Trump Admin Will Protect Health Workers Who Refuse Services On Religious Grounds

allnurses Guide · Jan 31, 2018

This is such funny fake news. The language re: this issue come straight out of the Affordable Care Act. It was not written by or proposed by Donald Trump. His protecting this clause means he is in agreement on this issue at least with the writers of the ACA. laws that protect nurses and doctors who refuse certain care based on religious belief have been around since the 1970s.

Hppy

Mavrick, BSN, RN · Jan 31, 2018

It's a very slippery slope when health care workers can refuse to treat patients because of religious or moral beliefs. If you work at a facility that performs treatments to which you object and would therefore have to pick and choose which patients you will care for, GET ANOTHER JOB.

There are plenty of places that don't perform abortions. Since abortions seem to be such a hot button for otherwise barely-religious persons, I suggest you don't even apply to work where they are done.

This other nonsense about LGBTQ discrimination is unacceptable. Don't go into a healthcare career if you are that bigoted.

BrandonLPN, LPN · Jan 31, 2018

How on earth could a nurse who is against abortion find herself in a job where abortions are performed?

As for refusing to care for a woman who, say, wound up being hospitalized for complications following an abortion..... of *course* said woman cannot be denied care by a nurse. It isn't about us and our beliefs. Convicted murderers and rapists receive medical and nursing care when needed. We don't get to pick and choose.

I am confident that the ethics of the nursing profession will prevail over whatever silly law Trump and the GOP push through.

brownbook · Jan 31, 2018

hppygr8ful said:
This is such funny fake news. The language re: this issue come straight out of the Affordable Care Act. It was not written by or proposed by Donald Trump. His protecting this clause means he is in agreement on this issue at least with the writers of the ACA. laws that protect nurses and doctors who refuse certain care based on religious belief have been around since the 1970s.
Hppy

I appreciate being educated and honestly (in spite of being a second generation Democrat/liberal) I want to know what the truth is behind fake news and sensational headlines.

I did a quick look at the ACA and laws that have been around since the 70's. However in my quick read all it mentioned was abortions, sterilizations, and assisted suicide or euthanasia.

I have no problem with those provisions. I am still not sure if Trumps proposal goes beyond that?

WestCoastSunRN, MSN, CNS · Jan 31, 2018

Mavrick said:
It's a very slippery slope when health care workers can refuse to treat patients because of religious or moral beliefs. If you work at a facility that performs treatments to which you object and would therefore have to pick and choose which patients you will care for, GET ANOTHER JOB.
There are plenty of places that don't perform abortions. Since abortions seem to be such a hot button for otherwise barely-religious persons, I suggest you don't even apply to work where they are done.
This other nonsense about LGBTQ discrimination is unacceptable. Don't go into a healthcare career if you are that bigoted.

Totally agree -- healthcare has no room for bigotry. That said, the above issues likely have nothing to do with bigotry for the educated (even if religious) healthcare workers that may object to certain procedures. In the case of abortion -- the dilemma is obviously between a set of two patients. There are non-religious people who see a pregnant woman as representing two patients. The dilemma for these folks, then, is obvious.

In gender reassignment surgery, the dilemma could very well be lack of evidence that said surgery is the best treatment for gender dysphoria. It comes with serious risks in a patient population with a higher % or SI. These are incredibly complicated cases with many layers.... and this is a new frontier for medicine (and nursing). While bigotry toward LGBTQ persons most certainly exists in the world, opposition to or reservations concerning life-altering surgical procedures and poly-pharmacy that *may* result in greater harm does not equate to bigotry.

offlabel · Feb 1, 2018

Mavrick said:
It's a very slippery slope when health care workers can refuse to treat patients because of religious or moral beliefs. If you work at a facility that performs treatments to which you object and would therefore have to pick and choose which patients you will care for, GET ANOTHER JOB.
There are plenty of places that don't perform abortions. Since abortions seem to be such a hot button for otherwise barely-religious persons, I suggest you don't even apply to work where they are done.
This other nonsense about LGBTQ discrimination is unacceptable. Don't go into a healthcare career if you are that bigoted.

Expressing ethical objections to participation in gender reassignment procedures does not mean an individual is mean, bigoted or hateful. It doesn't even have to be religious. It is an intellectual position that someone could have that merits the same civility as patients should receive when requesting these procedure. General service operating rooms are not specifically for any type of surgery and the below procedures are becoming brand new, never done before operations at some hospitals. This means that there are many staff that predate them even in their city or state. Do they have to quit now?

Surgeries specific to transgender populations:

Feminizing vaginoplasty

Masculinizing phalloplasty / scrotoplasty

Metaoidioplasty (clitoral release/enlargement, may include urethral lengthening

Masculinizing chest surgery ("top" surgery)

These are not benign elective procedures and there is no guarantee that a desired outcome will be achieved.

May OR personnel opt out of a procedure involving a 16 year old girl having purely cosmetic breast augmentation with parental consent? How about body integrity identify disorder? Can someone opt out of an amputation of a healthy arm or leg?

Mavrick, BSN, RN · Feb 1, 2018

WestCoastSunRN said:
Totally agree -- healthcare has no room for bigotry. That said, the above issues likely have nothing to do with bigotry for the educated (even if religious) healthcare workers that may object to certain procedures. In the case of abortion -- the dilemma is obviously between a set of two patients. There are non-religious people who see a pregnant woman as representing two patients. The dilemma for these folks, then, is obvious.
In gender reassignment surgery, the dilemma could very well be lack of evidence that said surgery is the best treatment for gender dysphoria. It comes with serious risks in a patient population with a higher % or SI. These are incredibly complicated cases with many layers.... and this is a new frontier for medicine (and nursing). While bigotry toward LGBTQ persons most certainly exists in the world, opposition to or reservations concerning life-altering surgical procedures and poly-pharmacy that *may* result in greater harm does not equate to bigotry.

The article refers to refuse to treat not opposition or reservation.

I have opposition to certain treatments (IVF, breast enhancements, frivolous surgery, etc.) not the people who have them. I care for any and all of these types of patients to the best of my professional ability.

I also do not think it is any of my business if surgery is the best treatment for gender dysphoria. The patient and their doctor make that decision. Transgendered people have enough pain and rejection in their lives without a healthcare provider giving them more grief.

WestCoastSunRN, MSN, CNS · Feb 1, 2018

Mavrick said:
The article refers to refuse to treat not opposition or reservation.
I have opposition to certain treatments (IVF, breast enhancements, frivolous surgery, etc.) not the people who have them. I care for any and all of these types of patients to the best of my professional ability.
I also do not think it is any of my business if surgery is the best treatment for gender dysphoria. The patient and their doctor make that decision. Transgendered people have enough pain and rejection in their lives without a healthcare provider giving them more grief.

You make good points about caring for all patients the same. I would hope this would be reflected in all of Nursing.

As for it not being any of your business - it may not be your intent (or maybe it is), but this attitude sounds a bit like "don't think, dear, just do your job" .

Nurses are patient advocates. I think we do have a place in making sure patients are fully informed regarding their treatments/procedures.

Gender reassignment surgeries are being performed on an extremely vulnerable population of patients. It is relatively new arena. There are ethical issues at play. There is the potential for there to be big winners and big losers.

We may disagree on this, but I think it's ok to ask questions. I think patients need health care professionals to ask questions.

My whole point in all of that is that you don't have to bigoted - or even religious - to have those concerns.

elkpark · Feb 1, 2018

WestCoastSunRN said:
You make good points about caring for all patients the same. I would hope this would be reflected in all of Nursing.
As for it not being any of your business - it may not be your intent (or maybe it is), but this attitude sounds a bit like "don't think, dear, just do your job" .
Nurses are patient advocates. I think we do have a place in making sure patients are fully informed regarding their treatments/procedures.
Gender reassignment surgeries are being performed on an extremely vulnerable population of patients. It is relatively new arena. There are ethical issues at play. There is the potential for there to be big winners and big losers.
We may disagree on this, but I think it's ok to ask questions. I think patients need health care professionals to ask questions.
My whole point in all of that is that you don't have to bigoted - or even religious - to have those concerns.

You make it sound like surgeons are just snatching people up and operating on them. The process of transitioning is long and complicated. It typically involves as much as a year of hormone therapy and living as the other gender before you get to the point of talking about surgery. A psychiatric evaluation is part of the process. A large majority of transgendered persons never consider having surgery. There are only a few hundred procedures done in the US each year. There is a professional organization and agreed-upon standards of care. This isn't some kind of amateur, fly-by-night operation, and it's not a decision anyone makes casually or impulsively. People are fully informed about the risks, benefits, and alternatives long before getting to the point of surgery. There's no need for any busybody nurses to be poking their noses into the personal decisions other people have spent time and effort making because of the nurses' personal biases and beliefs (conveniently dressed up as "professional concern and responsibility").

I'm reminded of the people who talk about late-term abortions as if women make that decision casually, like they get through six months of a pregnancy, then wake up one morning and say, "Oh, wait, I've changed my mind" and need to be protected from their poor decision-making by random strangers who know nothing of their situation and will be taking no responsibility for the outcome.

As with abortion, if nurses have personal opposition to participating in the surgery, they are free to decline. As far as I know, these procedures are done by specialized surgical teams at a limited number of medical centers, in which all the team members have chosen to be there and specialize in this kind of surgery. I don't think random OR nurses need to worry about suddenly being expected to take part. The real concern, re: the Trump administration's new, aggressive stance on the question of "religious freedom" in healthcare, is about healthcare providers feeling entitled to refuse to provide routine, ordinary healthcare for routine, ordinary health problems to people to whom the provider has some kind of "religious" objection.

WestCoastSunRN, MSN, CNS · Feb 1, 2018

elkpark said:
You make it sound like surgeons are just snatching people up and operating on them. The process of transitioning is long and complicated. It typically involves as much as a year of hormone therapy and living as the other gender before you get to the point of talking about surgery. A psychiatric evaluation is part of the process. A large majority of transgendered persons never consider having surgery. There are only a few hundred procedures done in the US each year. There is a professional organization and agreed-upon standards of care. This isn't some kind of amateur, fly-by-night operation, and it's not a decision anyone makes casually or impulsively. People are fully informed about the risks, benefits, and alternatives long before getting to the point of surgery. There's no need for any busybody nurses to be poking their noses into the personal decisions other people have spent time and effort making because of the nurses' personal biases and beliefs (conveniently dressed up as "professional concern and responsibility").
I'm reminded of the people who talk about late-term abortions as if women make that decision casually, like they get through six months of a pregnancy, then wake up one morning and say, "Oh, wait, I've changed my mind" and need to be protected from their poor decision-making by random strangers who know nothing of their situation and will be taking no responsibility for the outcome.
As with abortion, if nurses have personal opposition to participating in the surgery, they are free to decline. As far as I know, these procedures are done by specialized surgical teams at a limited number of medical centers, in which all the team members have chosen to be there and specialize in this kind of surgery. I don't think random OR nurses need to worry about suddenly being expected to take part. The real concern, re: the Trump administration's new, aggressive stance on the question of "religious freedom" in healthcare, is about healthcare providers feeling entitled to refuse to provide routine, ordinary healthcare for routine, ordinary health problems to people to whom the provider has some kind of "religious" objection.

You have made a lot of assumptions here.

I don't think people are getting gender reassignment casually. I do know a bit about the process as well as I work for an organization that performs it.

I will give you the benefit of the doubt regarding the "busybody nurse" comment. I have no more to say on the subject.

I share your concern regarding the current administration's stance on a great many things, healthcare included.

allnurses Guide · Feb 1, 2018

I know a retired nurse who left a job at a major medical center thirty years ago.

She worked on a unit that cared for patients undergoing surgery for "Gender Dysphoria"

offlabel · Feb 4, 2018

herring_RN said:
I know a retired nurse who left a job at a major medical center thirty years ago.
She worked on a unit that cared for patients undergoing surgery for "Gender Dysphoria"

Johns Hopkins I think was the only place that was doing that kind of procedure in the late 70's. They stopped because they were not seeing the psychological results they were hoping for as I remember. Somebody can check on that, but metrics like suicide and depression weren't helped by surgery, so they stopped.

I think they're up and running again.