you are accepting what they did was okay. None of us think (I hope!) that drunk driving is okay, yet they are treated all the time - even after they plow into innocent people in a crosswalk.

I can see why the subject would be touchy, but for me, even with my beliefs, I would never refuse to treat someone.

lisamc1RN, LPN

Specializes in LTC/Behavioral/ Hospice. Has 4 years experience.

Although I would not participate in an abortion, and would not choose to work in a place where it would be expected that I do so, I wouldn't refuse to care for someone who came from complications of an abortion. There is a difference to me.

RedSox33RN

Specializes in Emergency Dept, M/S.

We had that same discussion in our last semester when we covered the ethics/value topic of nursing. Personally, I would have no problem taking care of someone who was sufferring complications after an abortion. It would be no different that taking care of the overdose that came in through the ER, or the prostitute that is being treated for some sexual disease. They still need care.

However, I personally feel that I would not work with a patient going through an abortion. To me there is a difference. During or after an abortion...neither is judging the person. Afterwards, they are a patient in need of care. Going through the abortion goes against my own personal values. And though each person is an individual with their own values, each individual has the right to their own values, and everyone needs to respect that. To me its not a matter of judging others, but respecting each others values.

I agree that WORKING with patients in the capacity of assisting with one is a whole different ball game than treating someone after the fact. Very different.

Marie_LPN, RN, LPN, RN

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

I feel that refusing to care for someone because of your own personal opinions and feelings is wrong. Personal opinions and feelings on certain subjects should never interfere with a job, and if there's a possibility that would happen, perhaps that person should avoid an occurance of such, and not take a job where it might happen.

crb613, BSN, RN

Specializes in Med Surg/Tele/ER. Has 7 years experience.

Today our lecture was on ethics and values in nursing care. We were discussing abortions and our teacher was explaining to us that we can refuse to care for a patient if say they are in the hospital because of a serious medical problem due to an abortion. The discussion got a little heated (personally I wouldn't try and refuse to care for anyone unless I felt threatened in some way) but some of the students in my class explained they would never care for a patient who was in the hospital from a problem with an abortion unless obviously no one was available to take over that pt's care. I was surprised a few students felt so strongly about this. I thought a big part of nursing care is to not pass judgement and be as accepting as possible. I realize we're only human but personally I feel that if you have reservations about treating certain pt's because they believe in something you don't...or they have acted in a way that you feel is against your own morals, you're in the wrong profession.

Anyway...a little fired up from the lecture still and wondering how you guys feel about passing a pt on to another nurse and reasons that would make you refuse care to for someone.

(no abortion arguments please)

Ginyer

I personally don't think I could refuse to care for anyone. I may not agree with their values or lifestyle but I am not their judge. Who knows what you might do if you had been in their situation?? Life is a funny thing you swear you would never do something then it comes knocking at your door & all of a sudden things look a whole lot different when its you or someone you love. It's like the old saying "walk a mile in my shoes".

CNM-to-be

Specializes in L&D/birthing center.

I wouldn't refuse to care for any pt. I may not agree w/ them (heck, I don't agree w/ most conventional medical tx but I digress) but as a nurse my job is to care for the pt w/o passing judgement. That said, I am a Conscientious Objector of infant circumcision. When I'm in practice that's one procedure I will not assist. I will care for the pt. after the surgery but I will not help a doc perform cosmetic surgery on an unconsenting pt. I can understand someone being opposed to abortion (they obviously would not work in a PP clinic) but to refuse care to a woman who had complications from one...seems wrong to me. Kind of like me refusing care to a patient w/ CHF who ate McDonald's his whole life when I am a vegetarian, yk?

I agree, because if you refuse to care for one person for something, where would it stop? Refuse to treat someone with high cholesterol because they eat meat, and you don't? Refuse to treat a drug addict? An alcoholic? Someone that bungee-jumped because YOU would never do it?

Exactly...where would it stop? We are going to come across pt's all the time who have completely different lifestyles than our own. We won't know the whole story or the entire truth of the situation they are in which is why we couldn't appropriately pass any type of judgement on them. Like I said I was just really surprised that my classmates were so quick to say they would automatically refuse to care for this group of pt's. I sure hope they aren't planning on working in the ER.

A student in my class works on the telemetry floor as a pca. She was telling us about a pt that comes in almost every month who supposedly is sexually harassing his female nurses. He'll grab their butt, grab their breasts, talk dirty, exposes himself, and sometimes when they lean over him for something he'll grab the front of their scrub top and pull it down and look down their top. They get male nurses for him when they can but they're rarely available on that floor. I'm not aware of what hospital policy is on this type of stuff. This situation is a different can of worms but we're talking about what would affect our care for a pt. I have no idea how this would affect my care for this pt. Just wondering what yall thought about it.

Ginyer

From what I remember, you can refuse to care for a patient having an abortion but you cannot refuse care if they are their from complications of the abortion. Abortion and life threatening danger to the nurse is the only time you can refuse care to a patient.

VivaLasViejas, ASN, RN

Specializes in LTC, assisted living, med-surg, psych. Has 20 years experience.

I have never refused to care for a patient, although I came close to doing so a couple of years ago when we had a 'skinhead' come in for an appy with all sorts of racist tattoos on his arms, his chest, even his neck. He was a nasty piece of work who refused to be cared for by anyone who wasn't female and white. He wouldn't even allow the CNA, who was Filipina, to take his vital signs.........Naturally, it was my rotten luck to be assigned to him, and I was half-tempted to address him in Spanish just to see how he would react. :stone

What made me even angrier was, he was all friendly and polite with me right after he'd demanded "a WHITE nurse, g**dammit!" How I wanted to tell him, right then and there, what I thought of him and his views! :angryfire I've got some Cherokee and Hispanic background, plus I'm Catholic, so I could've really let him have it........but of course, that would have been unprofessional, so I contained myself and got through the day as well as I could. :stone

Ginyer, I used to feel the way you do. Then I took a job in an area of nursing that deals with a lot of ethical grey areas. I have asked to be assigned another patient once in my career because what we were doing to that child was so horrific to me that I knew I couldn't provide the best care to the family. I see no value in forcing nurses to care for those patients. It harms the nurse and the patient. Personal feelings probably shouldn't interfere with work, but I'm not a robot. I'm not the perfect nurse. I try to do my best every shift, but some things are just too much sometimes and I'm lucky that I have supportive coworkers who are understanding of that.

Some things that might make you understand where I'm coming from: Would you look after an infant that we were allowing to dehydrate to death and not give it any fluids? Would you be willing to code a child who has a terminal condition over and over (see a code yet? It isn't gentle)? These are both situations I've been faced with as a nurse. One I could deal with, one I couldn't. I hope you can understand, it isn't about judging others, it's about being ablt to live with myself.

I agree, because if you refuse to care for one person for something, where would it stop? Refuse to treat someone with high cholesterol because they eat meat, and you don't? Refuse to treat a drug addict? An alcoholic? Someone that bungee-jumped because YOU would never do it?

Exactly...where would it stop? We are going to come across pt's all the time who have completely different lifestyles than our own. We won't know the whole story or the entire truth of the situation they are in which is why we couldn't appropriately pass any type of judgement on them. Like I said I was just really surprised that my classmates were so quick to say they would automatically refuse to care for this group of pt's. I sure hope they aren't planning on working in the ER.

A student in my class works on the telemetry floor as a pca. She was telling us about a pt that comes in almost every month who supposedly is sexually harassing his female nurses. He'll grab their butt, grab their breasts, talk dirty, exposes himself, and sometimes when they lean over him for something he'll grab the front of their scrub top and pull it down and look down their top. They get male nurses for him when they can but they're rarely available on that floor. I'm not aware of what hospital policy is on this type of stuff. This situation is a different can of worms but we're talking about what would affect our care for a pt. I have no idea how this would affect my care for this pt. Just wondering what yall thought about it.

Ginyer

i am not a nurse yet so i am just anserwing as a woman, but there are public indecency laws that should be enforced here, if he is constatly exposing imself and grabbing someones private parts, that is sexual assault, and public indecency. If it has been well documented by a few different nurses and nothing has been done, i personally would call the police the next time it happens. He needs to be taught a lesson. :angryfire

And I am pro-life.

I won't ever work in a PP clinic, nor give them my money from United Way.

Nor would I work in a fertility clinic -- I'm one of those people who believes life begins at conception.

You are on dangerous, dangerous grounds if you refuse tx based upon lifestyle choices. Isn't it like 75% of disease is preventable, and is due to lifestyle choices (DM II--though not all suffers; CA from smoking; any number of diseases from obesity; alcoholism). DM II is a huge one, because so many of the pts in other departments (CV, Ophthalmology, PVD, surgery d/t amputations) are due to complications of DM. So, the DM is a case in point, right? Who's to say that someone has DM II because of lifestyle choices and who could have avoided it?

NurseFirst

I think there's a difference between treating someone with what you would consider to be unethical treatment and treating someone who has different morals than you do. Certainly we can probably all agree that we would not participate in the unethical treatment of a patient. After all, you have your license to protect. Now treating someone with different morals is another issue. The actions that bring a patient to the hospital may go against your morals, but it's not unethical to treat them. It would be unethical not to provide ethical treatment for them. What level would we be stooping to, if we chose not to help a patient? Would we be any better than the person who we thought acted immorally? Could we say that by not helping that patient we are acting morally or ethically?

If you cannot help all patients regardless of their beliefs, then health care probably should not be your career choice.

The difference as I see it is as others have mentioned, not assisting with an abortion if you are pro-life and see that as killing an innocent. However you most likely won't be faced with that if you don't work for a facility that performs abortions so that discussion is moot.

Taking care of someone who then comes to your floor from the ER after hemorrhaging at home is completely different. You are not helping facilitate an abortion, you are helping a women who was bleeding. You can't, in good conscience refuse to care for her, in my opinion.

Circumcision also - you have a right not to help the doctor with that but you should continue to care for the infant afterwards. To not do so would be wrong, again in my opinion.

That sexually deviant guy is a completely different story - we do not have to put up with being treated that way - it is harrassment and no one can force you to care for a patient who is harrassing you.

School is a good place to hash this stuff out though . . .these are things that before becoming a nurse most of us had not thought about. Better to hash it out in school than be faced with it at work and have no idea how to respond.

I think your teacher did a good thing to encourage discussion . . .. sometimes you find yourself changing your mind a bit when you hear others out.

Forced to assist in an abortion if you are pro-life - no. Taking care of a patient with complications - yes.

steph

. Certainly we can probably all agree that we would not participate in the unethical treatment of a patient. After all, you have your license to protect.

I'd be careful there. What is ethical/moral and what is needed to protect your lisence are not necessarily the same thing.

VivaLasViejas, ASN, RN

Specializes in LTC, assisted living, med-surg, psych. Has 20 years experience.

The difference as I see it is as others have mentioned, not assisting with an abortion if you are pro-life and see that as killing an innocent. However you most likely won't be faced with that if you don't work for a facility that performs abortions so that discussion is moot.

Taking care of someone who then comes to your floor from the ER after hemorrhaging at home is completely different. You are not helping facilitate an abortion, you are helping a women who was bleeding. You can't, in good conscience refuse to care for her, in my opinion.

Circumcision also - you have a right not to help the doctor with that but you should continue to care for the infant afterwards. To not do so would be wrong, again in my opinion.

That sexually deviant guy is a completely different story - we do not have to put up with being treated that way - it is harrassment and no one can force you to care for a patient who is harrassing you.

Forced to assist in an abortion if you are pro-life - no. Taking care of a patient with complications - yes.

steph

That's where I draw the line, too, Steph.......It's why I don't get people like that one pharmacist who refused to dispense birth control pills---if you don't believe a particular task or procedure is right, then you shouldn't work for an employer who expects you to perform it in the normal course of your job duties. It's a no-brainer........but then, some people have to make a statement , don't they? :rolleyes:

i'd be careful there. what is ethical/moral and what is needed to protect your lisence are not necessarily the same thing.

there are standards put in place that define the scope of everyone's practice, which involves the ethical treatment of a patient. can anyone truly say that there is an instance where it would be ethical to withhold the treatment of a woman who had an abortion? there are probably some gray areas that are harder to define, but i can't think of any right now. maybe this one will do...the subject of physician assisted suicide... some consider it unethical to allow a terminal patient to die without any mercy. others think it goes against good morals and is considered murder. some view healthcare professionals as people who are supposed to prevent death, not hasten it. others see it from the perspective that healthcare professionals should not cause suffering and yet allowing them to die without assistance is causing suffering. right now, i believe pas is only lawful in oregon, but should it become lawful everywhere, no one is going to force anyone to participate against their will. this is the kind of "treatment" where the healthcare professional can choose not to assist the patient in. some of you may come up with better ethical dilemmas with respect to non-treatment by a healthcare professional that involves a gray area.

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