Conscientious Objection AND Nurses: A Literature Review On The Right To Refuse Care Literature Review Samples

Abstract

Conscientious objection on the part of a nurse is not taken lightly by the nurse, the facility, co-workers, or patients. There is a wide range of procedures in which a nurse may refuse participation, but there are steps to take prior to the situation occurring in order for the facility to make arrangements to allow the procedure to take place. Nurses are protected legally in cases of conscientious objection, but this does not allow a person to deny participation in one instance and not in another nor to apply conscientious objection without discussion with administration. This paper discusses ten characteristics of complicated social issues, the personal ethical code, formal documentation, legalities, and problems associated with conscientious objection. While nurses have the right to deny participation in certain procedures, there are ways to do so without causing problems for themselves, the facility, or the patient. The thesis states the objections of nurses should not be allowed based on the violation of the code of ethics for nurses, regardless of legal provisions for them.
There are times when nurses are exposed situations when the needs of the patient conflict with the nurse’s morality and values. Situations may include administering blood transfusions, assisting in abortions, organ or tissue donation, withholding measures to sustain life, extending life through technology when there is no hope for recovery, and not administering cardiopulmonary resuscitation on a patient who has a Do No Resuscitate order on the record. Dickens (2001) described conscientious objection as any member of the health team who refuses to take part in any aspect of patient care that violate his or her conscience.

TEN CHARACTERISTICS OF COMPLICATED SOCIAL ISSUES

There are some social problems that are difficult or impossible to resolve due to four reasons: information is incomplete or contradictory, there are a large number of people and opinions on the problem, there is a substantial financial implication, and other problems are drawn into the original one (WickedProblems.com, n.d.). The issue of conscientious objection on the part of a nurse is one of these social problems in healthcare. According to Horst Rittel, a design theorist, there are ten characteristics that assist in defining this problem:
Conscientious objection by nurses has no definite guidelines. What is objectionable to one nurse is not to another.
Conscientious objection can be resolved in one circumstance, but the same nurse and the same objection may not be resolved in another.
The objection of a nurse creates a situation where the resolution can only be good or bad. There is not a determination of true or false, so there is not an ideal solution. The situation of objecting to a procedure can only have a good resolution or a bad one.
There is not a strict guideline to dealing with a conscientious objection by a nurse. It is handled on an individual basis in individual situations.
In a case of an objection by a nurse, there is always more than one solution with the best one decided on usually by several stakeholders. These can include the nurse, the supervisor, administration, co-workers, or the doctor.
The case of an objection on the part of the nurse is a symptom of another problem. Ethically questionable procedures require policies based on extensive research and discussion. Abortion was originally prohibited, then allowed if the life of the mother was at risk, then if the child has a poor prognosis, and in some facilities it is now elective. Changing ethical issues in healthcare result in changing attitudes by healthcare providers.
There is no logical or scientific solution to a nurse’s conscientious objection because it is based on a personal ethical decision. Therefore, a rational and systematic approach to an objection cannot be developed.
Resolving a situation where an objection has been raised is only a single success. It may possibly lay the groundwork if another similar situation arises, but there is still going to be an element of trial and error.

Every situation where a nurse has a conscientious objection is unique due to the staff, patient, and procedure involved.

The stakeholders involved in the decision surrounding the objection must be able to accept responsibility for their part in it.
PERSONAL ETHICAL CODE
A person’s integrity is threatened when she considers acting in a manner that compromises her ethics. There are three characteristics the comprise the conscience: a sense of feeling if an act is right or wrong, indoctrination of norms of upbringing and society, and the completeness of the person morally (Benjamin, 2004; Waller-Wise, 2005; Lachman, 2014).
Lachman (2014) stated that nurses avoid compromising their integrity by working within their personal code of ethics and the standards outlines in the Code of Ethics for Nurses (American Nurses Association, 2001). In doing so, healthcare practitioners can determine when a situation calls for conscientious objection.
If a nurse acts against her moral code, there are three types of distress that can manifest: suppressed, muted, and shocked (Odell et al, 2014). Results include anger, panic, exterior silence, fatigue, depression, gastrointestinal upset, or migraine headaches. Gallagher (2011) reviews studies of nurses who did not speak up when they thought patient care was not being performed ethically; findings were that patient care suffered and nurses were emotionally distressed.
When a nurse accepts a position in a medical facility that has the potential to ask her to participate in procedures to which she has a moral objection, there are procedures to document her stand. Waller-Wise (2005) presented a narrative following a hypothetical nurse who refuses to assist in abortion that is not medically required for the safety of the mother. The statement of refusal should be made at hiring in order to allow the employer to make arrangements for the exemption with adequate staffing. The author continued with a discussion of how normative ethics influence how a person makes decisions based on religious beliefs, ethics, or cultural values.

LEGALITIES

Waller-Wise (2005) provided the sources for nurse rights to refuse care. The Civil Rights Act of 1964 prevents discrimination in the workplace based on religion (Society for Human Resource Management, 2001). The American Nurses Association presented their position in the statement “The Right to Accept or Reject an Assignment” (American Nurses Association, 2009). The Joint Commission on Accreditation of Healthcare Organizations also recognizes the rights of nurses to refuse specific aspects of patient care (JCAHO, 2000). Odell, Abhyankar, Malcolm & Rua (2014) discussed the right of nurses to refuse care based on religious or moral beliefs, too.
Professional values take place on three levels: factors involving the nurse, the organizational influences, and political factors (Gallagher, 2011). Legal restrictions and professional guidelines are taken into account for the creation of all policies, but politics involved in running medical facilities also come into play. Conscientious objections by a nurse cause multiple factors to become disjointed.

PROBLEMS WITH CONSCIENTIOUS OBJECTION

Conscientious objection cannot be based on prejudice or dislike; it is a moral issue (Lachman, 2014). Problems arise when an individual claims conscientious objection inconsistently, as in performing a procedure one day on a patient but refusing to do so on another day for a different patient. Administration of the facility must be made aware of the objection possibility in order to arrange for replacement staffing. Odell et al (2014) talked about how other nurses will change schedules or patient assignments occasionally to accommodate a co-worker’s conscientious objection, but have a right to refuse to do so if the demands are excessive. At this point, the nurse’s objections place a hardship on the facility and a decision may have to be made concerning continued employment.
If the objectionable procedure is frequently performed at the facility, such as physician-assisted suicide at a hospice, human resources may consider that individual a poor fit for staffing. If the nursing applicant is not forward with her limitations, it places the facility in an uncomfortable position. Morton (2013) discussed the situation surrounding rural nurses and physicians who do not have the luxury of raising a conscientious objection due to the inability to replace the objector. The strategies used by larger medical facilities do not meet the needs of a practitioner in a rural setting with limited support, time, and resources.
Returning to the ten characteristics of complicated social issues, the problems associated with conscientious objections by nurses are interrelated. Co-workers eventually resent accommodating the needs of the nurse, patients may learn of the objection and question the judgment of the physician, there are possible legal implications is the facility does not hire the applicant or respect the nurse’s wishes if they do, potential problems in the human resources department if a number of nurses find raising an objection will release them from certain procedures without accompanying ethical reasons, and so on. A nurse who is not willing to perform all the procedures in a facility in which she is working should consider going to one that does not perform those procedures or changing her career path to one where she does not have to make a conscientious objection.

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