Bishop protests on behalf of nurses

Health care consolidation generates conflict

Thunder Bay, Ontario, Canada (1997)

This unusually sharp public rebuke of authorities at Thunder Bay Regional Hospital followed reports that Catholic nurses who had transferred from St. Joseph's Catholic Hospital were being forced to participate in abortions.2

Rhonda Crocker-Blackwood, vice president of Thunder Bay Regional Hospital's Clinical Services, emphasized that the seven full time and four part time operating room nurses from St. Joseph's knew, when they were transferred, that they could be asked to assist in abortions. She said that they could have remained at St. Joseph's at the same salaries, though not in their chosen specialty. "Clearly," she said, "we wanted them to think long and hard about whether they wanted to participate in this."3

A subsequent article quoted nursing ethicist Patricia Wall of McMaster University.4 Wall cautioned that ethical problems faced by health care workers could snowball, not just because of abortion, but because of social and scientific developments tending toward advanced reproductive technology and euthanasia.

Crocker-Blackwood allowed that a nurse with conscientious objections to abortion could arrange for another nurse to substitute for her5 and said that nurses were switching shifts for this purpose.6 However, citing Ontario College of Nurses ethical guidelines, she insisted that a nurse who was unable to find a substitute would have to participate in abortion. Failure to do so would, she said, be reason for discipline "because you're compromising the ability of the hospital to provide care". Crocker-Blackwood suggested that a nurse who found herself in a position that compromised her conscience should consider finding another job.7

Responses to the situation

The articles sparked several letters to the editor. Two came from a local pro-life representative, Robert Sutherland. Both addressed the issue of conscientious objection in general terms.8

Nine operating room nurses at the Thunder Bay Regional Hospital wrote to complain that Sutherland had no business speaking out on their behalf.9 It appears that they were referring to his reported remarks that the conscientious objectors had not complained to their supervisors "but obviously feel uncomfortable in their roles."10

Crocker-Blackwood's suggestion that conscientious objectors may have to seek employment elsewhere was echoed in a letter to the editor from the Chair of the Board of Governors and the interim President and CEO of the Thunder Bay Regional Hospital.11

Bishop Frederick Henry of the Catholic Diocese of Thunder Bay followed his first strongly worded letter (quoted above) with a second, no less blunt, challenging the response of official hospital spokesmen. The published correspondence highlights some points that are particularly relevant to protection of conscience.

The need for unambiguous text

In the first place, a key sentence in the Letter of Understanding governing the transfer of personnel was poorly drafted: "Nurses transferring to Thunder Bay Regional Hospital could be required to participate in clinical abortions."12

On the basis of discussions that led to the signing of this document, Catholic representatives believed that could meant that participation was not mandatory, and that every effort would be made to accommodate conscientious objectors.13 On the other hand, TBHR officials clearly interpreted the statement to mean that they could require participation.14

The simple lessons relearned here are that verbal agreements are not worth the paper they are written on, and good will does not survive long in the absence of sound draftsmanship.

'Values language' and professional antipathy

The Ontario College of Nurses ethical guidelines referred to by Crocker-Blackwood and quoted by hospital officials use 'values language' to express ethical norms.

"...When a client's wish conflicts with a nurse's personal values, and the nurse believes that she or he cannot provide care, the nurse needs to arrange for another caregiver and withdraw from the situation. If no other caregiver can be arranged, the nurse must provide the immediate care required. If no other solution can be found, the nurse may have to leave a particular place of employment in order to adhere to her or his moral values." 15

It appears that the guidelines resolve 'values conflicts' by giving priority to the wishes of the client. The guidelines do not explain why the mere "wish" of the client (as opposed to his needs) should prevail over the "personal values" of the nurse, but the use of the term 'client' rather than 'patient' suggests that the ethical paradigm is drawn from the marketplace; the customer is always right.

At any rate, professional ethical guidelines that use 'values language' do nothing to clarify the central moral issue: why one party (whether 'client' or employer) should be able to force another to perform an act that he finds morally objectionable.

Hostility perceived in the workplace

Hospital officials claimed that only one nurse was reluctant to assist with abortions, and that her reluctance arose from personal discomfort rather than moral or religious conviction.16 However, at least one must have approached the local pro-life society, and Bishop Henry wrote that two nurses - neither of them the nurse known to the hospital - had approached him personally.17

Thus, despite the assertions of hospital officials and the nurses who wrote to the Chronicle Journal, it is obvious that the nurses who most strongly objected to abortion did not feel that their concerns would be well received by their employer, and perhaps not even by their co-workers. Was this feeling justified?

Three points suggest that it was, at least with respect to the employer. First: Bishop Henry stated that he had told hospital officials about the two nurses who had approached him, yet the officials persisted in their claim that only one nurse had come forward. Second: the officials refused the Bishop's request to institute a "conscience policy", claiming that, if they did so, they would not have enough nurses to assist at abortions. Third: the officials rejected a suggested conscience policy that would have addressed their main concerns.18

Concerning the conscientious objectors' co-workers, it should be noted that the pro-life representative's public statements simply argued that nurses having moral objections to abortion should not be forced to assist in them. This prima facie reasonable position was characterized by the nine nurses who wrote to the Chronicle Journal as 'agitating the issues.'19

Had the issue been sexual harassment by supervisors rather than coerced participation in abortion, it is unlikely that someone speaking out in support of victimized employees would be criticized for 'agitating the issues'. It appears, then, that co-workers were at least insensitive to the sense of vulnerability and isolation experienced by conscientious objectors.

Personal discomfort vs. moral objections

Perhaps the most interesting aspect of the Thunder Bay controversy was the case of the single nurse acknowledged by hospital authorities to be suffering from 'personal discomfort' about assisting with abortions.20 This individual, who had been a peri-operative nurse for eleven years, suffered such intense "physical and emotional anxiety" as a result of her exposure to abortions at TBRH that she was referred to the Employee Assistance programme. When pressed, hospital authorities could not account for her reaction; they had not asked her why she had found the experience so devastating.21

Yet it is clear that this nurse, unlike the conscientious objectors, believed that she could approach hospital authorities about her personal discomfort. Why did conscientious objectors apparently lack that confidence?

Perhaps the answer is that, in the workplace, a nurse who was unable to assist with a procedure because it is personally distressing invokes a very different response from supervisors and co-workers than nurses who are unwilling to assist with a procedure because it is wrong. The former is "an employee to be assisted with her concerns."22 The moral objections of the latter, no matter how carefully expressed, are a standing and unsettling affront to the moral status quo.

It is probable that everyone in Thunder Bay Regional Hospital knew that, or at least sensed it, even if was not articulated , and the conscientious objectors acted accordingly.

Notes

1. Henry, Bishop Frederick, "Hospital stonewalling: Bishop", letter to Chronicle Journal, 15 July, 1997

2. Kelly, Jim, "Catholic nurses caught in dilemma: transfer to another hospital means having to assist with abortions", Chronicle Journal, 6 June, 1997.

3. Kelly, Jim, "Catholic nurses caught in dilemma: transfer to another hospital means having to assist with abortions", Chronicle Journal, 6 June, 1997.

4. Bron, Pamela, "Medicine and Morals: Is there room for both in our present day health care system?" Chronicle Journal, 17 June, 1997

5. Kelly, Jim, "Catholic nurses caught in dilemma: transfer to another hospital means having to assist with abortions", Chronicle Journal, 6 June, 1997.

6. Bron, Pamela, "Medicine and Morals: Is there room for both in our present day health care system?" Chronicle Journal, 17 June, 1997

7. Bron, Pamela, "Medicine and Morals: Is there room for both in our present day health care system?" Chronicle Journal, 17 June, 1997

8. Sutherland, Robert, "Nurses should be exempt from abortions", letter to Chronicle Journal, 17 June, 1997; "Nurses rights to refuse abortion", letter to Chronicle Journal, 8 July, 1997

9. Anderson, Ann, et al, "Nurses perform with good judgement", letter to Chronicle Journal, 5 July, 1997

10. Kelly, Jim, "Catholic nurses caught in dilemma: transfer to another hospital means having to assist with abortions", Chronicle Journal, 6 June, 1997.

11. Jobbitt, Keith and Scott Potts, "Bishop's letter doesn't explain whole issue: hospital officials counter they've been fair with nurses over abortions", Chronicle Journal, 26 July, 1997

12. Jobbitt, Keith and Scott Potts, "Bishop's letter doesn't explain whole issue: hospital officials counter they've been fair with nurses over abortions", Chronicle Journal, 26 July, 1997(emphasis added)

13. Henry, Bishop Frederick, "Nurses choice not so easy", Chronicle Journal, 16 August, 1997

14. Kelly, Jim, "Catholic nurses caught in dilemma: transfer to another hospital means having to assist with abortions", Chronicle Journal, 6 June, 1997. Jobbit & Potts).

15. Kelly, Jim, "Catholic nurses caught in dilemma: transfer to another hospital means having to assist with abortions", Chronicle Journal, 6 June, 1997; Bron, Pamela, "Medicine and Morals: Is there room for both in our present day health care system?" Chronicle Journal, 17 June, 1997; Jobbitt, Keith and Scott Potts, "Bishop's letter doesn't explain whole issue: hospital officials counter they've been fair with nurses over abortions", Chronicle Journal, 26 July, 1997

16. Jobbitt, Keith and Scott Potts, "Bishop's letter doesn't explain whole issue: hospital officials counter they've been fair with nurses over abortions", Chronicle Journal, 26 July, 1997

17. Henry, Bishop Frederick, "Nurses choice not so easy", Chronicle Journal, 16 August, 1997

18. Henry, Bishop Frederick, "Nurses choice not so easy", Chronicle Journal, 16 August, 1997

19. Anderson, Ann, et al, "Nurses perform with good judgement", letter to Chronicle Journal, 5 July, 1997

20. Jobbitt, Keith and Scott Potts, "Bishop's letter doesn't explain whole issue: hospital officials counter they've been fair with nurses over abortions", Chronicle Journal, 26 July, 1997

21. Henry, Bishop Frederick, "Nurses choice not so easy", Chronicle Journal, 16 August, 1997

22. Jobbitt, Keith and Scott Potts, "Bishop's letter doesn't explain whole issue: hospital officials counter they've been fair with nurses over abortions", Chronicle Journal, 26 July, 1997