View Full Version : Moral Dilemmas


Jaime
02-25-2008, 03:32 PM
When a patient presents with something that is in conflict with your own moral code, how do you best handle the situation and meet your professional obligation to care for the patient?

Julie
02-25-2008, 04:02 PM
In my experience you have to put your moral codes to one side and get on with providing care for your patient. Some people find this difficult e.g. abortion, but I believe it is not for us to judge the way others lead their lives.

Mother Jones, RN
02-25-2008, 04:30 PM
When a patient presents with something that is in conflict with your own moral code, how do you best handle the situation and meet your professional obligation to care for the patient?

I always try and treat patients the way I would want to be treated.


MJ :pepsi:

geenaRN
02-25-2008, 05:50 PM
I agree with Julie and MJ. Say you were the one in the bed and you were proposing an idea that your nurse had a moral conflict with.

How would that make you feel?

If you really feel as though you absolutely cannot put aside your feelings and care for the patient, ask to be reassigned to another patient. To try to care for the patient in that situation would not benefit either of you.

NurseSean
02-25-2008, 06:02 PM
personal morals and nursing are like the Church and State. They just don't mix well together! Try to keep them far far apart.

If you cannot do this, find a unit or a type of nursing that these situations will not arise.

I think if anyone is thinking of going into nursing, it's important to do some self-reflection, asking yourself, "do I have strong morals and beliefs that may interfere with my work?" If the answer is "yes," it may not be the best option.

We go into nursing to give everyone equal treatment without judgement without exception. This treatment is to be given within legal boundaries...not personal moral boundaries.

Sean

LesleyJoy
02-25-2008, 08:19 PM
What a good question!

In my opinion a nurse need not set aside his/her own moral code in order to provide excellent care. Sometimes it might be necessary to excuse oneself from providing the care a patient requests, but the patient is not abandoned. This allows for the nurse to maintain both personal and professional integrity.

Let me tell you what I did when I still provided patient care: If I could not in good conscious do as a patient desired, I first asked him/her to tell me more about "X." I did not ask him/her to explain why, only what it was he/she wanted. Oft times, however, the "why" would be offered with the "what." If the "why" could be met without doing "X," I explained the options. If the person was confident that "X" is indeed what he/she wanted, I informed him/her that I would not help him/her do "X" and why I would not. I made every effort to ensure that the person very clearly understood that it was the "X" that I found wrong, not the person! I would then state that I would find him/her another nurse right away. Then I would find another nurse.

This approach has landed me in hot water exactly twice in all my years of nursing. The first was when, as a hospice nurse, I refused to take an order from a physician because the medications were going to be used under Oregon's Physician Assisted Suicide act. I told the doctor that I would not help him kill a patient. I then stated that I would transfer his call to my nurse manager. If you don't think that stirred up a lot of dust, just let me tell you they were talking about what I did for weeks! The second occurence was when I respectfully and with great courtesy told a physician (out of the hearing of the patient) that I would not help him perform an abortion and why. Again, my decision to do as I thought was right caused quite a disturbance among not only fellow nurses, but among physicians and senior management as well.

So... I say know what you believe and why you believe it. Be prepared to explain yourself quietly and without condemnation to those whose beliefs are different from yours. Be ready to present options in care. Then if the patient or physician stills wants what you are not willing to give, excuse yourself from the situation with as much courtesy and grace as you are able.

Joy

P/J
02-26-2008, 02:28 AM
Joy I think that once again you have put a lid on my simmering temper and calmed me down after a rather stressful day. This has been a bit of a rant-y day for me as the clinical placement roster has just been posted with a few surprises (or one not so surprise).
---------
Is it a matter of moral code or just people who don't share your beliefs? There is a big difference between disagreeing with abortion and 'the fetus has a soul'; homosexuals and HIV; Drug uses and psychosis or overdose. Are you pushing your morals/religion onto someone else or do you really take issue with the situation (such as Joy and assisted suicide).

Example: As more male nurse come into the industry female patients are having to realize that they will someday have a male nurse looking after them, they can decline to have us wash them, but they must realize that they will have to wait every time they need assistance if they don't want the male nurse. I have had a few old ladies not wanting to have me wash them, I then over hear the female nurse saying to the patient that 'as if he wanted to see you naked anyway'.

One of my patients had a bone tumor removed from her hip, she was nervous when us male nurses came to change the dressing. We draped her as we are shown at university (something I have never seen a female nurse have to do so stratigraphical) to only expose the hip. As soon as she realized that we were not going to whip the blankets off and fully expose her, she relaxed and brightened up.

We have a nurse in our class who because of his religion doesn't believe in blood transfusions. He still performs them, he just doesn't want one himself.

We meet a lot of different people through our work and if we have an issue with every second one we meet, then maybe we are in the wrong profession. We are there to treat and care; not to judge others. If you have a real issue ask to change patients, however eventually I think that the NUM is going to tell you to get over it.

Julie
02-26-2008, 03:32 AM
One of my patients had a bone tumor removed from her hip, she was nervous when us male nurses came to change the dressing. We draped her as we are shown at university (something I have never seen a female nurse have to do so stratigraphical) to only expose the hip. As soon as she realized that we were not going to whip the blankets off and fully expose her, she relaxed and brightened up.


I just cannot understand why a patient would object to a male nurse exposing her hip and doing a dressing. After all, the person who did the operation was reasonably likely to have been a man and I'll bet there would have been no arguments about that!

LesleyJoy
02-26-2008, 07:28 AM
...Is it a matter of moral code or just people who don't share your beliefs?

...Are you pushing your morals/religion onto someone else or do you really take issue with the situation (such as Joy and assisted suicide)...

P/J, I am so glad you wrote as you did and am grateful for the questions you asked. Please allow me to attempt to explain myself:

1. I have not pushed nor will I ever push my "morals/religion" onto someone else. Likewise, I have neither compelled nor will I ever compel someone to agree with me on any point of morals or religion. I firmly believe that each person has the inherent and inalienable right believe as they choose.

2. I am willing and able to respectfully listen to another's beliefs. I am also willing and able to respectfully explain my own beliefs when asked about them.

3. I truly do "take issue" with both Physician Assisted Suicide
and abortion. They are, in my belief system and to put it bluntly, murder.

My practice as a nurse is, therefore, completely consistent with what I have written above. Do I demand that everyone believe and act as I do? Not at all. Do I disregard, minimize, or condemn a person who does not share my beliefs? No. One of the freedoms I so markedly enjoy is the ability to love a person without regard to his/her beliefs or behaviors. If I cannot agree with a person's beliefs or behaviors, I can still find the person of immeasureable value and worthy of every bit of honor and assistance I can give.

I hope I have answered your questions. If I have not, please let me know. I will try to find another way to explain myself.

Thanks.

Joy

P/J
02-26-2008, 08:42 AM
Sorry Joy you miss understood me and I have now tried to correct the post somewhat :flowers:. Any 'you/we's in the post are royal you/we. The questions were not directed at you directly; in fact I agreed with your views and would have done similar things in your circumstances.

Your post calmed me down quite a bit(lid on temper) after my rather stressful day, as you brought up the whole 'youth in asia' debate which I hadn't considered and I agree with you on. I however have recently come across a number of nurses who have refused to treat drug uses and gays as they don't agree with them on a religious basis, and I believe religion should not be the basis of our profession (the church and state).

Thank you for responding to the question anyway. :turtle: (the turtle of apology)

P/J
02-26-2008, 08:47 AM
I just cannot understand why a patient would object to a male nurse exposing her hip and doing a dressing. After all, the person who did the operation was reasonably likely to have been a man and I'll bet there would have been no arguments about that!

I think it was more the thought that we were going to fully expose her abdomen and pubic area (she was in her late 20s) and leave her exposed. I think she was pleased when we draped her then removed the blanket so that only her hip was exposed. I don't think any of us would like to have anyone come in and whip off our sheets exposing ourselves to everyone in the room. A doctor we have met before and chattered about the procedure, we are then put to sleep and you can't do much about your modesty then!

LesleyJoy
02-26-2008, 09:01 AM
Sorry Joy you miss understood me and I have now tried to correct the post somewhat :flowers:. Any 'you/we's in the post are royal you/we. The questions were not directed at you directly...

Thanks, P/J. I am so glad I misunderstood you! A transient misunderstanding is better than having given offense!

I posted the following in response to your private message to me. I think it is also suitable to post here:

Quote:
Originally Posted by P/J
...I am recently come across a number of nurses who have refused to treat gays and drug uses as they don't agree with them on a religious basis, and I believe religion should not come into it.

P/J,

What those nurses are doing is completely reprehensible! They are either practicing a harmful religion or their interpretation of their religion is badly skewed.

There is a vast and unbridgeable difference between what a person is worth and what a person does. We nurses are called (or should be called) to "do no harm" either physically, psychosocially, or spiritually.

I have prayed and will continue to pray for them, their patients - and you!

Joy

NurseSean
02-27-2008, 03:47 AM
I just cannot understand why a patient would object to a male nurse exposing her hip and doing a dressing. After all, the person who did the operation was reasonably likely to have been a man and I'll bet there would have been no arguments about that!

Honestly Julie, female patients refuse to have me, a male, perform procedures more often then you probably think. It's a discrimination that I feel we continue to allow. But, I don't want to hijack the topic...as I've seen in other forms, this particular issue could take up pages and pages of debate (usually quite vicious).

gracenotes1
02-27-2008, 08:05 AM
It is kinda funny. Patients want male Doctors and female nurses. Now why is that? Especially older people.

Some of my best nurses were male. They were caring and compassionate, and usually respected privacy of the patients more than the female ones did.

But alot of the time--the older residents in the SNF thought that the male nurses were doctors.

We had a female doctor that visited some of her patients--and they thought she was a nurse.

Course--these days everybody and their brother wears scrubs and no one can really tell who anyone is. Even the dietitcians look like nurses. This bugs me!!

I have a problem with it.

I think nurses should look like nurses. Not that we should go back to caps or anything like that but I think it is important to look like a nurse.

Whoever came up with the idea that nurses should wear white had not been a nurse very long. I don't think it was Florence--do yall?

I just think we should have some way to differentiate nurses from housekeeping. And Physcial therapist--oh don't get me started on them!!!
hahaha

Male nurses are becoming more and more prevalent and I am glad--take heart gentlemen--society will catch up--one of these days!!!
:flowers:

Julie
02-27-2008, 04:15 PM
I personally think these are subjects worthy of debate:

Nursing uniforms - why do they often look nondescript overalls worthy of wear by a housekeeper / cleaner (not that there is anything wrong in actually doing those jobs, they just aren't nurses).

Men in nursing - why are patients allowed to decide that they don't wish to have them near them when it would be rare (unless a very intimite examination were to take place) for a such a choice over a male doctor!

LesleyJoy
02-27-2008, 05:22 PM
Julie,

Perhaps the strong preference for female nurses is primarily cultural in nature. William Edward Towns, 2002, addresses the view of the nurse in a thought-provoking article entitled, Examining the Role of Men in Nursing: Recommendations for Action ( http://www.flcenterfornursing.org/files/MaleNursingRpt.pdf ). Furthermore, since sexual vulnerability and/or modesty issues must also be considered in the care of the female patient, allowing the patient to dictate the gender of the nurse is, in my opinion, prudent. This is not to say that men cannot provide good care. I am simply stating that some females do not feel completely safe with a male health care provider.

Now about the way we dress... I agree that something must be done. But I am not certain that returning to a specific uniform is indicated. I think that it is incumbent upon the healthcare provider to introduce themselves each and every time they enter a patient's room. For example, "Hello, Mrs. Smith. I am Robert/Susan (or Mr./Mrs. Anderson). I am a nurse." If RNs, CNAs, PTs, RTs, and MDs consistently introduced themselves (AND wore badges with letters large enough for the patient to read) we'd have less confusion in the healthcare setting.

OK, that's quite enough from me. What do the rest of you think?

Joy

LittleBird
02-27-2008, 06:14 PM
Men in nursing - why are patients allowed to decide that they don't wish to have them near them when it would be rare (unless a very intimite examination were to take place) for a such a choice over a male doctor!

At times we have male health care aids working on our unit. Sometimes it will happen where a patient (male or female) will refuse to be bathed by the male health care aid. It is their choice. However, we will remind them that this individual is a professional in their own right and here to do a job. If the patient chooses to refuse to be bathed by them, then they will be informed that they may not be bathed at all or will only have a very quick wash, depending on how busy their nurse is.

Mr Ian
02-29-2008, 09:31 AM
I've seen in other forms, this particular issue could take up pages and pages of debate (usually quite vicious).
Yeah I do a lot of that - but the forum annoys me too which just makes me write oppositionally to everything. However, on this point I am fixed. A pt has the right to refuse treatment from anyone.

As for uniforms - fluorescent yellow lettering "N U R S E" stamped on your butt.

Mr Ian
02-29-2008, 09:35 AM
On the more general issue of 'moral dilemmas' my forthright view is there are personal matters and you are not employed nor licensed for your personal feelings or beliefs but for your abilities as a nurse to provide care.
If there's a protocol or provision for it to be done - then it ought be done. However, I am prepared to accept in cases such as Joy issues may be dealt with responsibly and fairly. Seeking an alternative as Joy did is fine by me if you find yourself emotionally compromised - dumping the patient and telling people 'its not going to happen' is not right.
As a supervisor/manager I would prefer such things to be discussed before hand rather than at crisis point tho, especially if they are foreseeable.

MyOwnWoman
03-01-2008, 06:18 PM
Hmmmmmm...... I guess if it's not against the law, then I'd say it is my obligation to carry out the wishes of the patient when he/she is unable to carry them out him or herself.

Although some things may not be right for me, or be what I would do; I'm don't think that it is my responsibility to explain to the patient why I would not do something. That would serve to only make the patient feel bad or uncomfortable about his/her decision.

I suppose if I was in direct conflict, instead of telling the patient why I would not do it, I'd get someone else to do it who did not have issues with what is to be done. In that way, both your mind and the patient's mind can be free from guilt.

In the long run, I believe I am here for the patient's right and beliefs, not my own. I'd expect a nurse to respect my decisions if I were a patient as well.