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in Health Care; Delegations of Authority expands the ability to discriminate, denies patients health care and should be rescinded.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]

 

Palliative care nurses quit ‘houses of euthanasia’

Catholic Herald

Simon Caldwell

Belgian nurses and social workers who specialise in treating dying patients are quitting their jobs because palliative care units are being turned into “houses of euthanasia”, a senior doctor has alleged.

Increasing numbers of hospital staff employed in the palliative care sector are abandoning their posts because they did not wish to be reduced to preparing “patients and their families for lethal injections”, according to Professor Benoit Beuselinck, a consultant oncologist of the Catholic University Hospitals of Leuven.

He said that after more than 15 years of legal euthanasia in Belgium “palliative care units are … at risk of becoming ‘houses of euthanasia’, which is the opposite of what they were meant to be”. . . [Full Text]

Complaint filed with federal agency by Rockford nurse over abortion mandates

rrstar.com

Georgett Braun

ROCKFORD.  A local woman has filed a complaint with a federal agency alleging that she was forced from her job in 2015 at the Winnebago County Health Department because of abortion mandates.

The complaint was filed Tuesday with the U.S. Department of Health and Human Services by attorneys representing Sandra Rojas.

The complaint alleges that Rojas, a pediatric nurse who worked 18 years at the Health Department, objected to a requirement that nurses be trained to make referrals to abortion providers and to help women obtain abortion drugs. . . . [Full Text]

Quebec nurses back euthanasia for the demented to the hilt: survey

BioEdge

Michael Cook

An overwhelming majority of registered nurses working in Quebec nursing homes support euthanasia for dementia patients who have left a living will, researchers from Canada and the Netherlands. In an article in the journal Geriatric Nursing.

Euthanasia is legal in Canada, but only for patients who are competent, even if they had expressed a request for “medical aid in dying” in their lucid moments. However, this restriction is under pressure. After a man killed his demented wife, the Quebec Minister of Health and Social Services asked experts to study whether MAiD could be provided for patients with advance directives.

Although only doctors are able to euthanize patients, the researchers point out that “Given their unique experience and expertise, nurses’ voice must be taken into account in deciding whether or not to modify the current legislation to give incompetent patients access to MAiD.”

Five hundred and fourteen nurses were surveyed; 219 responded. Of these, “83.5% agreed with the current legislation that allows physicians to administer aid in dying to competent patients who are at the end of life and suffer unbearably. A similar proportion (83%) were in favor of extending medical aid in dying to incompetent patients who are at the terminal stage of Alzheimer disease, show signs of distress, and have made a written request before losing capacity.”

Just as interesting as the nurses’ attitudes towards incompetent patients was their feelings about how they would like to be treated themselves should they become demented. If diagnosed with Alzheimer’s, 79% said that they would make a formal request to die. If a love-ones were diagnosed, 65% would call a doctor to euthanise them (provided they had left a request).


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Nurses’ perspectives on whether medical aid in dying should be accessible to incompetent patients with dementia: findings from a survey conducted in Quebec, Canada

G. Bravo, C. Rodrigue, M. Arcand, J. Downie, M.-F. Dubois, S. Kaasalaine, C.M. Hertogh,S. Pautex, L. Van den Block

Abstract

We conducted a survey in a random sample of 514 Quebec nurses caring for the elderly to assess their attitudes towards extending medical aid in dying to incompetent patients and to explore associated factors. Attitudes were measured using clinical vignettes featuring a hypothetical patient with Alzheimer disease. Vignettes varied according to the stage of the disease (advanced or terminal) and the presence or absence of a written request. Of the 291 respondents, 83.5% agreed with the current legislation that allows physicians to administer aid in dying to competent patients who are at the end of life and suffer unbearably. A similar proportion (83%, p = 0.871) were in favor of extending medical aid in dying to incompetent patients who are at the terminal stage of Alzheimer disease, show signs of distress, and have made a written request before losing capacity.


Bravo G, Rodrigue C, Arcand M, Downie J, Dubois M-F, Kaasalaine S, Hertogh CM,  Pautex S, L. Van den Block L. Nurses’ perspectives on whether medical aid in dying should be accessible to incompetent patients with dementia: findings from a survey conducted in Quebec, Canada. Geriatr Nurs. 2018 Jan 3. pii: S0197-4572(17)30319-1. doi: 10.1016/j.gerinurse.2017.12.002.

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]