In lieu of an abstract, here is a brief excerpt of the content:

It is a not always easy to know when members of the professional staff should be exempted from particular patient care situations for reasons of personal conscience. Acceptance of the conscientious beliefs of individuals is an essential part of any society or any organization committed to respecting individuals in their differences. On the other hand, those seeking professional services have a legitimate expectation that professionals will respond on the basis of professional standards, not on the basis of simply personal beliefs. Not every request to be excused from patient care responsibilities because of a conscientious objection should be honored. The ¤rst objective of this chapter is to review some important considerations related to such requests and to propose criteria or guidelines to assist supervisors in determining whether a particular request should be honored. The second objective is a little different. The discussion of conscientious objection is a good occasion to consider the parameters of an organization’s conscientious objection. The healthcare provider organization might decide, on the basis of the governing board’s or the sponsor’s ethical principles, not to permit certain legal patient treatment options. This practice is reviewed in this chapter in terms of how it relates to patient rights and to demands placed upon employees. Policy on Staff Conscientious Objection The expectations of the Joint Commission on the Accreditation of Health Care Organizations have resulted in the preparation of many institutional policies related to requests by staff that they be excused from patient care Eleven Conscientious Objection to Participation in Certain Treatment Options responsibilities that are in con®ict with their ethical values or with their religious or cultural beliefs. The policies vary, but often include the following features: (1) initial responsibility for determining whether the employee’s request should be honored is placed with the employee’s supervisor, director, or department head; (2) there is a requirement that the requesting employee continue to provide appropriate patient care unless and until alternative arrangements are made; and (3) if the request is denied at the ¤rst level, an appeal is permitted to another person or group. These are important features, but if nothing more is included, the policy does not assist employees or supervisors in determining whether a particular request should be honored. Case 11.1. A. H. is a registered nurse working in a long-term-care facility . J. B. is a patient in the home who is suffering from terminal colon cancer. To relieve the pain that has become dif¤cult to control, the doctor has prescribed moderate doses of morphine. The patient has accepted that she is dying and welcomes the morphine prescription. A. H. requests that she be excused from administering the morphine, based on her belief that this treatment may well cause the patient to die earlier than she would otherwise, by depressing respiration. A. H. argues that it goes against her conscience to give the ordered dosages. Other nurses have no moral problem following the orders. Should A. H. be excused from the responsibility to provide the ordered care for J. B.?1 The claim here on the part of the nurse is that she should not be required to participate in treatment that she thinks is wrong. Some such claims should be honored and accommodated; some should not.2 When an employee asks to be excused from certain care responsibilities because of a con®ict with values or beliefs, that employee is making one of two different claims. She or he may be saying that (1) “it is wrong to do this” or that (2) “it is wrong for me to do this.” An employee making the ¤rst kind of claim is expressing a conviction that the patient is not being treated according to professional or ethical standards. An employee making the second kind of claim is saying that the patient is being treated in a way that is not in con®ict with the ethics of healthcare, but that the employee’s own personal values do not permit participation. Both are conscience-based claims, but they are different statements that call for different responses. If A. H. wants to be excused because she thinks that the patient is not being treated right, according to professional or ethical standards, the response will need to include efforts to address the issue of the appropriateness of the patient care being provided. This may require a review Conscientious Objection to Participation in Certain Treatment Options 101 [3.144.243.184] Project MUSE (2024...

Share