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

The constant debate over the rights of those who identify with a particular sexual identity seems never-ending. How does it affect nursing? How does the new proposed bill in Michigan make the situation change? Find out the facts before forming an opinion.

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?

Specializes in Pediatrics.

We are working for a business servicing many beliefs and ideologies and I respect that. When I come to work, I am there to uphold that companies ideals. I am a Christian. My company is not Christian. However, I do not believe that everyone that says they are Christian is a Christian. I bring this up to say that if I were to only take care of the people that believe as I do, I would not be taking care of anyone. Nevertheless, there are moral issues that people subscribe to that I fully and completely disagree with. Any sex (and that includes between a man and woman outside of marriage) is immoral - plain and simple. So again, if I were to deny care to every person that walked in that disagreed with my moral beliefs based on the Words of Scripture and how God judges His creation, I would have very few patients. I don't have to agree with someone's ideas to take care of them.

In my opinion, certain businesses should have the right to deny services and employment such as cake decorators and educational institutions. We do these background checks on people for that very reason and some people are denied employment because of their criminal past. Employers are searching Facebook to learn about the person that they are getting ready to employ. And trust me, people such as myself who have vocalized concern on these moral issues are often not hired because of our beliefs. I would lose my job in a day if I came out and spoke out about these beliefs. Not only are we not allowed to speak of these things at work but we are denied our freedom of speech outside of work and that is where I sincerely draw the line. That is one of our basic freedoms as Americans.

You have to deny God and a Designer to accept that the way a person reaches an organism is a matter of unchangable DNA especially when there is no empirical evidence to support this and when it is obvious that the whole act of sex is designed for intimacy between a man and woman. The reproductive tract and the GI tract are not designed to be put together especially when one considers the number of microbes that are harmful to the urinary tract. Under that definition of this being a race of people, anything can be allowed and trust me, in the future, will be allowed and we who have set this precident will have to endure the horrific sexual orientation that follows.

Specializes in Emergency.

Hmmmm...this may be off topic: "In the beginning...man created god(s)" How about a law ridding our human society of all religion? That would quickly end all the wasted life energy spent debating such horse s***. Those of us that would actually like to put our frontal lobes to some good use might then be able to...

Specializes in Emergency.
I would provide care, but I will not participate in any procedure that goes against my beliefs, for instance abortion or sex change surgery.

Really??? How about cardiac catheterization of 90 yr. old demented patients that are not making the decision...hmmm?

In my opinion, certain businesses should have the right to deny services and employment such as cake decorators and educational institutions. We do these background checks on people for that very reason and some people are denied employment because of their criminal past. Employers are searching Facebook to learn about the person that they are getting ready to employ. And trust me, people such as myself who have vocalized concern on these moral issues are often not hired because of our beliefs. I would lose my job in a day if I came out and spoke out about these beliefs. Not only are we not allowed to speak of these things at work but we are denied our freedom of speech outside of work and that is where I sincerely draw the line. That is one of our basic freedoms as Americans.

"Freedom of speech" in the private sector is NOT one of our basic freedoms as Americans. The First Amendment refers only the governmental restrictions on free speech. It has no power to prevent consequences of speech by non government entities.

You have to deny God and a Designer to accept that the way a person reaches an organism is a matter of unchangable DNA especially when there is no empirical evidence to support this and when it is obvious that the whole act of sex is designed for intimacy between a man and woman. The reproductive tract and the GI tract are not designed to be put together especially when one considers the number of microbes that are harmful to the urinary tract.

There is a good bit of empirical evidence that sexual orientation and gender identity are biological phenomenons influenced by genetic factors and hormonal effects during prenatal development. The authors of the Bible can be excused for not having the knowledge we now have about these things. But as modern human beings with the scientific method to help us understand how biology and human sexuality are related, I think we can do better.

Under that definition of this being a race of people, anything can be allowed and trust me, in the future, will be allowed and we who have set this precident will have to endure the horrific sexual orientation that follows.

Just what horrors will we actually have to "endure"? Someone else's sexual orientation (straight, gay, bisexual, pansexual, asexual, what have you) affects me not one iota.

At least you keep your judgmental thoughts private when you work, but I have to wonder if that's out of compassion for your patients, or simply concern for your own job security.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
We are working for a business servicing many beliefs and ideologies and I respect that. When I come to work, I am there to uphold that companies ideals. I am a Christian. My company is not Christian. However, I do not believe that everyone that says they are Christian is a Christian. I bring this up to say that if I were to only take care of the people that believe as I do, I would not be taking care of anyone. Nevertheless, there are moral issues that people subscribe to that I fully and completely disagree with. Any sex (and that includes between a man and woman outside of marriage) is immoral - plain and simple. So again, if I were to deny care to every person that walked in that disagreed with my moral beliefs based on the Words of Scripture and how God judges His creation, I would have very few patients. I don't have to agree with someone's ideas to take care of them.

In my opinion, certain businesses should have the right to deny services and employment such as cake decorators and educational institutions. We do these background checks on people for that very reason and some people are denied employment because of their criminal past. Employers are searching Facebook to learn about the person that they are getting ready to employ. And trust me, people such as myself who have vocalized concern on these moral issues are often not hired because of our beliefs. I would lose my job in a day if I came out and spoke out about these beliefs. Not only are we not allowed to speak of these things at work but we are denied our freedom of speech outside of work and that is where I sincerely draw the line. That is one of our basic freedoms as Americans.

You have to deny God and a Designer to accept that the way a person reaches an organism is a matter of unchangable DNA especially when there is no empirical evidence to support this and when it is obvious that the whole act of sex is designed for intimacy between a man and woman. The reproductive tract and the GI tract are not designed to be put together especially when one considers the number of microbes that are harmful to the urinary tract. Under that definition of this being a race of people, anything can be allowed and trust me, in the future, will be allowed and we who have set this precident will have to endure the horrific sexual orientation that follows.

So God made us the way we are, and you've decided that's not good enough? Being a "Christian" makes you special enough to decide what God intended when he made some of us homosexual, some of us heterosexual and some of us transsexual? My goodness, but you must be special.

By "Christian," I take it that you mean some special sort of Christianity that makes you able to discern (and spout off about) God's intentions as opposed to us ordinary Christians who know that our understanding of the Supreme being is incomplete but do our best to follow the teachings of Christ as we go about our daily business and attend our humble Lutheran, Methodist or Catholic Churches on Sunday.

I fail to see how refusing to bake a cake to celebrate the marriage of two moral, ethical and lawful persons who happen to share the same gender is practicing your religion. I find myself very fortunate that my religion doesn't require such hatefulness.

All in all, I don't sense much of God's love in your post; I suspect any and all "compassion" you exhibit is more out of concern for your job security than actual caring about others.

Specializes in Hospice, Palliative Care.
I fail to see how refusing to bake a cake to celebrate the marriage of two moral, ethical and lawful persons who happen to share the same gender is practicing your religion. I find myself very fortunate that my religion doesn't require such hatefulness.

On this issue, there was a journalist posing as (maybe was) a homosexual who went to Muslim bakeries asking if they would bake a wedding cake for him and his male wife. All refused. Double standard much?

Now, in terms of the opening post... healthcare providers should treat the healthcare needs of all who come for care noting that murdering innocent unborn babies in abortion is not healthcare (so no provider should be forced to harm an innocent unborn baby in the guise that it is somehow healthcare). Yet, on the same token, since we supposedly live in a free country, no provider should be forced to provide care. That doesn't mean the said provider will face zero consequences from society, but unless we believe it is ok to enslave a population of people to provide services.

In my opinion, laws like the one mentioned in the opening post are coming back as extremes to fight the unfortunate event that should have have happened to a handful of businesses that exercised their due right to say they will not provide service (questions, see my opening paragraph about no one making a single successful legal complaint making the news about Muslim bakeries refusing to make wedding cakes for any homosexual couple).

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
On this issue, there was a journalist posing as (maybe was) a homosexual who went to Muslim bakeries asking if they would bake a wedding cake for him and his male wife. All refused. Double standard much?

Now, in terms of the opening post... healthcare providers should treat the healthcare needs of all who come for care noting that murdering innocent unborn babies in abortion is not healthcare (so no provider should be forced to harm an innocent unborn baby in the guise that it is somehow healthcare). Yet, on the same token, since we supposedly live in a free country, no provider should be forced to provide care. That doesn't mean the said provider will face zero consequences from society, but unless we believe it is ok to enslave a population of people to provide services.

In my opinion, laws like the one mentioned in the opening post are coming back as extremes to fight the unfortunate event that should have have happened to a handful of businesses that exercised their due right to say they will not provide service (questions, see my opening paragraph about no one making a single successful legal complaint making the news about Muslim bakeries refusing to make wedding cakes for any homosexual couple).

If you're accusing me of having a double standard, I don't. Christian bakeries, Muslim bakeries -- it surely cannot be "practicing your religion" to refuse to bake a damned cake!

Providing abortion services is a lawful healthcare procedure in the United States. Healthcare workers who are vehemently against providing such services to women are free to not take jobs where this is required. Whether it consists of "murdering an innocent unborn baby" or removing a fetus that has not yet become a human being is controversial and subject to interpretation, I will go so far as to grant you that. But it is moral, ethical, and a majority of Supreme Court justices concluded that it is lawful. If you disagree with that, there is a perfectly simple remedy for you: do not, under any circumstances, have an abortion. Do not under any circumstances take a job where one of responsibilities is to assist with an abortion. Problem solved. And it's solved without having to infringe upon anyone's rights, whether they agree with you or not.

You -- I mean you personally as well as your political party -- do not have the right to legislate or control what other women do with their bodies. Those women have the right to choose. Fortunately, enough people agree with a woman's right to choose that there is no need to "enslave a population of people to provide services."

As far as bakeries, they would seem to be in the business of baking cakes. I fail to see how being hateful about baking a cake or not baking a cake is "exercising freedoms" or "practicing religion." If, during the course of ordering the cake the potential client espouses some belief that the baker disagrees with, the baker absolutely has a right to harm his own business and shoot himself in the foot by refusing to bake the cake. But refusing to bake the cake because "you're homosexual and God hates you" is assuming that you know what God hates, and it's hateful to the potential client. Any God I want to believe in is a God of love who disapproves of hatefulness to others.

To be a registered nurse you had to lobby the government, and by extension the public, for the right to provide healthcare services in a professional manner in exchange for compensation.

I think you lose your right to discriminate, for non-professional reasons, who you serve in the public.

As for elective non-medical abortion I think there may be a case to refuse assisting in the procedure since there may be a case for refusal in the spirit of primum non nocere. There is not only historical precedence but a professional dictate for nurses to refuse to assist, even to physically intervene, in procedures in which they feel unethical. Wrong side and inadequate consent surgeries come to mind. Note that in this case it is not characteristics of the patient but the characteristics of the procedure or practice that are the determinate.

The whole "no one should be forced to assist in an abortion" debate is a total straw man. Someone who feels so strongly about that is just not going to work for a facility which performs abortions anyway. I would be willing to bet that most abortions are performed in facilities in which everyone who works there understands that the facility offers this service, and also know absolutely whether or not they would be called to assist in the procedure.

And it would be impossible to "force" any nurse to do any particular intervention in any case. One could fire the nurse for refusing to care for a given patient, but the nurse would go home having been "forced" to do nothing.

On this issue, there was a journalist posing as (maybe was) a homosexual who went to Muslim bakeries asking if they would bake a wedding cake for him and his male wife. All refused. Double standard much?

Now, in terms of the opening post... healthcare providers should treat the healthcare needs of all who come for care noting that murdering innocent unborn babies in abortion is not healthcare (so no provider should be forced to harm an innocent unborn baby in the guise that it is somehow healthcare). Yet, on the same token, since we supposedly live in a free country, no provider should be forced to provide care. That doesn't mean the said provider will face zero consequences from society, but unless we believe it is ok to enslave a population of people to provide services.

In my opinion, laws like the one mentioned in the opening post are coming back as extremes to fight the unfortunate event that should have have happened to a handful of businesses that exercised their due right to say they will not provide service (questions, see my opening paragraph about no one making a single successful legal complaint making the news about Muslim bakeries refusing to make wedding cakes for any homosexual couple).

Wait, if it didn't make the news, how did you hear about it? And why would you assume that people who support LGBT rights would be okay with a Muslim bakery discriminating against them, but upset with a Christian or Jewish baker discriminating? Who exactly is applying a double standard here? I'm confused.

In my nearly 30 years of nursing, I have taken care of murderers, child molesters, thieves, and wife beaters. I do not agree with their life style and life choices, some could say I have religious beliefs against those acts, yet they got the same care as anyone else. No one would even think of refusing to care for them. How can anyone refuse to care for a gay man in need? Based on religion? Whose religion says it's OK to let someone suffer?

Not only is it unethical, it is UNCHRISTIAN. Jesus healed EVERYONE he came in contact with who was sick. He knew everything there was to know about them, and loved them anyway. He has COMMANDED us to do the same. Love them as I have loved you. I get the issues of not wanting to bake a wedding cake for a gay couple, but we aren't bakers. We're nurses, and we are CALLED. We have no right to refuse care for anyone. We surrendered our rights when we accepted the Call. Period.