HHS rules prevent providers from being forced to do things that violate moral convictions

The Hill

Reproduced with permission

Diana Ruzicka*

In the April 4, 2018 article, HHS rule lowers the bar for care and discriminates against certain people, nursing leaders, Pamela F. Cipriano and Karen Cox, wrote that the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) Proposed Rule: Protecting Statutory Conscience Rights in Health Care; Delegations of Authority expands the ability to discriminate, denies patients health care and should be rescinded. These accusations are unfounded and the rule should be supported.

What the rule does is “more effectively and comprehensively enforce Federal health care conscience and associated anti-discrimination laws.” It is not an effort to allow discrimination but an effort to prevent it by enforcing laws already on the books and gives the OCR the authority to oversee such efforts. This is something that nursing should encourage because it supports the Code of Ethics for Nurses (code).

The code reminds us that, “The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence and continue personal and professional growth.”

It is precisely because nurses are professionals who hold themselves to these standards that patients have come to see nurses as persons worthy of their trust, persons in whose hands they are willing to place their lives. Being granted by the public this weighty and solemn responsibility is humbling and must never be taken lightly. Thus the nurse’s duty to practice in accord with one’s conscience, to be a person of wholeness of character and integrity, is recognized by the.

It is odd that, despite supporting a nurse’s duty to conscience and the right to refuse to participate in an action to which the nurse objects on the grounds of conscience, Cipriano and Cox insist that the nurse, must assure that others make the care available to the patient. This suggests a failure to recognize that referring the patient to someone who will do the objectionable act in place of the nurse can make the nurse complicit.

The culpability of complicity is well recognized in law and ethics, as an accomplice is liable to the same extent as the person who does the deed. Thus, to make a referral and be complicit in an act to which the nurse conscientiously objects, also violates conscience. We doubt nursing leaders actually support this, as the consequences would be chilling.

When persons are made to violate their conscience, to set it aside, to silence it, moral integrity is eroded and moral disengagement progressively sets in. To move from caring for our fellow human beings to acting on them in ways that our conscience tells us we should not, requires powerful cognitive manipulation and restructuring to free ourselves of the guilt associated with this violation of our deeply held moral or religious beliefs.

Moral disengagement has frightening negative consequences, namely a pernicious dehumanization of persons, including oneself and of society as a whole. Rather than a nurse being someone of moral courage, ethical competence and human rights sensitivity, as our code directs, a nurse would have to be someone who is willing to surrender their conscience to expediency, powerful others, or whatever happens to be permitted by law at the time and place.

No longer would patients find that nurses are persons they can trust. It is precisely because nurses practice in accordance with their conscience that the public continues to grant them high scores on honesty and ethics.

None of this is to say that nurses may abandon patients. By promptly seeking a transfer of assignment that does not involve the objectionable act or by transferring the patient elsewhere without making a referral, the nurse continues to uphold the code by “promoting, advocating for and protecting the rights, health and safety of the patient [and, at the same time,] preserving wholeness of character and integrity.”

Clearly, refusal to care for a patient based on an individual attribute is unjust discrimination and has no place in nursing or health care. But that is not what the rule does. It protects the right to object to being forced to participate in an act that violates a person’s deeply held moral convictions or religious beliefs and from discrimination as a result of one’s refusal to participate in such an act.

To call for rescinding the rule, whose purpose is to protect this fundamental human right, would be short-sighted and could make unjust discrimination more likely and harm not only nursing but also the patients we serve.

 

Nurse practitioners not always compensated for providing medical assistance in dying

Ministry of Health and Long Term Care does not provide fee-for-service the way it does for physicians

CBC News

Angela Gemmill

The Nurse Practitioners Association of Ontario says some of its members are helping to provide their patients with medically assisted deaths without compensation.

It wasn’t until April of 2017 that nurse practitioners (NPs) in Ontario could prescribe the controlled substances used for medical assistance in dying (MAID).

Since then about 40 NPs across the province have provided either patient assessments or the procedure itself.

A patient must be assessed by two independent health care providers. This can be either a physician or a nurse practitioner. The procedure is the same regardless of who provides it.

One nurse practitioner in Sudbury, Ont. says it’s important for her to provide support to patients who want to take this step. She admits that medical assistance in dying is rather limited in Sudbury, in that not a lot of physicians or nurse practitioners are willing to provide it for patients. . . [Full text]

 

Christian nurse sues hospital for requiring her to assist abortions

Lifesite News

Claire Chretien

DURHAM, North Carolina, November 3, 2017 (LifeSiteNews) – A Catholic nurse is suing Duke University Hospital, claiming that the university discriminated against her religious and pro-life beliefs by requiring her to assist in abortions.

Sara T. Pedro was told during her employee orientation that Duke University Hospital provides no exceptions to employees in its Emergency Department who don’t want to participate in abortions. The lawsuit, filed by The Thomas More Law Center on Pedro’s behalf, says that Duke’s Emergency Department performs “a large number of abortions.”

The lawsuit claims that Pedro faced retaliation and discrimination after she made a written request to be exempt from the pro-abortion policy. . . [Full text]

 

Canadian nurse forced out for refusing to participate in euthanasia

Lifesite News

Pete Baklinski

PALMER RAPIDS, Ontario, June 14, 2017 (LifeSiteNews) — A Canadian nurse no longer has her job helping the sick and the elderly after she was told that she must either assist patients who wanted to kill themselves using the country’s new euthanasia law, or resign.

Mary Jean Martin, a Registered Nurse who worked in middle-management as a Homecare Coordinator in Ontario, said she became a nurse in the late 1980s to help the “vulnerable and the struggling,” not to be a link in a chain that would ultimately lead to a patient’s death.

“Can you imagine being a nurse and being told that you have to help kill someone? That’s so against the philosophy of nursing and it’s so against the heart of the healthcare person,” she told LifeSiteNews in an exclusive interview. . . [Full text]

 

New threat to nurses and midwives over abortions, warns Christian nurse

Christian Today

Ruth Gledhill

A leading Christian nurse is warning that nurses and midwives could find themselves under new pressures to be involved with abortions and other procedures that go against their conscience.

Steve Fouch, head of nursing with the the Christian Medical Fellowship Head of Nursing, warns in a blog of a  challenge to the rules that allow doctors to opt out of abortions.

He is writing after a new study, headlined ‘Vacuum aspiration for induced abortion could be safely and legally performed by nurses and midwives’,  questions the need for abortions to be carried out by doctors in the first place. . . [Full text]

New study threatens midwives’ freedom of conscience on abortion

CMF Blogs

Steve Fouch

In the latest bid to circumvent the increasing number of younger doctors being unwilling to perform abortions, a new report has challenged the need for some surgical abortions to be undertaken by doctors at all.

Sally Sheldon, a Law Professor at the University of Kent, has published a study into the 1967 Abortion Act and subsequent legal opinions to argue that in the case of vacuum aspiration (VAs), midwives or nurses should be able to carry out the procedure.

This, she argues is congruent with ‘recognition of nurse competences, follows government policy that patients should receive the right care, in the right place at the right time by appropriately trained staff, fits with guidance offered by relevant professional bodies, and offers the potential for developing more streamlined, cost-effective abortion services.’ . . . [Full text]

 

Politicians wrestle with doctors’ consciences in Victoria

Conscientious objection needs to be protected

MercatorNet
Reproduced with permission

Paul Russell*

As the Victorian Ministerial Advisory Panel on “assisted dying” makes ready to release its interim report sometime in April, The Age newspaper turned its attention to the matter of conscience whether a doctor may refuse to take part in any action that would bring about the premature and deliberate death of a person.

Conscience – or the ability to draw upon one’s own personal belief system in making a decision about an action – plays out at different levels in any debate on euthanasia and assisted suicide. . . [Full text]

 

Scarborough health practitioners stand against assisted suicide

Doctors seek protection from policy requiring them to make referral

Scarborough Mirror

Dominik Kurek

A number of local healthcare practitioners fear their right to choose whether or not they participate in providing assisted suicide to patients is being taken away from them.

Assisted suicide became legal in Canada in June 2016.

The Canadian law to allow medical assistance in dying (MAID) followed a Supreme Court of Canada ruling that struck down the law forbidding physician assisted dying, saying the old law violates the Canadian Charter of Rights and Freedoms. The federal law, however, makes no indication that healthcare professionals would have to participate in MAID.

But, a College of Physicians and Surgeons of Ontario policy requires practitioners who conscientiously object to MAID to provide an effective referral to a non-objecting, available and accessible physician, nurse practitioner or agency. . . [Full text]

 

Doctors will have right to refuse assisted death requests under planned reforms

The Age

Farrah Tomazin

Doctors will have the right to refuse to help terminally ill patients who wish to die provided they don’t obstruct people from seeking support elsewhere, under assisted dying laws to be drafted by the Andrews government.

In a high-level report to be considered by cabinet, an expert panel is set to recommend allowing doctors to hold a “conscientious objection” to physician-assisted death – similar to the provisions that allow them to refuse abortions in Victoria.

But medical clinicians who are willing to help patients end their life may be required to have extra training, and anyone who tries to pressure someone to die could face criminal sanctions in a bid to ensure there are strict safeguards against exploitation. . . [Full text]

Fostering Nurses’ Moral Agency and Moral Identity: The Importance of Moral Community

Abstract: It may be the case that the most challenging moral problem of the twenty-first century will be the relationship between the individual moral agent and the practices and institutions in which the moral agent is embedded. In this paper, we continue the efforts that one of us, Joan Liaschenko, first called for in 1993, that of using feminist ethics as a lens for viewing the relationship between individual nurses as moral agents and the highly complex institutions in which they do the work of nursing. Feminist ethics, with its emphasis on the inextricable relationship between ethics and politics, provides a useful lens to understand the work of nurses in context. Using Margaret Urban Walker’s and Hilde Lindemann’s concepts of identity, relationships, values, and moral agency, we argue that health care institutions can be moral communities and profoundly affect the work and identity and, therefore, the moral agency of all who work within those structures, including nurses. Nurses are not only shaped by these organizations but also have the power to shape them. Because moral agency is intimately connected to one’s identity, moral identity work is essential for nurses to exercise their moral agency and to foster moral community in health care organizations. We first provide a brief history of nursing’s morally problematic relationship with institutions and examine the impact institutional master narratives and corporatism exert today on nurses’ moral identities and agency. We close by emphasizing the significance of ongoing dialogue in creating and sustaining moral communities, repairing moral identities, and strengthening moral agency.

Liaschenko J, Peter E.  Fostering Nurses’ Moral Agency and Moral Identity: The Importance of Moral Community.  The Hastings Center Report, Volume 46, Issue S1, September/October 2016, Pages S18–S21.