Survey of Nurses Rights In Abortion

[kmchugh]

WITHOUT STARTING A FLAME WAR, OR A HOLY CRUSADE!! The thread in OB/GYN nursing got me wondering.

Does a nurse have a right to refuse to participate in certain procedures, if s/he feels those procedures violate their ethical code?

Or, is a nurse required to put aside how they feel about an issue to care for a patient whose moral beliefs may be different?

I'd like opinions, but remember, no flaming or evangelism.

Kevin McHugh

[purplemania, BSN, RN]

even though I am a nurse I am also a person who, thank God, lives in America. I have the same working rights as any other worker or any other American.

[Roland]

Roland, this student didn't just refuse to perform abortions, he refused to refer women to someone who would or even discuss them. If he is incapable of discussing a procedure his patients have a RIGHT to know about and refer them if they want it, he should be failed. He crossed the line by imposing his beliefs on patients. He has no business going into medicine if he can't understand that.

Fergus, I think I would agree with your perspective IF he was intending to specialize in OB/GYN medicine. However, someone who just wants to be a Dr. shouldn't be forced to participate in something that they find to be reprehensible. On the other hand were I in his situation I probably would have told the client/patient "Look, I don't believe in abortion except to protect the health and life of the mother, therefore if that is something you might want to consider I need to set you up with a different resident/intern."

[fergus51]

Fergus, I think I would agree with your perspective IF he was intending to specialize in OB/GYN medicine. However, someone who just wants to be a Dr. shouldn't be forced to participate in something that they find to be reprehensible. On the other hand were I in his situation I probably would have told the client/patient "Look, I don't believe in abortion except to protect the health and life of the mother, therefore if that is something you might want to consider I need to set you up with a different resident/intern."

He isn't being forced to participate in anything, he's made to refer those patients who want abortions. Discussing and performing are very different, and he needs to be capable of discussing all the medical options his patients have or he isn't being a good doctor. If he thinks it is ethically acceptable to NOT inform patients of all their options, he has no business being a doctor.

It doesn't matter if he doesn't want to be an OB/GYN, as GPs face this kind of thing as well. Plus no matter what type of doctor he wants to be, he still has to pass all his rotations in medical school. I couldn't fail my psych rotation and still become a nurse, even though I knew I was NEVER going to work psych. Those are just basic requirements of the profession. If he can't do it, he needs to look for another job.

[Roland]

Yes, but with issues where the world is so clearly divided there should be some "wiggle room". After all as a NURSE or a DOCTOR you can choose to work in one of the MANY facilities (most Catholic for instance) that don't utilize abortion. Those of us who oppose abortion believe it is every bit as EVIL as was slavery or the murder of minorities during the Second World War (except under certain exceptions such as medical necessity to save the life of the mother). Also, I thought that freedom of Religion was a fundamental right under the Constitution (at least in America). In the same way that an employer cannot force someone to work on Sunday or eat pork they shouldn't be able to force them to advocate positions that are directly contrary to their fundamental beliefs. Let me turn the question around. IF somehow conservatives were SUCESSFUL in outlawing all abortion (except under very limited circumstances) would you advocate barring health professionals from "referring" women who wanted the procedure to places like Canada where the procedure was still legal? What if an Orwellian government (some would say the Bush administration has just those sort of ambitions) came to power which mandated that all those of Middle Eastern decent be referred to "special" treatment facilities for observation. Would you think it proper to force medical personnel to participate in such procedures? What if they passed laws that mandated (as some have sought to do) Dr's participate in captial punishment via lethal injection (and be trained to do so)? Force health professionals to participate in abortion (via referral or otherwise) and you may some day regret the ramifications of such power being placed in the hands of authority. Fundamental freedoms must be preserved if the concept of liberty is to mean anything. I'll make you a deal. I won't attempt to pass laws that force physicians and nurses to instruct nurses about the potential complications (short term, long term and otherwise) if you don't try and force me to partake in the practice of the procedure.

[fergus51]

Yes, but with issues where the world is so clearly devided there should be some "wiggle room". After all as a NURSE or a DOCTOR you can choose to work in one of the MANY facilities (most Catholic for instance) that don't utilize abortion. Those of us who oppose abortion believe it is every bit as evil as was slavery or the murder of minorities during the Second World War (except under certain exceptions such as medical necessity to save the life of the mother). Also, I thought that freedom of Religion was a fundamental right under the constitution (at least in America). In the same way that an employer cannot force someone to work on Sunday or eat pork they shouldn't be able to force them to advocate positions that are directly contrary to their fundamental beliefs. Let me turn the question around. IF somehow conservatives were SUCESSFUL in outlawing all abortion (except under very limited circumstances) would you advocate barring health professionals from "referring" women who wanted the procedure to places like Canada where the procedure was still legal? What if an Orwellian government (some would say the Bush administration has just those sort of ambitions) came to power which mandated that all those of Middle Eastern decent be referred to "special" treatment facilities for observation. Would you think it proper to force medical personnel to participate in such procedures? What if they passed laws that mandated (as some have sought to do) Dr's participate in captial punishment via lethal injection (and be trained to do so)? Force health professionals to participate in abortion (via referral or otherwise) and you may some day regret the ramifications of such power being placed in the hands of authority. Fundamental freedoms must be preserved if the concept of liberty is to mean anything.

There is wiggle room, he can REFER WOMEN OUT and never participate in a single termination. There is however no wiggle room in keeping patients informed of their rights. Some things are absolutes, and that is one of them. What if your doctor is against blood transfusions? Should he not inform you that transfusions are available when your Hgb is in your boots or refer you to a physician that is ok with them? Of course not. His responsibility is to inform his patients of their options and if he can't agree with their choices to send them to a doctor who can. That's it. He isn't being forced to murder people or commit genocide or kill condemned criminals or monitor Middle Easterners. All your comparisons are simply waaaaaayyyy out in left field. All he has to say is "If you choose termination, you will have to see Dr X, I don't participate in them".

Freedom of religion means you have the right to practice your own religion. It doesn't mean you have the right to join a profession and not practice ethically. Your example of FGM is appropriate. I am sure there are some muslim docs who think that FGM is important to their religion. However, in Canada, it is child abuse and any doctor who performs it will be arrested and charged and kicked out of the profession, no matter how passionately he pleads for his "religious freedom" to be respected.

Freedom of religion also doesn't mean you can impose your religious beliefs on someone else. You can refuse to participate in abortions, you just can't refuse to tell your patients that they can have one or refer them if they choose one (especially important in Canada as patients are referred to specialists through their GPs most of the time). Freedom of religion is not absolute and does not absolve you of the obligations of being a doctor, and that includes informing your patients of all their options before they make a decision about their care. Arguing otherwise is just beyond me. Should doctors be allowed to refuse to inform women about birth control or refer them to a doctor who will? Patient choice is the issue here, not religious freedom.

FYI, there are not a ton of Catholic hospitals in Canada like in the US, and even if there were, that does not release a med student from passing clinical rotations to meet the minimum standards to become a doctor in the first place.

[Roland]

Going back to your FGM example, I think that even REFERRING someone to a doctor who DID that procedure would constitute participating in child abuse. If I provide specific information that ultimately culminates in someone having an abortion, I believe that I have PARTICIPATED in that act. A procedure being legal such as abortion doesn't imply a RIGHT to that procdure (except in cases where the life or legitimate health of the mother is at question). This is why we shouldn't define things like abortion into requirements for being ethical in a profession. Birth Control is a more difficult issue especially if it involves a barrier method which doesn't interfere with a fertilized egg. My beliefs about abortion have little to do with religion. In all honesty there are many days that I border on being an agnostic (but never an atheist). I simply believe that it is wrong. If I lived in a country where FGM was legal, and widely championed I would feel the same about that issue, and wouldn't participate without regard to the consequences. Also, I think there is a difference between saying "I don't perform abortions" and saying "I don't perform abortions, you need to go see Dr. X". In the second instance you are providing specific information which furthers the persons ability to obtain the procedure.

If you were looking for a compromise I would be willing to support mandatory signs at every entrance to a facility or Dr's office which read something like "This facility doesn't particpate in any act that would terminate a pregnancy ". At one time not performing abortion was part of the HIPPOCRATIC OATH (in all fairness so was promising not to perform surgery!) I believe that society will one day look back upon the widespread practice of abortion in much the same way that we now view slavery and other horrible, practices from the past. However, I could be wrong just don't try to involve those of us who are against what we consider to be wrong. Those people that dis-agree can find providers who see things your way (in fact special abortion provider registries could be publicized by those who support the concept or even the government in Canada).

[Riseupandnurse]

True story. I had a friend, Rudy, whose parents were physicians, first in Germany during the Second World War, and then afterwards in America. During a long week-end at his house in Iowa, I spent some time getting to know his mother. She told me that in the middle of the war a representative of the German government decided that she should be the medical director of a local concentration camp. Her job? To figure out the least amount of calories that the worker slaves could survive on, and to conduct ongoing research on what combination of nutrients would produce the most work at the least cost. She was given a target for survival; there was no need to expect to keep these people living very long, after all. She tried to refuse, but the government explained that since she was a doctor, and there was a war going on, they had every right to "draft" her and make her perform any service that was legal under the Third Reich. She agreed because she was afraid that she would be blacklisted if she refused, and she had Rudy and his sister to think about.

Our country, and our profession, must never try to rip the consciences from its citizens.

[fergus51]

And it doesn't Jan. No one is forced to participate in abortions or any other morally objectionable procedure.

[Jaaaman]

My answer to the survey is:

A nurse has the right to refuse to participate on the grounds that elective abortion violates his/her moral beliefs.

:)

[fergus51]

Going back to your FGM example, I think that even REFERRING someone to a doctor who DID that procedure would constitute participating in child abuse. If I provide specific information that ultimately culminates in someone having an abortion, I believe that I have PARTICIPATED in that act. A procedure being legal such as abortion doesn't imply a RIGHT to that procdure (except in cases where the life or legitimate health of the mother is at question). This is why we shouldn't define things like abortion into requirements for being ethical in a profession. Birth Control is a more difficult issue especially if it involves a barrier method which doesn't interfere with a fertilized egg. My beliefs about abortion have little to do with religion. In all honesty there are many days that I border on being an agnostic (but never an atheist). I simply believe that it is wrong. If I lived in a country where FGM was legal, and widely championed I would feel the same about that issue, and wouldn't participate without regard to the consequences. Also, I think there is a difference between saying "I don't perform abortions" and saying "I don't perform abortions, you need to go see Dr. X". In the second instance you are providing specific information which furthers the persons ability to obtain the procedure.

If you were looking for a compromise I would be willing to support mandatory signs at every entrance to a facility or Dr's office which read something like "This facility doesn't particpate in any act that would terminate a pregnancy ". At one time not performing abortion was part of the HIPPOCRATIC OATH (in all fairness so was promising not to perform surgery!) I believe that society will one day look back upon the widespread practice of abortion in much the same way that we now view slavery and other horrible, practices from the past. However, I could be wrong just don't try to involve those of us who are against what we consider to be wrong. Those people that dis-agree can find providers who see things your way (in fact special abortion provider registries could be publicized by those who support the concept or even the government in Canada).

If you believe that refering a woman to another doctor is against your religion and can't do it, then you just shouldn't be a doctor. One of the ethical requirements of being a doctor is keeping your patients' informed of their rights (and as long as abortion is legal, they do in fact have the right to it). Doctors don't get to control patients by limiting their information or their access to other health care providers. That's unethical, period....

Medicine and nursing have made reasonable accomodations for religious beliefs while respecting patients' rights and that's referals. You can't do it, you send them elsewhere. That is just recognizing that it's the patient who gets to decide what they want, not the doctor or nurse.

People need to make choices in their life. If you can't DO the job, you shouldn't expect to HAVE the job. Become a dentist. Become a vet. Don't expect professional standards of practice not to apply to you because you don't agree with them. You don't have a right to practice medicine or nursing exactly how you want to. Your registering body gets the final say on that. Don't like it? Well, too bad, that's just life.

btw,

Although it's a nice idea, I can't see registries for abortion providers working in the real world, not with all the crazies out there fighting for the anti-abortion cause. A doctor was shot and killed in BC a few years ago and anyone who puts their name on that list might as well put a target on their backs while they're at it.

[Roland]

Look Fergus, abortion is "not against my religion", I haven't attended church since I was a kid. However, federal courts in the United States have consistently held that employers cannot COMPEL someone to act in a manner that is in conflict with their basic religious beliefs. Instead, I think that abortion except when it's done to preserve the life, or save a mother from grave health concerns is at best killing innocents, and at worst simply first degree murder. Polls show depending upon how the question is worded that anywhere from thirty to sixty percent of people in the United States agree with me on that point.

We have a basic disagreement. I think that the foetus is a HUMAN life, a baby waiting to enter the world. You don't believe this, because if you did you probably wouldn't support abortion. Many on my side are willing to "suspend" the argument in the belief that science, will eventually prove to almost everyone's satisfaction that these really are LIVING human beings that are being terminated often for frivolous (at least non life threatening) reasons. However, this is nothing, but a thinly veiled attempt to force agreement or at least compliance with your perspective in the NAME of ethics.

Roe V. Wade and other United States Supreme court decisions simply said that we can't legally PREVENT abortion. They did nothing to establish the procedure as a fundamental right. In fact, current United States law prohibits federal monies being used to fund abortion.

Also, we have a fundamental disagreement on what it means to "participate" in something. "And it doesn't Jan. No one is forced to participate in abortions or any other morally objectionable procedure " By my book referring someone to a Dr. who WILL perform the procedure IS participation. Where is the law which says that such referrals must be made?

I actually enjoy debating with you but it's having negative repercussions for my marriage. We'll just have to agree to disagree (or at least I will have to).

Finally, let me leave you with what I consider to be a couple of innovative solutions to reduce abortion:

1. First the least controversial. I would seek to creat an aggregate, private fund collected from churches, NPO's ect that would support, women "at risk" for abortion. It would also help pay for college tuition, living expenses, and child care. Since it was private money, and might reduce abortions many conservative who normally oppose welfare might support such an initiative (I understand that it's not a perfect solution since it could be argued that it created an incentive to get pregnant just to qualify).

2. Okay, this one will cause a bit of controversy. People who passed a background check, and interview process could "pay" women for their kids who otherwise might consider abortion. Here's how it might work. A woman is given abortion options and information ALONG with information about my "abortion diversion program". All perspective parents approved to be in the "program database" would have passed backgound checks, and would agree to followup for some period of time after the adoption (the funds to support such oversight would be paid for by an administrative fee included within every "adoption"). It might save some kids from abortion, and would allow couples to cut years off their waiting period as compared to traditional adoption. In addition, the money might help women who would otherwise abort to go to school or otherwise improve their lives (and would provide another option for those women who were considering abortion due to economic pressures). Included within the program would be "places to live" while they were pregnant (for those women that needed and wanted such accomodations). Again, it's not a perfect solution, but it might be something that both sides could agree on (or at least oppose less). To all of those who say these proposals are immoral or offensive I would ask the question, but are they BETTER than the alternative?

If these solutions were implemented then I would be willing to refer women out for abortions (I would feel that the kids at least had a fighting chance).

[fergus51]

Roland, it doesn't matter what you or I think about abortion, what matters is what a professional body believes about patient rights. This med student is learning that. He doesn't have the right to NOT refer patients and get a pass in his clinical rotation because of HIS personal religious beliefs. There are limits to his religious freedom when it impacts his patients and if he can't accept that, he can't get a medical lisence.

I completely support the right to not participate in procedures (and don't participate in circs for that reason). I do not support the right to prevent your patients from choosing those procedures. There is a difference and the BON and medical colleges have made that clear.

Just so you know, one and two pretty much do exist already. Women who want to put up their baby for adoption can receive money for living expenses and medical care while they are pregnant and there are a lot of charities out there if they want to keep the baby. I think the best way to decrease abortions is to get women on birth control and force men to step up and be involved when they impregnate someone (I bet the condom use would rise!).