Nursing is one of the professions governed by codes of ethics which should be stringently adhered to by all the practitioners. Whenever discharging their duties, nurses are required to prioritize the interest of the patients because they are the primary focus in healthcare delivery. Meaning, nurses have obligations to comply with all the codes of ethics as well as legislations governing the profession. However, this notwithstanding, nurses are still entitled to freedoms and rights. One such freedom enjoyed by the nurses is conscientious objection. This simply implies that nurses are allowed to make choice whether to participate in certain procedures.
In as much as it can be argued that nurses have a responsibility to deliver quality care to the patients, the nurses still have a right to refuse to participate in a patient care. According to the principles of conscientious objection, a nurse can flatly refuse to participate in a medical procedure deemed ethically or unacceptable. Nurses are allowed to make such a choice because, just like the rest of the society, they are entitled to have personal values and beliefs. Therefore, whenever they feel that a medical procedure is unacceptable, they cannot be compelled to engage in it (Walsh, 2016). Instead, they are allowed to think about it and refuse to attend to a patient no matter how serious the condition might be.
The freedom of conscientious objection can also be granted on religious grounds. Like any other human being, nurses have a right to profess their religious beliefs. Therefore, when attending to their patients, nurses can have a liberty right to opt out of a medical procedure if by any chance they are convinced that it contravenes the religious beliefs. Examples of situations in which a conscientious objection can be applied are during sterilization, abortion and aided suicide. For example, when a nurse feels that it is unethically justifiable to use Plan B contraception after unprotected sexual intercourse, a nurse can refuse to recommend such prescriptions to the patient (Harries, Cooper, Strebel & Colvin, 2014). In this case, the nurse cannot be considered to be unprofessional or irresponsible in their duties.
Even if the nurses have an opportunity to express their liberty rights, the freedom should be exercised responsibly. The decision should only be made on a conviction that it is morally and legally justifiable. At the same time, it should be weighed against the available priorities such as quality care, life improvement, and conservation of resources, patient involvement, and adherence to prerequisite standards. The decision should not be based on personal preferences, but on acceptable religious and moral standards (Lachman, 2014). So, after making a decision to refuse participation in a medical procedure, the nurse should inform the patient and relevant authority and make timely arrangements for referrals. This can indicate that the nurse is a responsible practitioner who complies with the ethical standards of the nursing profession.
In Australia, nurses are required to adhere to the codes of ethics of nursing. By doing this, a nurse will always strives to deliver benevolent, just and quality healthcare to the patients. In a nutshell, a nurse has a mandate to comply with the ethical principles of autonomy; respect of the patient’s rights and culture; quality care for all; confidentiality; accountability; and responsibility (Edwards, 2016). From this, it can be observed that the concept of conscientious objection is directly related to nursing ethics (Walsh, 2016).
For a nurse to deliver quality healthcare to the patients, a nurse should feel motivated. To motivate the nurses, the employer does not only need to offer rewarding remunerations, but also recognize the nurses and avail a conducive working environment. And one way of accomplishing this goal is to enable nurses to operate without any unnecessary interference. So, when it comes to decision making, nurse should be given an ample opportunity to decide on what to do at any given time so long as it is within the stipulated regulations. A nurse who enjoys his liberty rights is a highly motivated (Morrell & Chavkin, 2015). Meaning, he can deliver high quality services because there are no hindrance whatsoever. It is for this reason that the concept of conscientious objection is in line with the nurses’ ethical responsibilities.
Apart from motivating the nurses to deliver exceptional services to the patients, the idea of conscientious objection can play a significant role in ensuring that a nurse remains responsible in their decisions. The acknowledgement of the fact that the nurse should act in the interest of the patient can not fade away from the mind of the nurse even after refusal to participate in a medical procedure (Chan, Chan, Lui, Yu, Law, Cheung & Lam, 2014). Thus, the nurse has to take the necessary measures such as informing the patient and the employer on the decision. At the same time, the nurse, upon making a decision to refuse participation in a procedure, has a duty to collaborate with his colleagues and refer the case to other specialists to serve the client without any delays. This shows that conscientious objection comes with responsibilities that have to be observed by the nurse. Otherwise, the nurse would just abandon a patient and leave them to suffer in pain and unnecessarily lose their lives so long as the procedure is refused on moral and spiritual convictions.
The concept of conscientious objection is in line with the nursing ethical responsibilities because it does not just give nurses a right to refuse participation in a medical procedure without justifying the cause. The right should be exercised with lots of responsibilities. For example, even if a nurse feels to be excluded from a procedure, the nurse should not do so on personal preferences. Instead, the decision should only be pegged on justifiable reason that is morally right and legally accepted (Burston & Tuckett, 2013). Only when a nurse is capable of proving that the decision is in a violation of the religious and moral beliefs should it be valid enough to warrant refusal. At the same time, all the decisions should be made in compliance with all the existing refusal laws.
The idea of conscientious refusal is necessary in the nursing practice because it can help in addressing the challenges that do arise as a result of ethical collision that exists between an of individual nurse’s liberty rights or values and professional standards, legal regulations and common practice standards from the colleagues (Harding, 2013). It is for this reason that a hot debate has ensued on whether conscientious refusal is done in the interests of the patient or the nurse.
This paper refutes the claim peddled by the critics that conscientious objection is a liberty right that should be deprived because it is undesirable practice done for the sole interest of the practitioner. It is unjustifiable to claim that such liberty rights can erode the nursing profession by making the nurses to deprive the patients of their autonomy and compromising the quality of services delivered (Walsh, 2016). It is not true to make such an argument because nurses also deserve to have liberty rights upheld just like the rest of the people in the society.
It is therefore undeniable that a nurse who engages in a conscientious objection does so for the benefit of the patient. A nurse who refuses to engage in a procedure is serving the interests of the patients. It is right for a nurse to refuse to participate in a procedure if it is exclusively aimed at promoting the well-being of the patient. For example, when a nurse feels that the best alternative to adopt while serving a patient is to refrain from participating in the treatment process, it means that the nurse is concerned about the patient (Nieminen, Lappalainen, Ristimäki, Myllykangas & Mustonen, 2015). The feeling that the involvement of a nurse in a procedure can compromise the quality of the service rendered, implies that the nurse is not serving his own interests, but responsibly acting on behalf of a patient.
The other reason why the refusal of a nurse to participate in a medical procedure is in the best interests of the patient is because such decisions are made as the last resort. Meaning, a nurse can only decide to conscientiously object an intervention after exploring all the other options. For instance, when exclusion is based on the fact that the nurse might be fatigued or distressed at the time of service delivery, it becomes crystal clear that the nurse is not interested in participating in a procedure that can harm the patient or negatively impact on their health. A fatigued or distressed practitioner should be excused from engaging in healthcare delivery because it can result into low quality services (Atkins, De Lacey & Britton, 2014). Conscience-based decisions are far much beyond individual interests because they are aimed at offering what is best in the opinion of the healthcare provider.
As a professional, a nurse should always be guided by the ethical codes and professional standards governing nursing. Although there are ethical and professional regulations to apply whenever attending to a patient, a nurse is still subject to their own opinion provided it is done in the interest of the patient. It is moral for a nurse to exercise the freedom of conscientious objection granted. However, the nurse requires doing so not for personal gain, but for reasonably justifiable grounds aimed at meeting the needs of the patient.
Atkins, K., De Lacey, S., & Britton, B. (2014). Ethics and law for Australian nurses. Cambridge University Press.
Burston, A. S., & Tuckett, A. G. (2013). Moral distress in nursing Contributing factors, outcomes and interventions. Nursing Ethics, 20(3), 312-324.
Chan, Z. C., Chan, Y. T., Lui, C. W., Yu, H. Z., Law, Y. F., Cheung, K. L., ... & Lam, C. T. (2014). Gender differences in the academic and clinical performances of undergraduate nursing students: A systematic review. Nurse education today, 34(3), 377-388.
Edwards, M. (2016). Physician-Assisted Death and Conscientious Objection: Implications for Critical Care Nurses. Canadian Journal of Critical Care Nursing, 27(2).
Harding, T. (2013). Cultural safety: A vital element for nursing ethics. Nursing Praxis in New Zealand, 29(1), 4-12.
Harries, J., Cooper, D., Strebel, A., & Colvin, C. J. (2014). Conscientious objection and its impact on abortion service provision in South Africa: a qualitative study. Reproductive health, 11(1), 1.
Lachman, V. D. (2014). Conscientious objection in nursing: definition and criteria for acceptance. Medsurg Nursing, 23(3), 196.
Morrell, K. M., & Chavkin, W. (2015). Conscientious objection to abortion and reproductive healthcare: a review of recent literature and implications for adolescents. Current Opinion in Obstetrics and Gynecology, 27(5), 333-338.
Nieminen, P., Lappalainen, S., Ristimäki, P., Myllykangas, M., & Mustonen, A. M. (2015).Opinions on conscientious objection to induced abortion among Finnish medical and nursing students and professionals. BMC medical ethics, 16(1), 1.
Walsh, K. (2016). Perspectives: Nursing, ethics, human rights and asylum seekers: an Antipodean perspective on 2015. Journal of Research in Nursing, 20(8), 741-745.
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