ethics lecture rant (sensitive topic)

[Ginyer]

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

[Soleilpie]

i actually didn't refuse to care for that infant soleilpie. surprised? new research says dehydration is not painful and that infant was well medicated and i believe his death was merciful. other nurses in the unit did not care for him because they felt as you do and i respect that.

the child i refused to care for was the one who had a condition that was incompatible with life, but whose parents insisted be a full code. i could not reconcile that with my beliefs because i thought it was cruel. other nurses could. i guess my point is with enough understanding coworkers, nurses shouldn't be forced to do things that they find unethical or immoral because it doesn't do anyone any good. if we're going to suggest that people can't go into nursing if they can't look after every patient we are going to lose a lot of good people.

can anyone tell me the benefits of forcing a nurse to care for such patients when there are other nurses who are willing to do it and don't have the same ethical qualms?

i'd be interested in that study. i just know that when i'm slightly dehydrated, i don't feel too well. with the infant being heavily medicated, that changes the situation for me. this is more merciful to me. i don't think i ever said that healthcare professionals must be required to treat in all situations. i believe ethical treatment should be required by all though. i know that what constitutes ethical versus unethical treatment can be hard to define and is subjective but for the most part, people tend to agree on what ethical treatments are. now, if that study without a doubt proves that dehydration is painless and no one suffers, then that's ethical to me. it's merciful. the case where you chose not to assist was because you thought it was cruel. this is how i would base my decisions as well. anything that causes unjustifiable suffering and harm without any reasonable benefit to me is unethical. no one should be required to provide unethical treatments. i could not in good conscience keep doing a procedure that will cause the pateint harm and/or cause pain and suffering, especially if permanent. my argument is that by refusing to help a person strictly because of their views or procedures they themselves have chosen to have done is unethical. for example, choosing not to help a pedophile solely because he/she is a pedophile to me would be unethical because no treatment is being provided. choosing not to help because a treatment to heal a patient or a procedure to hasten the death of a terminally ill person will cause merciless pain and suffering is another situation altogether.

i think all healthcare professionals should be required to perform ethical treatment to a patient regardless of the patient's lifestyle or past procedures they've had done. i do not however believe that all healthcare professionals should be required to perform questionable procedures or treatment that is going to cause suffering without any reasonable benefit or to provide treatment that goes against their moral judgement such as abortions and suicide assistance.

fergus51 you sound like a great nurse. you seem to be very empathetic and treat patients as you would want to be treated. you don't seem to see them as just a job you have to do for a paycheck. :)

[Soleilpie]

You bring up good points as does Fergus . . .I would quarrel with the way you phrased how some who don't believe in assisted suicide don't believe in letting a patient die with mercy.

Your definition of mercy = assisted suicide. I think mercy means letting someone die a natural death with more than adequate pain relief.

I don't think not believing in assisted suicide means I'm unmerciful.

So, just a difference of opinion of mercy.

Otherwise - good discussion everyone - keep going.

steph

You're right Steph, it did sound like I was making the judgement that PAS=merciful. That's definitely not what I want to convey:no: There are situations where a patient will die a horrific death if no assitance is provided and that was mainly where I was speaking from. I watched a documentary in class where this woman had terminal cancer and wanted to die with dignity. She wanted to be able to choose how she was going to die. She knew it would be painful and needed the assistance of a physician to perscribe her the medication she would need to assist in her death, if it became unbearable. She was not admitted to the hospital but lived at home. PAS is just one way to assist the patient and some just don't agree because it involves such an active role on the physician's part. Some see discontinuing treatment or withholding treatment as different from PAS. It's more passive and sometimes can cause pain and suffering.

[fergus51]

Well thanks Soleilpie. I do love my babies. I didn't have nearly as many grey areas when I worked in L&D, but the NICU is much different. What's ethical to one person is completely unethical to someone else and sometimes two opposite scenarios can both be care consistent with keeping a nursing lisence... It's a mess some days! I know those parents have the right to determine their infant's code status and I certainly don't think it's my business to decide for them, but I think a nurse who agrees with the ethics of the treatment will be a much better resource for the family than one who doesn't. Sometimes the most ethical thing is admitting our deficits and seeking help if we can't do the best job.

btw, if you are interested in the issue of dehydration and death, you can always google "terminal dehydration". Hospice and palliative care is certainly not an area I am well versed in. My only experience was with this one child and the specialist docs came to speak with us about it before that plan of care was instituted.

[Ginyer]

I think that whatever environment we decide to work in we need to be aware of the most common ethical dilemmas that may arise. NICU and PICU nurses will come across very sick terminal babies that are only being kept alive because their family is too devastated to let them go...all we can do as nurses is make sure the pt is as comfortable as possible and educate the family on the situation at hand. You can't say...ok I would never do this..this and this and then work in a place where you'll constantly be put in those situations. Someone who would have a hard time caring for a hooker or drug addict shouldn't work in the local charity hospital ER. I realize situations arrise that we can't anticipate but we should be aware of the obvious.

[Marie_LPN, RN, LPN, RN]

I realize situations arrise that we can't anticipate but we should be aware of the obvious.

Exactly. Thank you.

[Rhoresmith]

I worked as a hospice care aide for 4 years and it changed my thinking on dying. I saw patients who were in so much pain that they SCREAMED and begged to die, because the doctor would not up the morphine because it could cause them to go into Respiratory failure or get this one, they were concerned the patient would become addicted to the morphine. I am sorry but NO ONE should have to be in pain for days and days on end waiting to die. I do not believe in giving them drugs to kill them but keep them from being in severe pain YES. I would take care of a patient that had complications from an abortion Yes. I would take care of a patient that was a criminal and did a terrible crime because it is my duty as a NURSE. As a student I was concerned last April when my brother was hurt in Iraq, and we had a Musliem man in the hospital who was very vocal about the "murdering American soldiers in his country" and had many other comments about how they all deserved to die. I would have went in and cared for this man I would not have liked it but I would have cared for him to the best of my ability because that is what I feel that a NURSE does. I am not saying that I was very relieved that I didn't have to care for him but I would have. About the man who is harrassing the nurses shouldn't the hospital have a policy about this ? Not sure how to handle that one

[NurseFirst]

I worked as a hospice care aide for 4 years and it changed my thinking on dying. I saw patients who were in so much pain that they SCREAMED and begged to die, because the doctor would not up the morphine because it could cause them to go into Respiratory failure

Wow. I thought the hospice movement was based upon providing adequate pain relief. In fact, I think it was the hospice movement that promoted the idea of "pain cocktails" (not called such anymore that I know of, I think because they are so common.) Pain cocktails were basically giving the patient pain medication around the clock, that it was a lot harder to bring a patient's pain under control if you waited until they were in pain to give the medication.

Someone else said

"I know that what constitutes ethical versus unethical treatment can be hard to define and is subjective but for the most part, people tend to agree on what ethical treatments are."

Disagree with this statement; if that were the case, ethical committees in hospitals would not be necessary.

And to the poster who posted on assisted suicide:

They have had assisted suicide in Holland for many years--and they have surveyed the physicians, assuring them of their privacy. They asked the physicians if they had ever assisted someone's death even though they had not asked...the number who answered affirmatively was surprisingly high.

Also, many years ago I sat next to a woman on the plane who ran the local hospice program out of a local hospital (before hospices became so popular; in part, I think, because Medicare now re-imburses for it.). I made a comment that she must approve of Dr. Kevorkian. Nothing was further from the truth. She even mentioned that many of Dr. Kevorkian's patients were not even terminally ill, but, rather, chronically ill. One, in particular, that she mentioned was a lady (in Oregon, I think) who had just been diagnosed with Alzheimer's and, though early in her diagnosis sought Kevorkian's help to die. I can't help but think of her family who lost the pleasure of her company that would have been available to them until she became much sicker.

NurseFirst

[fergus51]

You can't say...ok I would never do this..this and this and then work in a place where you'll constantly be put in those situations.

I get what you're saying but just wanted to point out the situation I described is one I've only seen once. It isn't an everyday occurence.

[Aneroo, LPN]

I had one instructor who cared and assisted in abortions when she was beginning (this was back in the day). She said she was ok in assisting until she herself had a miscarriage, and then she felt unable to assist with the actual abortion. Many of the people who were on the pro-life side when we had this lecture pointed out their choice was for religious reasons (living in the bible belt).

In terms of refusing care for a patient, if you have a serious reason not to care for this patient, then that's fine...but be prepared to take care of someone else. We recently went over this in class. Example- Rn is assigned a patient who is also an alcoholic. She gets mad and refuses care for the patient. Do you get mad? If you check to find out what's going on, maybe her father was a raging alcoholic and she doesn't feel she can care for a patient without getting emotionally involved. I feel it's better for the patient...if the nurse refuses, and you assign her that patient anyways, "just because"...she's going to give poor care (hopefully not though).

-Andrea

[Tweety, BSN, RN]

I would never participate in the murder of a fetus, so don't ask me to.

I will care for an admission who had complications relating from an abortion because that's a whole other issue to me.

I think there is nothing wrong with reassigning patients we are uncomfortable with, especially if it's a moral issue.

I work with a Jehova Witness who doesn't hang blood. She doesn't mind caring for patients that have received blood, but she won't hang blood. I don't see how asking a nurse to sacrifice his/her moral principles is helping the patient.

[lmcnabbkv]

I think being a nurse is a choice and I don't think anyone is forced into it. What comes along with being a nurse is having and conveying a non-judgemental approach to ALL of your patients not just the ones whose principles you agree with. I think if someone would refuse to care for a patient who was suffering from complications of an abortion, then they chose the wrong profession. Nurses ARE professionals and are expected to act as such. This sense of professionalism means treating every person as an equal no matter whether they are a homeless alcoholic, an HIV positive patient, or someone's grandmother!

Our job is not to agree with our patients and what they do in their own lives, our job is to provide compassionate, unbiased care to them!!

Grrr...people like this make me mad~~ :angryfire :angryfire

[lapappey]

I can and have refused to participate in abortions. I feel very strongly about the issue. For that reason, I would prefer not to care for a patient who was going through complications relating to one not because I would find doing so in and of itself morally objectionable, but because it would be hard for me not to judge. I would never dream of making a forthrightly demeaning comment or compromising care but it would just be awkward. If I had to, of course, I would take such a patient, but I think it would be better for all if someone who did not feel strongly about the issue did.