The right to refuse.. on what basis??

Nurses General Nursing

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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

I could not put up a morphine drip for the usage of putting a person to sleep. I can put one up for pain control not just because the person is coming back and forth to the hospital and nothing else can be done. It is not legal for morphine to be use as suicide method. I explained to my superviser and to the doctor in charge how I feel about it and then I would ask another nurse to complete the order and to maintain it. I was successful to meet the request of the order and to help the patient to cross into the next world. I just feel when God is ready for you then he will send for you. I do not want it on my conscious about the death of a person and explaining my actions to God, Therefore, I can understand the positive usage of morphine and the application of allowing someone a peaceful death when the Lord has not called for them.

Yes, if a person is suffering from pain than I would put the morphine up. Yes, I can maintain the line just cannot increase it so death can occur. I hope you can understand it.

Have a great day and evening,

Buttons

PS. I think too many doctors are quick to order a morphine drip for several of patients. However, they are not face with application of thier order. Or how it effects a person who is carrying out their order.

I can't imagine there was a written Morphine order for the purpose of hastening death....people, and more often than not, nurses, have a grand misconception about palliative care and symptom management. Morphine can be used for other things beside pain, and perhaps you were not aware of the implications of it's use in that case....I don't know, I wasn't there....but we must remember the ethical principle of double effect....sometimes death may be very briefly hastened in effort to make the person comfortable...but there are numerous studies to show that the use of narcotics in the closely terminal pt, usually does not hasten death.

Now, I do realize that this has nothing to do with the original post, but I had to reply.

As far as the OP, I hope when I need care in the hospital, the nurses know how to assess me, implement prescribed care, and evaulate for it's effectiveness. I do not need for them to pray for me or consult with the Bible to figure out if the prescribed treatment I NEED is good for them. And I would imagine this same principle would apply to those who are deeply religious....I would imagine that you would hope that if you get an agnostic nurse caring for you, that she would care for you appropriately and with all due respect for your beliefs despite that fact that he/she might think they are ridiculous.....there are 2 sides to this coin....ultimately, we have made a committment to care for the patients and respect their beliefs....and to be able to carry out care accordingly.....our beliefs are secondary at that point. If that is not ok with you, then you should find something else to do.

Kathryn

Wow, there were at least two recent very lengthy threads about this issue . .. . not sure where they are though - and I never can figure out how to link to them anyway. So this sounds like deja vue to me . .. :)

Fergus, what about circumcision? You won't help in a circ, right?

I think what most folks finally came to agree with is that you can't take a job in a place where you know ahead of time that procedures done there are against a belief that you hold and then refuse to participate.

But if a pharmacist OWNS his own pharmacy, he can choose to not sell bcp's or the morning after pill. If someone chooses to work at a pharmacy that dispenses said pills, then then cannot refuse to dispense them ... if so, then they can be fired.

A pharmacist cannot keep the RX though - the RX goes back to the patient to take to another pharmacy.

We do retain the right to not participate in things that are against our values though . .. . and you can always quit your job by the way. No one makes us slaves to our profession.

steph (who really needs help finding those other threads) :)

In my mind, the question boils down to what type of job you accepted when you were hired. In my case, my own beliefs would not allow me to participate in elective abortions. (I make no judgments about patients who choose to have abortions, or providers to participate in their care. I simply could not participate in this particular procedure.) Therefore, I should never apply for a job that would entail providing anesthesia, or other nursing care, to patients undergoing elective abortions. If I applied for an accepted such a job, providing care to these patients would be part of my responsibility. I would have no right to refuse. However, if I apply for a job at a hospital that at the time of my application does not perform elective abortions, but decides to do so after my hire date, I believe I would be completely within my right to participate in such procedures. (Of course, before the hospital ever made such a decision, it would be my responsibility to inform the hospital of my personal objections and refusal to participate.)

As Stephanie pointed out above, the same kind of rule can be applied to pharmacists. If a pharmacist applies for a job at a pharmacy that dispenses birth control medication, then that pharmacist has no right to refuse to dispense that medication. The pharmacist knew (or should have known) the policies of the pharmacy when he or she applied for the job. On the other hand, if a pharmacist chose to open a pharmacy, he or she would be with in their rights to decide not to dispense certain medications. Of course, they have to accept the consequences of that decision, which may include patients choosing not to patronize their pharmacy, and certainly decreased profits.

I have a real problem with employee pharmacists who "suddenly" find dispensing birth control medication to be a violation of their religious principles. Rather than refuse to dispense the medication, I believe the pharmacist has an obligation to inform their employer of their new beliefs. This gives the employer the opportunity to either ensure someone else is always available when the pharmacist with objections is on duty, or more likely hire a replacement pharmacist. I also question the real motivation of the pharmacist who makes such a public issue out of this matter.

Bottom line, it is up to each of us as health-care providers to not seek employment in areas were procedures are performed or medications dispensed that might violate our own personal, ethical, or religious beliefs. If we accept such a job, then later develop objections, we have a responsibility to notify our employers of our change of heart. It isn't up to us to use our position as health-care providers to proselytize to the general public.

Kevin McHugh

In my mind, the question boils down to what type of job you accepted when you were hired. In my case, my own beliefs would not allow me to participate in elective abortions. (I make no judgments about patients who choose to have abortions, or providers to participate in their care. I simply could not participate in this particular procedure.) Therefore, I should never apply for a job that would entail providing anesthesia, or other nursing care, to patients undergoing elective abortions. If I applied for an accepted such a job, providing care to these patients would be part of my responsibility. I would have no right to refuse. However, if I apply for a job at a hospital that at the time of my application does not perform elective abortions, but decides to do so after my hire date, I believe I would be completely within my right to participate in such procedures. (Of course, before the hospital ever made such a decision, it would be my responsibility to inform the hospital of my personal objections and refusal to participate.)

As Stephanie pointed out above, the same kind of rule can be applied to pharmacists. If a pharmacist applies for a job at a pharmacy that dispenses birth control medication, then that pharmacist has no right to refuse to dispense that medication. The pharmacist knew (or should have known) the policies of the pharmacy when he or she applied for the job. On the other hand, if a pharmacist chose to open a pharmacy, he or she would be with in their rights to decide not to dispense certain medications. Of course, they have to accept the consequences of that decision, which may include patients choosing not to patronize their pharmacy, and certainly decreased profits.

I have a real problem with employee pharmacists who "suddenly" find dispensing birth control medication to be a violation of their religious principles. Rather than refuse to dispense the medication, I believe the pharmacist has an obligation to inform their employer of their new beliefs. This gives the employer the opportunity to either ensure someone else is always available when the pharmacist with objections is on duty, or more likely hire a replacement pharmacist. I also question the real motivation of the pharmacist who makes such a public issue out of this matter.

Bottom line, it is up to each of us as health-care providers to not seek employment in areas were procedures are performed or medications dispensed that might violate our own personal, ethical, or religious beliefs. If we accept such a job, then later develop objections, we have a responsibility to notify our employers of our change of heart. It isn't up to us to use our position as health-care providers to proselytize to the general public.

Kevin McHugh

:w00t:

stephanie :)

JW do not believe that a transfusion is a "ticket to Hell." We don't even believe in Hell.

I'm not picking on DayRay personally, but this is what I mean when I say people who don't fully understand our beliefs shouldn't speak on them as if they were experts:

JW's belive that reciveng a blood tranfusion is a ticket to hell.. so when you ask them to do that they are activly perticipateing in sending someone to hell. Now mabey some of them can see it as okay to do this on a non JW (someone they belive is going to hell anyway) but the ones that cant should not be forced to, even in a life or death situation. To them it would be worse to give blood then to let the person die.

This whole post is full of inaccuracies about JW and what they believe. Again, I am not picking on any one individual, but this is one of the reasons people have negative opinions about JW (and other faiths, for that matter).

JW do not feel that way about non-Witness patients, period. I'm offended by this, that someone would think I am so unfeeling about others. That runs contrary to everything JW believe in.

Fergus, what about circumcision? You won't help in a circ, right?

:)

Reread my post Steph, it says "provide that service or refer them to someone who will". Not once have I stopped or delayed or even discouraged a circumcision because of my personal beliefs. None of my patients on post-partum were ever even made aware of my personal beliefs on the matter. I don't go into rooms and say "Why would you subject your son to needless pain and suffering and risks of surgery just to mutilate his genitalia?" :chuckle I'm not a looney....(no comments from the peanut gallery on that one!)

I don't expect people to do things against their personal morals, I just expect them to allow others to live by theirs.

I didn't see anyone say that you don't have the right to believe anything you want to believe. I'm with you Sharon. Some people just can't understand the difference between having personal beliefs and forcing those beliefs on others. As long as I'm asking for a service that is legal, I will expect my health care providers to provide it or refer me to someone who can.

You're right. I see the last 6 words more clearly now . .. excuse me - I've been in the Cyber Saloon with Tweety and Jnette and Suzi and Jessica and Roy and a bunch of other people . ... :)

steph

JW do not believe that a transfusion is a "ticket to Hell." We don't even believe in Hell.

I'm not picking on DayRay personally, but this is what I mean when I say people who don't fully understand our beliefs shouldn't speak on them as if they were experts:

This whole post is full of inaccuracies about JW and what they believe. Again, I am not picking on any one individual, but this is one of the reasons people have negative opinions about JW (and other faiths, for that matter).

JW do not feel that way about non-Witness patients, period. I'm offended by this, that someone would think I am so unfeeling about others. That runs contrary to everything JW believe in.

I am sorry Fab.....

I do not think anyone is trying to attack you or the religion. I think sometimes we all miscommunicate our thoughts and words. Hopefully, this is the case.

Buttons

I'm not saying DayRay is attacking my faith. But there are things in that post that are flat out wrong, and I don't want anyone to come away from reading that post thinking that's what Witnesses believe or how they feel about others.

I'm not saying DayRay is attacking my faith. But there are things in that post that are flat out wrong, and I don't want anyone to come away from reading that post thinking that's what Witnesses believe or how they feel about others.

I agree

Specializes in Telemetry, ICU, Resource Pool, Dialysis.

JW's belive that reciveng a blood tranfusion is a ticket to hell.. so when you ask them to do that they are activly perticipateing in sending someone to hell. Now mabey some of them can see it as okay to do this on a non JW (someone they belive is going to hell anyway) but the ones that cant should not be forced to, even in a life or death situation. To them it would be worse to give blood then to let the person die...

Even if this were true (the hell part), what if there was nobody else that could do it? Would it be OK to allow someone to die so someone else didn't have to compromise their own beliefs? Which the unfortunate dead person did not believe in because they had their OWN beliefs??

...So for them to do this they would either need to participate in an action that in effect says "what I belive is not true" or commit a very evil act.

many in our country critisize people with strong conviction to one way of thinking but can't you see that asking them set them aside is just as bad as them trying to make you belive the way they do?

But the very act of denying care/service/medication/procedure is saying to the OTHER person "what you believe is not true, because what I believe is true for everyone, including you, even if you do not believe it" Is that any better?

I have a choice to be at work, my patients generally do not.

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