Last Friday, the Obama administration took a first step to reverse one of the most disconcerting policy changes made by the Bush administration during its 11th hour on a topic that I’m sure will be controversial among nurses, as it has been in society—the so-called “conscience rule.” There is a 30-day public comment period before the rule can be rescinded.
I’ve been ruminating about this new rule permitting health care workers to refuse to provide care that they find objectionable on ethical, moral, or religious grounds. The rule also threatens enforcement by cutting off federal funding for any health care facility or program that fails to protect these workers’ “rights” to refuse care. While it’s clearly aimed at abortions and contraception, the implications of this rule could be far reaching. For example, what if I objected to caring for anyone who committed adultery and refused to provide care for the prostitute with syphilis—or the man who now has it. Or, suppose I work in a community health clinic that provides birth control, among other myriad services, but I’m Catholic and don’t believe in family planning other than the rhythm method. I’m the only primary care provider working today and you come in for birth control pills, but I not only refuse to provide the prescription, I don’t refer you to someone who will. Or I find homosexuality morally reprehensible and refuse to care for the patient I’m assigned who is gay. Or maybe I believe obesity and smoking to be failures of character, and decide that it’s unethical for me to care for patients who present with health problems that result from their obesity or smoking. Where does it end? It’s all too reminiscent of the late 1980s, when some nurses were refusing to care for people with AIDS.
Our role is not to judge but to care for people. If you have moral or religious objections to providing care to some segment of the population, then it’s incumbent upon you to inform your potential employer when applying. If your objection arose because of a change in your beliefs or in the services offered by a facility after your employment, discussing your concern with your employer may enable a reassignment, but you should be prepared to look for another job. I don’t want to land in an ER some day and find that the nurse or physician refuses to care for me because of some personal moral or religious objection.
–Diana J. Mason, RN, PhD, Editor-in-Chief