The right to refuse.. on what basis??

psalm, RN · Aug 2, 2005

Hi guys,
I had a very interesting discussion with a work colleague today based on a topic he saw on another forum. It turned into a very heated argument amoungst staff members and so I would be interested to see what anyone else thinks.
The question posed was: 'Could a health professional refuse to treat a patient?' The answer to this was of course: yes a health professional does have that right.. especially in cases where treatment options can be unsafe for the nurse or the client.
However.... could a health professional refuse to treat on the basis of religious or cultural beleifs??
For example.. lets say a catholic pharmacist refuses to fill a prescription for an oral contraceptive based on the fact that this is against the pharmacist's beleifs?? The pharmacist has the right to refuse.. but by doing so is he infringing on the cultural beleifs of the client?? Or should he deny his own beleifs between the hours of nine to five to appease others??
Or another example: a surgeon in an emergency department refusing to give a patient a blood transfusion due to the surgeons religious beleifs??
My workplace was split in two by this argument. On one hand some people think that the right to refuse should be irrespective of the type of reason, or simply you should not enter a job in which you have obvious personal dilemmas.
On the other hand, some believe that letting your own personal beleifs affect the health of your clients is unprofessional, and that refusal of treatment should not be for personal cultural or religious beleifs but instead should be for safety or precautionary reasons.
There is alot of talk about cultural safety when a nurse is dealing with a client.. but how about the respect of our own cultures in our nursing practice?
It poses some interesting questions.. Id be glad to know what you all think

...hmmm. cultural dilemmas. There are some cultural practises that some of us can't agree with and would be better if we let that be known up front. While this may cause some staffing problems we are dealing with people who happen to be professionals and our right to refuse a pt. or case should be respected, just as our patients have a right to care.

...right now I am sleep deprived so will be more specific later. Our rights are important also, though, and no one should be forced into something they can't live with.

goober · Aug 2, 2005

I agree that our rights are important, but how can you make the call to let your beleifs over ride that of your patients?? If there came a time when u had to choose between your beleifs and that of your clients, what would u do?? Such as the example about the surgeon refusing the blood transfusion?? If in a position like this where your beleifs need to be compromised for the best interests of the client... which would you choose??

justmanda · Aug 2, 2005

Hi guys,
I had a very interesting discussion with a work colleague today based on a topic he saw on another forum. It turned into a very heated argument amoungst staff members and so I would be interested to see what anyone else thinks.
The question posed was: 'Could a health professional refuse to treat a patient?' The answer to this was of course: yes a health professional does have that right.. especially in cases where treatment options can be unsafe for the nurse or the client.
However.... could a health professional refuse to treat on the basis of religious or cultural beleifs??
For example.. lets say a catholic pharmacist refuses to fill a prescription for an oral contraceptive based on the fact that this is against the pharmacist's beleifs?? The pharmacist has the right to refuse.. but by doing so is he infringing on the cultural beleifs of the client?? Or should he deny his own beleifs between the hours of nine to five to appease others??
Or another example: a surgeon in an emergency department refusing to give a patient a blood transfusion due to the surgeons religious beleifs??
My workplace was split in two by this argument. On one hand some people think that the right to refuse should be irrespective of the type of reason, or simply you should not enter a job in which you have obvious personal dilemmas.
On the other hand, some believe that letting your own personal beleifs affect the health of your clients is unprofessional, and that refusal of treatment should not be for personal cultural or religious beleifs but instead should be for safety or precautionary reasons.
There is alot of talk about cultural safety when a nurse is dealing with a client.. but how about the respect of our own cultures in our nursing practice?
It poses some interesting questions.. Id be glad to know what you all think

Sure, a pharmacist could refuse to fill a BCP prescription...but I don't know how long he would keep his job. And a doctor refusing to order blood on a patient who clearly needs it will probably be sued and reported to the Medical Board for negligence. Just because you are following your religious/cultural beliefs doesn't mean you are not being negligent. Yes, one's religious beliefs should be respected, but not at the peril of someone else. I don't know any nurses who are Jehova's Witnesses, but if a doctor prescribed blood, and they didn't give it...she would lose her license if she didn't make arrangements for another nurse to administer it for her.

UM Review RN, ASN, RN · Aug 2, 2005

Perfect example. I will not ever work in an area where I might have to participate in an abortion procedure because I simply couldn't shed my religious beliefs in order to assist.

Happily, I have that option--so far.

I do not march. I do not condemn or judge those who have made this choice. It's just not for me. If I had to choose between nursing and being part of this kind of procedure, I would have to go work at Burger King, I guess.

Nella · Aug 2, 2005

Is it okay for a vegitaritian who works in a sandwich shop and refuses to serve meat to those ordering because he doesn't believe in eating the flesh of animals ??? How long would this person keep their job?

Tweety, BSN, RN · Aug 2, 2005

I would like to think that people would not work in a place that confllicts with their beliefs. Like a vegetarian who is ethically won't serve meat...why put yourself in that environment.

I'm pro-life and I would not work in an abortion clinic.

I think that we need to be supportive of coworkers whose ethics are strained in certain cases. I work with a Jehova Witness who won't administer blood products. We support here in that idea and don't assign her patients to get blood, or if a patient needs blood, we hang it for her. We're not a floor that gives a whole lot of blood. Now if we were a chemo floor or a blood bank, I'd have to advise this person to find another area.

A person should not have to be put into the situation where it gets ugly. He/she should be able to say "I can't do this because............" and we should respect that wether we agree or not.

To me it is unethical to force someone to do something against their beliefs. Or force them to choose between their job and their ethics, if it's an isolated or uncommon incident. R.E.S.P.E.C.T.

flashpoint · Aug 2, 2005

If there is no one else to care for that patient, I think the nurse (doctor, pharmacist) needs to do what is best for the patient, whether we agree or disagree. We once had a patient that somehow drank about 8 ounces of antifreeze...doctor prescribed a shot of Everclear every hour...one of the nurses refused to give it because her religion believes that you should abstain from alcohol 100%...we just juggled assignments a bit and another nurse took responsibility. But, if there had been no one else available, she would have needed to do what was best for the patient...you can't let someone die or suffer because your beliefs conflict with the best course of treatment.

grinnurse, RN · Aug 2, 2005

Good thread.

Just recently we had a pharmacist in the DFW area refuse to fill a script for the morning after pill and I believe that he is being sued b/c of the conflict that arose with the script and his relgious beliefs..........he was the only pharmacist on duty.

If I had a specific belief such as, if I was pro-life, I definately would not work in an abortion clinic, if I had a problem hanging blood b/c of my religous beliefs, I would tell the NM in advance so other arrangements could be made for another nurse to hang it.

I agree with Tweety, we all need to respect each others religious and cultural practices as well as the patient. Never had to cross that bridge yet!

barefootlady, ADN, RN · Aug 2, 2005

I have refused to take care of distant family member, only to have that person request me to care for them. I have refused to take care of a patient who threatened me with physical harm because I found a knife and pills in his belongings during a routine admit search to psych unit. I locked these items in the safe. He became angry when he demanded them returned and I refused. I refused to care for another family member, we have a bad history of discord, he is mean and lies about everything and everyone, he made a threat, in front of another staff member, I refused to take care of him or go into his room while he was hospitalized. In all, I have refused 3 patients in over 25 years. Not a bad record.

pricklypear · Aug 2, 2005

I've never run across anything close to this. Like everybody else here, I wouldn't put myself in a workplace environment where my beliefs would likely be compromised. But, I don't believe that everybody else is required to believe or follow my own beliefs. To each his own. I've worked with Jehova's Witnesses who didn't think twice about hanging blood on a "non-believer." They told me that the blood thing is only within their religion. They (the ones I've worked with) didn't have a problem with anybody else getting it, but they wouldn't participate in another JW receiving blood. I don't believe in forcing my beliefs on ANYONE.

The birth control and abortion thing is iffy for me. I suppose pharmacists (in their own privately owned pharmacy) should have the right to refuse to dispense whatever they want. But certainly not in a hospital, clinic or large pharmacy chain. Just like a doctor can refuse to accept a patient at the get-go. But once that patient is under your care, the patient's needs come 1st.

But a surgeon refusing to order blood for a patient??? No way. We are here to serve the public, whoever walks in the door. I think if you work in a public institution, you should leave your personal beliefs at the door if there's a chance they will come between a patient and his right to medical attention.

stn2003, RN · Aug 2, 2005

i do believe there are times when it is appropriate to refuse care based on religious/cultural beliefs IF there was another healthcare professional there willing to provide the care and IF it wasn't a crisis situation; for example:

the situation with the pharmacist has been occuring frequently lately, and i heard that the consensus was: the pharmacist may refuse to fill the prescription as long as there was another pharmacist available who could OR the pharmacist gave the script back to the person and directed them to where it could be filled.

a nurse in a place like a hospital does not have to help prep or help the doctor if a patient needed an abortion if it was against her religious beliefs as long as it was not a life or death situation- the assignment could be jiggled around so that another nurse who was willing would be able to provide care. (of course this does not pertain to nurses who knowingly hire in at these clinics; then they are obviously at the risk of losing their jobs.)

yes, it is our responsibility as healthcare professionals to be caregivers and advocates, to do no harm and try our best to do good. but at the end of the day, we have to live with ourselves- the person, not the job- and our conscience. if we find we are being put in a position often that compromises our beliefs, it may be time to look for a different place of work.