As a nurse, there may be times where I won’t agree with what the patient or healthcare provider thinks is the best treatment. This could be due to several reasons: it could bring harm to the patient, it could go against nursing ethical standards, it could go against my morals, or it could go against my interpretation of what the Christian faith teaches. One treatment that falls into the latter category is abortion, which is the act of taking away the life from one of the most vulnerable populations among us.
Moral and ethical dilemmas such as these are very complex and difficult to navigate, especially when patients, doctors, nurses, and other healthcare staff may have differing opinions and stances on them. There are also many different facets to each dilemma, and the “right” answer or stance is not always clear. Of course, knowing what action to take when such ethical and moral issues arise is even more difficult. However, as a Christian nurse, I can approach them through the more secular nursing ethical standards and through the Bible, which, surprisingly, harmonize quite well together.
Nurses are called to turn to The Nursing Code of Ethics, a document that provides an extensive ethical framework for how nurses are to go about their profession by addressing almost every ethically difficult situation a nurse could come across. All nurses are required to study and stay up to date on nursing ethical standards through this literature, as it provides guidelines nurses can use should they run into a moral dilemma or even when they want to make a conscientious objection. So, with the Nursing Code of Ethics and Christian teachings in hand, how exactly should I respond if I am asked to do something morally objectionable in the workplace?
According to the Code, nurses have the right to refuse to participate in actions that go against their morals. Provision 5.4 states that,
When a particular decision or action is morally objectionable, whether intrinsically so because it may jeopardize a specific patient, family, community, or population, or when it may jeopardize nursing practice, the nurse is justified in refusing to participate on moral grounds. (ANA, 2015, p. 21)
Being asked to deceive patients or withhold information such as side effects from them are examples of jeopardizing behaviors. Controversial practices that aren’t viewed as concretely right or wrong by everyone, such as abortion, are examples of actions that may be intrinsically morally objectionable. Once I determine I do not want to participate in a morally objectionable act, I will typically be required to make what is known as a conscientious objection. This act is the primary step nurses can take when they come across difficult ethical situations they don’t want to participate in. Aside from such a formal action, I would argue that one’s attitude in addressing ethical issues is just as, if not more, important.
Having the right mindset is essential when one is attempting to traverse the murky waters of ethical and moral dilemmas. Nurses are to think and act as what the Code calls “moral agents” (ANA, 2015, p. 20). Provision 5.4 states that “as moral agents... nurses express moral perspectives, especially when such perspectives are integral to the situation, whether or not those perspectives are shared by others and whether or not they might prevail” (ANA, 2015, p. 20). As a “moral agent,” I am called to express my opinion when it applies, and, I would argue, to advocate for and help create an environment where expressing honest opinions is encouraged and welcomed.
Before a moral dilemma can even be addressed, an environment must be found or created where everyone’s perspective is welcomed to be expressed. The Code reveals that nurses must strive to build a community of moral discourse, and that “authentic expression of one’s own moral point of view is a duty to self ” (ANA, 2015, p. 20). Along these lines, Christians are called to be quick to listen (James 1:19), which to me means having a humble attitude where I’m willing to listen to and understand the perspectives of those around me. This especially means being willing to listen to my patients’ opinions, perspectives, and wishes, and making sure they are communicated with the necessary staff and that they are followed. Having this attitude will not only further create an inclusive and trusting healthcare environment, but it will also help create a place where patients feel included, listened to, and connected to the staff. Overall, as a Christian nurse, my role in facilitating an environment like this is listening to others’ views and moral values, standing firm in my moral standards, and expressing my moral point of view.
During my time in nursing school, it was often emphasized that nursing care is a holistic profession. This means we are to look out for and address patients’ physical, mental, emotional, and spiritual needs and health. Christians are called to look out for the best interests of those around us (Philippians 4:2) and to love others (John 13:34). I would contend that this means we are to serve others and help them grow by looking out for their holistic needs. I feel that a key part of this is communicating openly and honestly not only with our brothers and sisters in Christ but also with those outside of the Christian faith. To me, this looks like building each other up through encouragement, as well as calling each other out as necessary so that people can be made aware of issues they may not have noticed before and parts of them that are encouraging to others. This type of honest communication is a way to show that you care about the person and the person’s needs on a holistic level.
Christians are called to tell the truth and to be honest with each other (Ephesians 4:25). Similarly, in the nursing world, I am required to be honest with my patients by providing all of the information they need to make an informed decision, to help them “in weighing the benefits, burdens, and available options in their treatment, including the choice of no treatment” (ANA, 2015, p. 2). Additionally, I must also explain the implications of all possible decisions. This looks like walking patients through the entire treatment or procedure thoroughly and explaining what they might feel and experience. I would ask my patients if they needed any clarifications or further explanations. For example, with abortion, I would explain exactly what it is scientifically: the removal of a fetus from the womb which therefore ends its life. I would also explain what risks are involved, including both physical and mental health risks for the mother. As a Christian, I might also explain spiritual consequences that can result because I believe abortion is self-destructive, as it violates God’s teachings and morals.
According to provision 1.2 of the Code, nurses are to address risky and self-destructive patient choices that could lead to negative ramifications by offering opportunities and resources that address these (ANA, 2015). From a scientific standpoint, there are many risks involved with abortion, some that often get looked over. Included in this are mental health consequences such as depression. Because I consider this procedure both self-destructive and destructive of others, I would provide resources and opportunities that encourage my patients to steer away from getting one. This could look like connecting them with pregnancy centers or recommending an ultrasound. Addressing socioeconomic issues through the appropriate healthcare staff is another necessary step to take. Not only is it our duty to ourselves in addressing and resolving ethical issues, but it is our duty to others to address perceived ethical issues as well, particularly when we find ourselves in roles of power. Provision 5.4 also reveals that nurses in positions of authority are called to “seek to change enduring activities or expectations in the practice setting that are morally objectionable” (ANA, 2015, p. 21). Turning to the Christian faith, Christians are called to repent of their sins on an individual level and communal level. Authoritative figures, such as pastors and priests, are called to guide their congregations in turning away from sin—turning away from morally objectionable behaviors, you could say. As I start my career as a Navy nurse and will be in a position of authority, I am allowed, even required, to find ways to change how ethical issues and morally objectionable acts are viewed and implemented. To realize these changes, I can first make sure those I oversee are kept up to date on ethical standards of practice by teaching them often through seminars. Additionally, I can make sure they understand the importance of educating patients thoroughly on all treatment options, including any and all benefits and side effects. Teaching communication and patient interaction techniques and attitudes may prove useful for this as well; it’s important that those I am in charge of know to show empathy and are willing to walk with patients on their
journeys. Above all, the most important way I can implement change in a position of authority is to lead by example.
As a nurse, if I make a conscientious objection about abortion or anything else I find morally objectionable according to God’s standards, I may still face reprimands. Even though the code shows that nurses “have a right and duty to act according to their personal and professional values,” it also reveals that when a conscientious objection is made, it may be an act of moral courage and may not protect nurses from formal or informal consequences (ANA, 2015, pp. 20-21). I got a taste of some of these “consequences” throughout my four years of nursing school, where tension always seemed to be present whenever a controversial ethical issue was brought up. For example, I always felt that only one side of the abortion debate was expressed openly whenever we had to study or talk about it in class. The pro-choice side was often freely expressed, but I felt that the pro-life side was not welcomed to be voiced. I personally didn’t feel comfortable sharing my pro-life opinion, and I know that some other pro-life students in my classes felt the same way. I feared that I would be rejected and not listened to were I to make my view known to the class. There never seemed to be a safe environment where we could have a conversation about this topic and could exchange perspectives respectfully with each other. Whenever my professors taught ethically muddy subjects, they always seemed to emphasize how important it was to support our patient’s decision whether or not we agreed with it, which shut down any potential discussion on the subject. This of course contradicts the Code, which, as we’ve seen, says we are allowed to disagree, voice our opinions, and make conscientious objections as necessary.
There is also the risk of refusing to participate or of a conscientious objection being met with dismissal. A study was conducted in 2018 that explored the impact conscientious objections had on eight nurses who made them. Almost all of them revealed that they were often dismissed or met with silence by their superiors whenever they made a conscientious objection (Lamb et al., 2018). One nurse in particular from this study shared that he faced stigma “in the form of automatic dismissal for his perspectives based on other’s instant assumption that he is religious” (Lamb et al., 2018). So even though nurses are legally allowed to voice their opinions and make concrete conscientious objections, they are likely to still face rejection and other social ramifications. As a Christian nurse, I am still called to value and follow God’s laws above the world’s laws, even if that means facing these ramifications.
Ethical and moral dilemmas that I may encounter as a nurse are often complex and confusing, making it challenging to know what action to take. The Code, used in tandem with Christian teachings, creates a powerful foundation from which I can work through these challenging circumstances and reveals numerous duties I am to follow, from acquiring the right mentality to using my place of leadership. Though I may not be accepted for the actions I take when facing unique challenges, I will remain steadfast because I know that, in the end, the Lord’s call is greater than that of the world.
References:
American Nurses Association. (2015). Code of Ethics for Nurses with Interpretive Statements (Second ed.). American Nurses Association.
Lamb, C., Babenko-Mould, Y., Evans, M., Wong, C. A., & Kirkwood, K. W. (2018). Conscientious objection and nurses: Results of an interpretive phenomenological study. Nursing Ethics, 26(5), 1337–1349. https://doi.org/10.1177/0969733018763996