Swastikas & Nursing | Refusing care based upon moral objection?

Davey Do · Sep 30, 2018

Naturally, I cared for this patient the same as anyone else. That's my job.
However, my question is:
Can a nurse refuse to care for a patient based upon moral objection?

Our job is to provide a service, not to judge another. We must strive to be objective and non-judgmental in providing those services.

And, yes, we as nurses, can refuse to care for a patient, based on moral objection.

However, we will have to deal with the ramifications of our actions or inactions.

**CalicoKitty, BSN, MSN, RN** · Sep 30, 2018

I've never refused care for moral beliefs. I did ask to be reassigned when I was working with a geriatric patient with dementia that grew up in the era of jim crow. She would call me the "white devil" and stuff, and I didn't think it was helpful to her to be her nurse. I'd help coworkers if they needed help with her (she was also one of those LoLs that used a cane - and not always for walking....)

I've taken care of a patient with a Swastika. I didn't ask him about it, and he was perfectly nice to all of my coworkers (primarily African american and a significant amount of immigrants).

I think beyond the "moral issue", I think there would be another option of "behavior contract". Assuming he's of sound mind (dementia and other brain illnesses aside), you don't have to like xyz people, but I really don't have to listen to derogatory statements while at work (even if not directed at me). I'd explain that if he's going to swear or call my awesome coworkers names that I don't have to listen to it. Assuming he's safe, I'd walk out and tell him to call when he can control his language. Maybe uptalk a few coworkers, like the ones that trained you.

allnurses Guide · Sep 30, 2018

The only moral objection I'm familiar with is a nurse would not be obliged to assist with abortions based on their religious beliefs. I've never seen a situation involving a nurse refusing to care for a patient because they objected to the patient's expressed opinion on any topic, I believe the ANA Code of Ethics states something like we're supposed to care for our patients "without bias" meaning the nurse.

FolksBtrippin, BSN, RN · Sep 30, 2018

I wouldn't refuse care for someone based on their wrongmindedness.

I cared for a serial killer once.

I do stand up for staff though.

I have had to stand up for a staff member who was groped by a patient.

I am sure that I could get a white supremacist patient to fire me without doing anything wrong.

macawake, MSN · Sep 30, 2018

However, my question is:
Can a nurse refuse to care for a patient based upon moral objection?

I'm not a U.S. nurse. In my country you can't refuse care to a patient based upon moral objection and expect to keep your job. There's are no exceptions. It doesn't matter if the basis for refusal is personal beliefs regarding for example abortion or feeling antipathy and aversion towards an extremely bigotted patient voicing their racist views. It might even cost you your license depending on the circumstances of the situation when care was withheld.

However the fact that you don't have a right to refuse to provide care doesn't mean that you have to accept illegal behavior. If a patient is verbally or physically threatening or aggressive, charges can be filed with the police. In the instances where the stuff patients spout isn't illegal but still highly objectionable, you can ask them to stop just as you would any other adult in any other situation. Simply having patient status doesn't give the person carte blanche to be racist, inflammatory or offensive.

It goes against everything I believe in to refuse care to a patient. In my opinion a patient's right to receive care trumps a nurse's feelings about the choices a patient makes and the opinions a patient holds. But I have, and will continue to do so when appropriate, asked a patient to kindly put a sock in it, when they are alert and oriented and being outright obnoxious.

Years ago when I worked in the ER a neo-nazi was admitted after being stabbed in a fight. He was in sufficiently good shape to hurl racist insults towards one of the trauma docs, originally from Iran, who just happened to walk by us on his way to the ambulance bay. I assured my patient that he would get the best care that we are capable of giving, just as any other patient will, but that what he was saying was not acceptable behavior in our ER and that it needed to stop right away. It did.

OP, I don't know how the culture is in your place of work, but to me it should be acceptable for you to express to this particular patient that you don't agree with his views or at the very least be allowed to ask him to stop saying the things he was saying. If it isn't, I think that's wrong.

CharleeFoxtrot, BSN, RN · Sep 30, 2018

Can a nurse refuse to care for a patient based upon moral objection?

As an exercise in thought, substitute out the profession of "nurse" and ask the question again:

Can a police officer refuse to help a person based upon moral objection?

Can a firefighter refuse to fight a house fire based upon moral objection?

Can a physician not treat someone based upon moral objection?

Can an EMS worker refuse to treat someone based upon moral objection?

It should be a resounding "NO". It's the ultimate hubris to suggest that a nurse, a professional, should refuse care to a patient based upon how that patient's morality (or lack thereof more likely) makes that professional nurse feel. That's not what this job is about. If that was the case how could those brave souls who work in corrections deal with that population? I'm pretty sure prison nurses have a "moral objection" to at least some of the patients they deal with.

Anyone and everyone who has worked front-line care has a story of someone that they rendered aid to that they had a "moral objection" to. I've had a few, the one that immediately came to mind was a person directly involved with (later charged and convicted) of participating in the systematic abuse of a 4 year old child that died from that abuse.

I was in EMS at that time, second unit in on the scene of a reported child in full arrest. I helped the other crew do CPR and get ready to transport that lifeless child. I saw what they did to that child. I then had to suck it up, bury those feelings and render aid and transport my patient. Did I have a "moral objection"? Yes but I did my job and trusted the legal system and the Supreme Being to sit in judgement. Amazing, a decade later and just thinking about that incident made me feel that revulsion/anger/nausea and overwhelming wish that person had died just as horribly as that child all over again.

Editorial Team / Moderator · Sep 30, 2018

I have provided care for the Taliban, well known (in my area) convicted murderers, and a person who was a leader to some people but who also molested his own children and was incarcerated but dying of disease. Did these people disgust and repel me personally? Oh yes. Did they still require and receive my care? Yes, they did.

Kallie3006, ADN · Sep 30, 2018

I've cared for many patients who was also prisons at the time of their admission. I never wanted to know what they were in for unless pt had to do with their treatment during that stay, or why they was admitted.

If one of the people that has been caught shooting schools, churches ect came into the ER would you refuse to care for them because of the allegations?

Nurses are not supposed to judge, and then render care or refrain from providing care based on that judgment. Nurses only need to judge if they are on a jury.

CharleeFoxtrot, BSN, RN · Sep 30, 2018

tl/dr version of this thread:

Her lamp did not just shine on those soldiers she agreed with.

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Ddestiny, BSN, RN · Sep 30, 2018

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Pictures like the above circulate every now and then.

It's always nice when you can bond with your patient, laugh and enjoy each other. It's less fun when they act like d-bags, are belligerent or offensive, but they're needing of care nonetheless. I've taken care of current and previous inmates, patients that I knew were lying with just about every word that came out of their mouth and patients that saw me as the way to serve their unstated, ulterior motives. I do also remember a man with swastika tattoos....he was surprisingly pleasant to me and all of the staff. I heard him get a bit terse with someone to which he was speaking on his personal phone but that was about it. I didn't try to "fix" his beliefs, or even bring them up. For his part, I sensed that he seemed grateful to be treated like a human being. Maybe that was just my interpretation, but it made me feel good to go with it even if it wasn't necessarily true.

Above all, we are professionals. You don't have to like your patient but you do have to be professional and do your job. There are other jobs out there where you can not keep a customer that doesn't share your beliefs (with whatever ramifications might come to your business) but healthcare doesn't fall under that umbrella.

On a slight tangent, I've heard plenty of people request to not have the same needy/frustrating/demented/confused/whatever patient multiple days in a row....in a, "it's someone else's turn" kind of way. I don't see that as equivalent, I view that more as sharing patients that are more emotionally burdensome. Some days you get the fun patients and families with which you can joke and make a connection. Other days you get the confused LOLs that constantly scream about how you're going to hell for locking them in the basement and have no capacity to understand their illness or location.

dbabz · Sep 30, 2018

As nurses, we work with many types of people.
Some really amazing people.
Some unsavory people.
Some you wouldn't want to be caught dead associating with.
Tonight, I was watching Grey's Anatomy!
I'm way behind the times as I just started only a few weeks ago.
For the die hard fans, I'm on season four so you might remember this episode.
An ambulance T-boned another ambulance.
One of the paramedics injured kept refusing care from the doctors (2 African Americans).
Come to find out the paramedic was a white supremicist and had a HUGE swastika tattooed on his abdomen.
This episode is quite timely because I cared for a very similar patient recently.
Swastika tattoos. Racist comments. The stereotypical white supremacist.
It was quite uncomfortable to say the least.
He assumed that I was like him.
Whenever he spoke about the African American CNAs, he spoke in derogatory terms that I don't feel the need to repeat here.
We've all heard these words before.
It was even more uncomfortable when he assumed I would agree or that I was like him.
He assumed I believed in the same skewed moral values he had about African Americans.
I understand we are supposed to objective during our care.
At the same time, I DO NOT share those racist and hateful views these types of people have.
I've never understood it and I avoid anyone that is like that in my life. Naturally, I cared for this patient the same as anyone else. That's my job.
However, my question is:
Can a nurse refuse to care for a patient based upon moral objection?

Nope.

Swastikas & Nursing | Refusing care based upon moral objection?

Have you ever refused care based upon moral objection?