Accommodating conscience

This article originally appeared in the BC Catholic.
Reproduced with permission.

The nurses' code of ethics and their collective agreements recognize their right to withdraw from giving care that offends their morality, as long as the patients they tend are placed in others' care.

What's more, when they apply for work, nurses have the opportunity to state which medical practices offend their morality or religious convictions, allowing management to hire and staff accordingly.

However, a recent contract cancellation at B.C. Women's Hospital, as well as developments in other provinces, raises doubt as to whether nurses do in fact enjoy unfettered freedoms of conscience and religion.

Nurses get apprehensive when asked whether they do. They're cautious when it comes to sharing information, whether about themselves or colleagues. In the course of this report, several backed away from interviews they'd previously committed to, ultimately making it difficult to determine how much of their fearfulness is due to rumour or innuendo, and how much is fear of the consequences of being a whistle blower.

Barb Pesut, director of nursing at evangelical Trinity Western University in Langley, said she has never seen a nurse's freedoms of conscience and religion violated during her career.

"This is not to say," she continued, "that there is no moral distress in nursing, because there is, but most of it doesn't surround the biggies such as abortion."

Abortion is a practice that nurses can avoid by working in other areas, and nurses who can't cope with death and dying avoid hospice care.

B.C. Nurses Union acting president Andy Wiebe told The B.C. Catholic that her union recognizes its members' freedoms of religion and conscience and has in fact supported members facing discipline for conscientious objection. Citing confidentiality, she refused to provide documentation.

However, Wiebe admitted that conscientious objectors in the province's more remote hospitals might have a harder time because it's often difficult to find replacement staff in small towns.

Under the current agreement, nurses in conflict need only contact their union steward, who then notifies management. If the grievance can't be settled, labour relations staff get involved.

The quality of help the union gives its members is not dependent on the morality of its stewards, Wiebe said. If, for example, a nurse were being disciplined for refusing to do abortions, a union steward who is pro-abortion would refer her to a more sympathetic steward.

"Under the labour code, we are bound to provide services that are not discriminatory. If there's a conflict, the steward will declare herself in conflict and another steward will step in."

Pesut and Weibe both pointed out that most grievances have nothing to do with conscientious objection, but rather with safety or working conditions. When it comes to discussing conscientious objection, however, the nursing profession tends toward silence.

Nurses who were contacted made a point of explaining that they work in a specialty posing no ethical dilemmas. Some simply didn't return phone calls, while others avoided direct questions by referring to situations experienced by nurses in Ontario, or at Calgary's Foothills Hospital, or the janitorial company that lost its cleaning contract recently with B.C. Women's Hospital in Vancouver.

Similarly, nursing management tend to claim that freedom of conscience conflicts arise because nurses don't reveal their objector status when they are being hired.

In the publicized cases, however, ineffectual management seems to have been as much a factor in the disputes as was nurses who don't reveal their objector status.

Cecilia von Dehn, a well known pro-life nurse, was but marginally involved in a company that lost its cleaning contract at B.C. Women's Hospital in Vancouver. Hospital management cited the retired nurse's well publicized pro-life work and her ownership of less than five per cent of the company, which is controlled by her husband, Ulf von Dehn, as sufficient reason to cancel the contract out of ostensible concerns for security.

No other pro-life staff have been fired from the hospital, however, and to date, numerous talented pro-life medical students, nurses, doctors, and researchers remain at work at the hospital.

The Hospital Employees Union played a role in the cancellation of the company's contract, and the cleaning company is suing the union for defamation.

The situation was different at Foothills Hospital in Calgary, where management decided to move late-term abortions into the maternity ward, telling delivery nurses they had to assist in them. These drug-induced "still births" often result in live births. If the doctors who are supposed to deliver the aborted babies are late, nurses have to deliver them; and if they're born alive, they can survive for extended periods, requiring comforting; however, no feeding or other medical care is given.

The nurses, who were Baptist, Canadian Reformed, Pentecostal, Missionary, and Alliance, as well as Catholic, complained to Alberta Report newsmagazine, claiming that management had given them no choice in the matter.

One nurse was quoted as saying, "These are not little lima beans with feet. These so-called genetic terminations are babies. If you were holding their heads in the palm of your hand, their little feet would reach your elbow. We're crossing the line."

In Ontario, after a re-organization, management ordered very experienced obstetric and neo-natal nurses at Markham-Stoufville Hospital to assist in abortions. Again, no choice was offered. Eight nurses filed a complaint with the Ontario Human Rights Commission.

Five years later, in 1999, the hospital reached an out-of-court settlement, agreeing that nurses may opt out of doing abortions and that it is up to the hospital, not the dissenting nurses, to find replacements for themselves.

In Thunder Bay, Ont., in 1997, Bishop Frederick Henry spoke out for operating nurses who transferred from St. Joseph's Catholic Hospital to Thunder Bay Regional, where they were required to do abortions.

Management claimed that the nurses knew that they would be required to assist in abortions, but Bishop Henry pointed out that management's wording of the Letter of Understanding was ambiguous: the nurses interpreted it to mean that every effort to accommodate conscientious objectors would be made, while management claimed it meant nurses could be required to do abortions.

"Don't they care about the moral principles of their employees?" asked Bishop Henry in a letter to the editor. "Are they anti-Catholic?"

Sean Murphy of the Protection of Conscience Project pointed out that management reacted sympathetically to a nurse who was emotionally and physically sickened when exposed to abortions, but ignored two others who objected for moral reasons. They had no confidence in management to hear their concerns, so they complained to Bishop Henry, who made their concerns known to the hospital administrators.