Conscientious Objection

Conscientious object in nursing: Regulations and practice in two European countries

BACKGROUND

The concept of conscientious objection is well described; however, because of its nature, little is known about real experiences of nursing professionals who apply objections in their practice. Extended roles in nursing indicate that clinical and value-based dilemmas are becoming increasingly common. In addition, the migration trends of the nursing workforce have increased the need for the mutual understanding of culturally based assumptions on aspects of health care delivery.

AIM

To present (a) the arguments for and against conscientious objection in nursing practice, (b) a description of current regulations and practice regarding conscientious objection in nursing in Poland and the United Kingdom, and (c) to offer a balanced view regarding the application of conscientious objection in clinical nursing practice.

DESIGN

Discussion paper.

ETHICAL CONSIDERATIONS

Ethical guidelines has been followed at each stage of this study.

FINDINGS

Strong arguments exist both for and against conscientious objection in nursing which are underpinned by empirical research from across Europe. Arguments against conscientious objection relate less to it as a concept, but rather in regard to organisational aspects of its application and different mechanisms which could be introduced in order to reach the balance between professional and patient's rights.

DISCUSSION AND CONCLUSION

Debate regarding conscientious objection is vivid, and there is consensus that the right to objection among nurses is an important, acknowledged part of nursing practice. Regulation in the United Kingdom is limited to reproductive health, while in Poland, there are no specific procedures to which nurses can apply an objection. The same obligations of those who express conscientious objection apply in both countries, including the requirement to share information with a line manager, the patient, documentation of the objection and necessity to indicate the possibility of receiving care from other nurses. Using Poland and the United Kingdom as case study countries, this article offers a balanced view regarding the application of conscientious objection in clinical nursing practice.

Nurses' use of conscientious objection and the implications for conscience

AIMS

To explore the meaning of conscience for nurses in the context of conscientious objection (CO) in clinical practice.

DESIGN

Interpretive phenomenology was used to guide this study.

DATA SOURCES

Data were collected from 2016 - 2017 through one-on-one interviews from eight nurses in Ontario. Iterative analysis was conducted consistent with interpretive phenomenology and resulted in thematic findings.

REVIEW METHODS

Iterative, phased analysis using line-by-line and sentence highlighting identified key words and phrases. Cumulative summaries of narratives thematic analysis revealed how nurses made meaning of conscience in the context of making a CO.

RESULTS

Conscience issues and CO are current, critical issues for nurses. For Canadian nurses this need has been recently heightened by the national legalization of euthanasia, known as Medical Assistance in Dying in Canada. Ethics education, awareness, and respect for nurses' conscience are needed in Canada and across the profession to support nurses to address their issues of conscience in professional practice.

CONCLUSION

Ethical meaning emerges for nurses in their lived experiences of encountering serious ethical issues that they need to professionally address, by way of conscience-based COs.

IMPACT

This is the first study to explore what conscience means to nurses, as shared by nurses themselves and in the context of CO. Nurse participants expressed that support from leadership, regulatory bodies, and policy for nurses' conscience rights are indicated to address nurses' conscience issues in practice settings.

Conscientious objection and nurses: Results of an interpretive phenomenological study

Background:

While conscientious objection is a well-known phenomenon in normative and bioethical literature, there is a lack of evidence to support an understanding of what it is like for nurses to make a conscientious objection in clinical practice including the meaning this holds for them and the nursing profession.

Research question:

The question guiding this research was: what is the lived experience of conscientious objection for Registered Nurses in Ontario?

Research design:

Interpretive phenomenological methodology was used to gain an in-depth understanding of what it means to be a nurse making a conscientious objection. Purposive sampling with in-depth interview methods was used to collect and then analyze data through an iterative process.

Participants and research context:

Eight nurse participants were interviewed from across practice settings in Ontario, Canada. Each participant was interviewed twice over 9 months.

Ethical considerations:

This study was conducted in accordance with Health Science Research Ethics Board approval and all participants gave consent.

Findings:

Six themes emerged from data analysis: encountering the problem, knowing oneself, taking a stand, alone and uncertain, caring for others, and perceptions of support.

Discussion:

This study offers an initial understanding of what it is like to be a nurse making a conscientious objection in clinical practice. Implications for nursing practice, education, policy, and further research are discussed.

Conclusion:

Addressing ethical issues in nursing practice is complex. The need for education across nursing, healthcare disciplines and socio-political sectors is essential to respond to nurses’ ethical concerns giving rise to objections. Conscience emerged as an informant to nurses’ conscientious objections. The need for morally inclusive environments and addressing challenging ethical questions as well as the concept of conscience are relevant to advancing nursing ethics and ethical nursing practice.

Conscience, conscientious objection, and nursing: A concept analysis

BACKGROUND:

Ethical nursing practice is increasingly challenging, and strategies for addressing ethical dilemmas are needed to support nurses' ethical care provision. Conscientious objection is one such strategy for addressing nurses' personal, ethical conflicts, at times associated with conscience. Exploring both conscience and conscientious objection provides understanding regarding their implications for ethical nursing practice, research, and education.

RESEARCH AIM:

To analyze the concepts of conscience and conscientious objection in the context of nurses.

DESIGN:

Concept analysis using the method by Walker and Avant.

RESEARCH CONTEXT:

Data were retrieved from Philosopher's Index, PubMed, and CINAHL with no date restrictions.

ETHICAL CONSIDERATION:

This analysis was carried out per established, scientific guidelines.

FINDINGS:

Ethical concepts are integral to nursing ethics, yet little is known about conscientious objection in relation to conscience for nurses. Of note, both concepts are well established in ethics literature, addressed in various nursing codes of ethics and regulatory bodies, but the meaning they hold for nurses and the impact they have on nursing education and practice remain unclear.

DISCUSSION AND CONCLUSION:

This article discusses the relevance of conscience and conscientious objection to ethical nursing practice and proposes a model case to show how they can be appreciated in the context of nurses. Conscientious objection is an option for ethical transparency for nurses but is situated in contentious discussions over its use and has yet to be fully understood for nursing practice. Conscience is an element in need of more exploration in the context of conscientious objection. Further research is warranted to understand how nurses respond to conscience concerns in morally, pluralistic nursing contexts.

Conflicts of conscience in the neonatal intensive care unit: Perspectives of Alberta

Background:

Limited knowledge of the experiences of conflicts of conscience found in nursing literature.

Objectives:

To explore the individual experiences of a conflict of conscience for neonatal nurses in Alberta.

Research design:

Interpretive description was selected to help situate the findings in a meaningful clinical context.

Participants and research context:

Five interviews with neonatal nurses working in Neonatal Intensive Care Units throughout Alberta.

Ethical consideration:

Ethics approval from the Health Research Ethics Board at the University of Alberta.

Findings:

Three common themes emerged from the interviews: the unforgettable conflict with pain and suffering, finding the nurse’s voice, and the unique proximity of nurses.

Discussion and conclusion:

The nurses described a conflict of conscience when the neonate in their care experienced undermanaged pain and unnecessary suffering. During these experiences, they felt guilty, sad, hopeless, and powerless when they were unable to follow their conscience. Informal ways to follow their conscience were employed before declaration of conscientious objection was considered. This study highlights the vital importance of respecting a conflict of conscience to maintain the moral integrity of neonatal nurses and exposes the complexities of conscientious objection.

Conscientious Objection: Understanding the Right of Conscience in Health and Healthcare Practice

In situations of moral gravitas, healthcare professionals are largely protected in the Western world to invoke their right to conscientiously object to providing care that conflicts with their personal, moral, and religious beliefs. However, making a conscientious objection needs to be predicated by an understanding of conscience, and knowledge of conscience is largely absent in definition as well as discourse surrounding conscientious objection in healthcare practice. Moreover, current definitions of health do not place emphasis on the ethical well-being of patients as well as care providers. Exploring health as an ethical condition of wellness in the light of conscientious healthcare provision will be addressed in my paper. I will also discuss how a distance from conscience in conscientious objection could compromise a healthcare professional's right to conscientious objection, if the fundamental, human right to conscience is not protected in the first place, supported by a focus on the importance of health as a state of ethical well-being.

Professional right of conscience

In recent years there have been numerous media reports of professionals attempting to expand the right of conscience and deny health care services requested by consumers. While the media has focused the most attention on pharmacists' right to refuse access to contraception, this trend is an expansion of the right originally established to protect professionals from being required to perform abortions or to provide direct assistance with abortions. State legislatures have addressed this issue, in some cases by overtly protecting consumers' rights and in other cases by broadening professional right of conscience. In this article, the literature on provider right of conscience is reviewed, and approaches advised by professional organizations are discussed.