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Protection of Conscience Project

www.consciencelaws.org

Service, not Servitude

Policy Positions

College of Registered Nurses of British Columbia

Freedom of conscience and religion

Annotated Extracts and Links


Duty to Provide Care
[Full Text]

Principles

1. Nurses have both a professional and legal obligation to provide their clients with safe, competent and ethical care.

2. Nurses do not allow their personal judgments about a client, or the client’s lifestyle, to compromise the client’s care by withdrawing or refusing to provide care.​​​​

3. Nurses do not abandon their clients. Abandonment occurs when the nurse has engaged with the client or has accepted an assignment and then discontinues care without:

a. negotiating a mutually acceptable withdrawal of service with the client, or

b. arranging for suitable alternative or replacement services, or

c. allowing the employer a reasonable opportunity to provide for alternative or replacement services

4. Nurses who have a conscientious objection to a client’s request for a particular treatment or procedure:

a. listen carefully, respectfully, and explore the client’s reason for the request and their understanding of options that could meet their needs.

b. do not attempt to influence or change a person’s decision based on the nurse’s conscientious objection

c. do not allow his or her beliefs or values to alter or interfere with a client receiving high quality safe, ethical and competent care

d. ensure that the most appropriate person within their organization is informed of the conscientious objection well before a client is to receive the requested treatment or procedure

e. work with their organization to ensure uninterrupted continuity of care including reporting the client’s request and, if needed, safe transfer of the client’s care to a replacement provider

f. despite their conscientious objection, provide safe care to a client in situations involving imminent risk of death or serious harm that arise unexpectedly and require urgent action for the client’s safety . . .

Conscientious Objection

When a specific type of care, treatment or procedure, conflicts with your moral or religious beliefs and values, you may arrange with your employer to refrain from providing the care. Personal biases or judgments against the client or client's lifestyle are not grounds for conscientious objection. Make the conscientious objection known to your employer well before a client would require care.

If you have a conscientious objection you are responsible for ensuring that your conscientious objection does not impact the continuity of care or compromise the ability of the client to receive high quality, safe, ethical and competent care.

Project Annotations

The definition of "abandonment" makes clear that objecting nurses may sometimes have to arrange "alternative or replacement services," but a patient is not abandoned because  objecting nurses decline to provide or arrange for services to which they object for reasons of conscience.

The expectation that nurses listen and explore possible options may result in a mutually acceptable alternative that will make the objector's withdrawal unnecessary.

4(c) could be problematic if interpreted by ideologically driven employers or supervisors hostile to an objector's beliefs who consider anything short of providing or facilitating morally contested procedures to constitute "interference."

Advance notice required by 4(d) maximizes the likelihood of accommodation and minimizes inconvenience to others.  It is in everyone's interest to avoid conflict by providing advance notice when it is reasonable possible to do so.

Nurses are required to cooperate in transfers of care in the normal fashion, but not to initiate them, which would be unacceptable to some objectors.  The requirement in 4(e) to report a patient's request for a morally contested procedure might be seen by some to be an unacceptable form of facilitation.  On the other hand, making notes of key developments in a patient's chart is expected, so making note of the request in the chart in the ordinary way might be a mutually acceptable method of "reporting."

The final statement that objectors must ensure that the exercise of freedom of conscience "does not impact . . .care" presumes that the procedure or service in question can be untendentiously described as "care."  Other terms are similarly subject to interpretation and could be used by ideologically driven supervisors or employers to try to suppress freedom of conscience.


Scope of Practice for Registered Nurses (28 July, 2016)
(Medical assistance in dying)
[Full Text]

Nothing in the Criminal Code compels a nurse to aid in the provision of medical assistance in dying. A nurse may have moral or religious beliefs and values that differ from those of a client. Nurses who have a conscientious objection to medical assistance in dying may arrange with their employer to refrain from aiding in the provision of MAiD.

It is a requirement for nurses with a conscientious objection to take all reasonable steps to ensure that the quality and continuity of care for clients are not compromised.

To refrain from aiding in the provision of providing medical assistance in dying, nurses with a conscientious objection must notify their organization well before the client is to receive MAiD.  If such procedures are unexpectedly proposed or requested and no arrangement is in place for alternative providers, nurses must inform those most directly involved of their conscientious objection.  Nurses are required to ensure a safe transfer of care to an alternate provider that is continuous, respectful and addresses the unique needs of a client.

Project Annotations

"To aid in the provision" of euthanasia or assisted suicide, in the case of nurses, clearly includes actions other than actually providing the services because only physicians or nurse practitioners may do so.  This would extend to actions like inserting an intra-venous line for the purpose of delivering lethal drugs.

Nothing in the policy implies that objecting nurses must make arrangements for someone else to provide a service declined for reasons of conscience.  They are expected to provide adequate notice of their objections and to cooperate in transfers of care that have been arranged by others.  Assuring quality and continuity of "care" should not be problematic as long as "care" is not interpreted tendentiously to include homicide or suicide.


Scope of Practice for Nurse Practitioners (26 July, 2016)
(Medical assistance in dying)
[Full Text]

Conscientious Objection

Nothing in the Criminal Code compels nurse practitioners to aid in the provision of medical assistance in dying, determine eligibility for, or provide medical assistance in dying. A nurse practitioner may have moral or religious beliefs and values that differ from those of a client. Nurse practitioners who have a conscientious objection to medical assistance in dying may arrange with their employer to refrain from aiding in the provision of, assessing eligibility for, or providing MAiD.

Under CRNBC’s Duty to Provide Care practice standard, nurse practitioners who have a conscientious objection to medical assistance in dying are required to follow the standards which include the requirement for nurse practitioners with a conscientious objection to take all reasonable steps to ensure that the quality and continuity of care for clients are not compromised.

To refrain from aiding in the provision of, determining eligibility for, or providing medical assistance in dying, nurse practitioners with a conscientious objection must notify their organization as soon as the client requests medical assistance in dying. Nurse practitioners are required to ensure a safe transfer of care to an alternate provider that is continuous, respectful and addresses the unique needs of a client.

Project Annotations

The policy recognizes that nurse practitioners may object not only to providing euthanasia and assisted suicide, but to aiding in its provision. 

Nothing in the policy implies that objecting nurse practitioners must make arrangements for someone else to provide a service declined for reasons of conscience.  They are expected to provide adequate notice of their objections and to cooperate in transfers of care that have been arranged by others.  Assuring quality and continuity of "care" should not be problematic as long as "care" is not interpreted tendentiously to include homicide or suicide.

 

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