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 Long Term Acute Care, TCU.
Pious is not an insult. It means you respect God, try to obey Him, and strive for holiness. So far you're 0 for 2 on attempts to insult me.

As for using religion to rationalize prejudice, I did no such thing. My religious beliefs will dictate what's in my heart and mind, and how I vote on certain issues. But when I'm at work, how I treat people is what matters. I'm confident I do my job well for all my patients, have had no complaints, and all good performance reviews. I'm not at work here, and this is a discussion board, therefore I'll express my views.

No insult intended. You perceive my observations as condemnations due to your cognitive dissonance.

You have every right to express your views, this is an open and accepting community.

Peace be with you.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I'm sure you've heard the term "lesbian until graduation" where women have same sex relationships in college because it's hip, supported, and pisses off mom and dad with satisfying alacrity, but once out in the real world date and marry men. That's a choice. That's also not most homosexuality. There is no proof it's genetic either. I tend to believe it's all or mostly environmental factors growing up, and there may be a genetic disposition that plays in somehow.

And now back to regularly scheduled programming....

I've never actually heard that term, and it seems rather mean-spirited.

Ruby Vee,

It is not mean, it is a euphemism for the sex experimentation that goes on in high school and college. As I said, I researched bisexuality for a senior thesis and found that this stays with a person throughout their life. Social pressures cause them to choose heterosexual relationships.

One interesting thing about bisexual people that I discovered was they need to be intimate with both sexes throughout their life to satisfy that need. They keep these experiences separate. Many are usually in a heterosexual relationship, but their same sex encounters they refer to as "my time."

What the heck is wrong with the legislators in that state?

Health care professionals practice under the oath of caring for everyone regardless of beliefs or preferences.

Once we put on the uniforms we are under that oath to care, and no matter how bad something seems morally to us, we must provide the same level of compassion and care. Everybody deserves the same regarding personal choices or preferences.

Sometimes I wonder where people keep their brains stored... (Facepalm)

Specializes in OR, Nursing Professional Development.
Ruby Vee,

It is not mean, it is a euphemism for the sex experimentation that goes on in high school and college. As I said, I researched bisexuality for a senior thesis and found that this stays with a person throughout their life. Social pressures cause them to choose heterosexual relationships.

One interesting thing about bisexual people that I discovered was they need to be intimate with both sexes throughout their life to satisfy that need. They keep these experiences separate. Many are usually in a heterosexual relationship, but their same sex encounters they refer to as "my time."

Please do not paint all bisexual people with such a broad brush. There are many that are quite capable of being monogamous and happy without some need to be intimate with both sexes. Something tells me the sources from your senior thesis research were a bit biased.

Rose_Queen, I am sorry, I phrased that the wrong way. Human sexuality is so complicated and fluid, it is very hard to define. In my research, the people who "were" bisexual but in a long term monogamous relationship (tended to) describe their sexuality (homosexual or heterosexual) in terms of their (current long term) relationship.

I think the rates of monogamy in the bisexual population mirror the rates of the homosexual and heterosexual populations. That is another issue entirely...

Specializes in Cath/EP lab, CCU, Cardiac stepdown.

Personally i don't believe in the whole lesbian until graduation. It's more likely that they're either bisexual or just experimenting. Experimenting doesn't automatically mean you're a lesbian.

SNurseKylam,

We are all bisexual (Freud, Kinsey, Banterings). We are built for it, people of either sex can have pleasurable sex and achieve orgasm with both members of the opposite sex and same sex.

Gil Grissom in CSI (season 4, episode 5, "Fur and Loathing") said it best: "Well, Freud said that the only unnatural sexual behavior was to have none at all. And after that, it's just a question of opportunity and preference."

That just further demonstrates the hypocrisy of this law, since we are all (biologically) the same.

Specializes in OR, Nursing Professional Development.
SNurseKylam,

We are all bisexual (Freud, Kinsey, Banterings). We are built for it, people of either sex can have pleasurable sex and achieve orgasm with both members of the opposite sex and same sex.

That just further demonstrates the hypocrisy of this law, since we are all (biologically) the same.

A counterpoint to the Kinsey scale: Kinsey's Scale Is So 1948 | Patrick RichardsFink (Yes, I know it's not academic)

SNurseKylam,

We are all bisexual (Freud, Kinsey, Banterings). We are built for it, people of either sex can have pleasurable sex and achieve orgasm with both members of the opposite sex and same sex.

That just further demonstrates the hypocrisy of this law, since we are all (biologically) the same.

I disagree.

Just because a person is physically capable of achieving an orgasm with a person of either sex, that doesn't make him/her bisexual.

Of course any adult with working human genitalia can engage in sex with a member of the opposite gender. Closeted gay men have intercourse with, achieve orgasm with, and impregnate women on a regular basis. That doesn't make them bisexual. Or any less homosexual.

The terms "heterosexual", "homosexual" and "bisexual" define sexual preference​, not sexual capability.

Rose_Queen, That is great. I love it and could not agree more! Thank you for sharing!

If you Rose_Queen, or anyone, have any more research, links, papers, resources, etc. on this subject matter, please PM me so that I can add to my research.

Many of the critiques of the Kinsey Scale I share as well.

The one-dimensional nature of the Kinsey scale leads to an idea that the more attraction you have toward your own gender, the less you have toward the "opposite" gender, and vice versa. This flaw, this idea that attraction is measured in neat percentages that add up to 100, just doesn't hold up in the real world. Yes, behavior can be measured in this kind of objective and numerically neat way, but attraction cannot.

It leads to the idea that bisexuals are not wholly integrated people, that we are composed of a "straight side" and a "gay side" at war with each other, that there is an unresolvable conflict in our attractions and in ourselves that means we are undeveloped and unstable. It's one of the reasons people assume that anyone who loves us is doomed to be dumped or cheated on, that we cannot be satisfied with our partners.

Now, even if you want to buy some modification of the Kinsey scale (like the Klein grid) that includes attraction as well as behavior, it's still got problems.

Bisexuality is not a point on the scale, it is the scale. I also think that bisexuals are MORE integrated, not less. There is also the question that Klein addresses, preference vs opportunity (behavior). See my Gil Grissom quote above. Desire vs availability. What we are essentially looking at is the fulfillment of sex as a basic human need.

I also noted in my paper that my study of bisexuality was just one aspect of human sexuality. I believe that human sexuality is 3 (probably more) dimensional. A quote in the gay marriage debate, 10 years after my original paper, illustrated my 3 dimensional model:

"It does not affect your daily life very much if your neighbor marries a box turtle. But that does not mean it is right. . . . Now you must raise your children up in a world where that union of man and box turtle is on the same legal footing as man and wife."

-- Sen. John Cornyn (R-Tex.), advocating a constitutional ban on same-sex marriage in a speech Thursday to the Heritage Foundation.

I do not intend to offend anyone or gross them out, but just as the things that one can witness in the ED or trauma bay, they are varied and can be disturbing.

There is the aspect to bestiality. That resides in the 3rd dimension next to humans and various inanimate objects. There have been various philias noted of people with sexual attraction to inanimate objects such as cars (Mechanophilia) and trees (Dendrophilia). I have suggested philias as the 3rd dimension.

Please note I do not like the term "Paraphilia" because it implies an impediment to functioning. I prefer philia as a description meaning sexual deviation or "fetish." The problem in describing atypical sexual interests is you first state what is "normal." Homosexuality and bisexuality at one time were considered paraphilias.

I appreciate the insight from those of you who are familiar with this subject ant the research on it. Again, feel free to PM me if you have anything that you feel that I should include with my research.

BrandonLPN,

The terms "heterosexual", "homosexual" and "bisexual" are descriptors (adverbs, adjectives). People do not use the complete term of the "adjective and noun" or the "adverb and verb."

A person can preform a "heterosexual act or behavior", "homosexual act or behavior" or "bisexual act or behavior."

A person can have a "heterosexual preference", "homosexual preference" or "bisexual preference."

The purpose of my paper was to refute bisexuality/homosexuality as a paraphilia, but aspects of normal human sexuality by (as you noted) as the potential for bisexual sex.

The human body is bisexual by design.

I do not want to get into a debate about the human body and other philias. I did not (and don't know that I want to... LOL) address that issue. I simply noted they exist on the 3rd dimension of my model.

The 3 main aspects of human sexuality in (human-human) relationships are; sex (the body I have), gender (who I see looking back at me in the mirror), and preference (who I want lying in bed next to me). There may be a 4th; behavior (who has laid/is lying in bed next to me).

The answer for all 3 (4), can be male, female, or both.