Let's be clear. We offer no opinion in the case of Cathy Cenzon-DeCarlo, the nurse who filed suit against Mount Sinai Hospital in New York City for allegedly scheduling her to assist with a midterm abortion, even though she said the hospital knew about her objections based on religious belief. The facts in the complaint will likely be contested by the hospital. Let the lawyers sort it out.
However, the lawsuit raises a timely reminder of the importance for all healthcare providers to have clear procedures in place for such a scenario. Can a strong code of ethics and practical policies eliminate the tough moral dilemmas that healthcare professionals have to confront? Or, are tough moral dilemmas simply inevitable, given the life-and-death decisions that are part of the job?
"You can ameliorate them. You can figure out ways to manage them. I don't think you can eliminate them," says Mary Jean Schumann, RN, chief programs officer for the American Nurses Association. "My own experience in being a supervisor in a variety of settings where there are times when there is a conflict is clearly you try to accommodate the staff person when you can. Usually you can work that out."
Now might be a good time to meet with your CNO, management staff, and staff nurses to ensure that everybody is familiar and comfortable with your code of ethics, and that everybody is working off the same set of ethical principles on abortion, just as they would for issues like patient privacy and conflict of interest. Schumann says questions like those raised in Cenzon-DeCarlo's suit should be plainly and assertively addressed. "One of the pieces that should be addressed in policy is, when there are such circumstances, what is the procedure for getting those addressed so that if a nurse has an issue around something like this there is a process in place by which they inform their supervisors that they have a concern?" Schumann says. She also recommends that healthcare organizations make clear their policy and employee obligations during the interviewing and hiring process for new nurses and other healthcare professionals.
While it's up to the healthcare organizations to provide a strong and clear set of guidelines, Schumann says nurses also have a responsibility to determine if their moral or religious believes could create a barrier to care. The primary responsibility of a nurse is the safety and health of the patient. She says nurses who object to abortions that may be necessary to ensure the health of patients should go into a healthcare field that minimizes the risk that they will be forced into such a compromise. "At some level, you have to say to an individual who has that strong of a belief, 'if you feel that strongly, why are you working in this environment?'" Schumann says. "The nurse is responsible at the end of the day for that decision. Nobody is putting their feet to the fire that they have to work there. Typically, you would say 'you need to find a different place to work if it is that hard for you.'"
Cenzon-DeCarlo's suit centers around abortion, but Schumann notes that your healthcare organization's guiding principles should be broad enough to include other grave moral questions, such as end-of-life care, which she believes occurs far more frequently than abortion. "Everything works well for an end-of-life situation when the patient, the family, the doctors, and the nurses are on the same page," she says. "But when they aren't all in agreement conflict is inevitable and there need to be ways to sort this out and a policy and procedure for how you do sort them out. It's inevitable but there should be ways to deal with it."