Professional Ethics in Unintended Pregnancy Prevention and Care wwwRhNursingorg Objectives To understand the principles that underlay professional codes of ethics To identify key legislation that articulates rights of conscience in the US ID: 762905
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Professional Ethicsin Unintended Pregnancy Prevention and Care www.RhNursing.org
Objectives To understand the principles that underlay professional codes of ethics.To identify key legislation that articulates rights of conscience in the U.S.Apply principles of rights of conscience to clinical cases
Bioethical PrinciplesRespect for autonomy of patient decision-making Beneficence (positive steps taken to help others) Non-malfeasance (do no harm) Justice (or fairness) referring to the equity of distribution of health care resources
What is Conscience? Inner sense distinguishing right from wrongInternalization of parental and social norms Reflection of the integrity and wholeness of the person
Definitions of Conscience Refusal of care VERSUS Conscience provision of care
Conscience Legislation in the US: The Church Amendment Prohibits discrimination against health care workers who refuse to provide care based on ethical grounds Protects health care workers (by prohibiting discrimination) against health care workers who perform lawful sterilization or abortion procedures
Magelsson articulates six criteria for conscientious objection that take into account the patient's interests and the health professional's moral integrity.
Make explicit the goals, values, obligations of the professionAre based on bioethical principlesDeveloped by professional organizations Professional Nursing Codes of Ethics
Institutional Limitationsvs.Patient Care
Patient Situations
Caring for Sara
Conscientious Refusal Can the nurses refuse to care for Sara?
What Happens When ….One nurse makes a decision to provide (or not provide) an abortion procedure when other nurses are making a different choice?
Respect for human dignity Relationships to patientsThe nature of healthThe right to self-determination2.2 Conflict of interest for nurses4.2 Accountability for nursing judgement, decisions, and action How does our professional nursing organization guide us? ANA Code of Ethics
Does this case meet Magelsson’s criteria?Seriously damaging to moral integrityThe objection has plausible rationaleTreatment is not essential part of the work Burdens to patient are acceptably small Burdens to colleagues are acceptably small
What if a nurse began Sara’s care and then decided to invoke a conscience clause?
Caring for Elena
Elena is 38 years old and 22 weeks pregnant. She is experiencing heavy cramping, bright red bleeding and thinks her membranes ruptured. She and her husband went to the ER immediately. Her nurse midwife reviewed the current risks to her pregnancy and arranged a consultation with a obstetrician and a neonatologist.
What is the evidence-based standard of care for Elena?ACOG 2007 practice guidelines require that the pregnant woman be counseled about all the risks and benefits of continuing a pregnancy given Elena’s situation.
What If… What is the religious-based hospital had been able to provide all options for this early pregnancy with premature rupture of membranes?
Elena were 26 weeks pregnant? What if….
Class Discussion & Exercises
References AWHONN (2009). Standards for Professional Nursing Practice, 7th Ed. 2009Beal, M. & Cappiello, J. (2008). Professional right of conscience. J Midwifery Women's Health,53(5):406-12. doi: 10.1016/j.jmwh.2008.05.009.Beauchamp & Childress (2001). Principles of Biomedical Ethics, 5th edn . Oxford University Press. Benjamin, M. (2004). Conscience. In S.G. Post (Ed.), The encyclopedia of bioethics (pp. 513-516) (3rd ed.). New York, NY: Macmillan . Brumbaugh et al. (2004). Neonatal Survival After Prolonged Preterm Premature Rupture of Membranes Before 24 Weeks of Gestation. Obstetrics & Gynecology . 124(5), 992-998.doi: 10.1097/AOG.0000000000000511 Gallagher, K., Porock , D., & Edgley , A. (2010). The concept of 'nursing' in the abortion services. Journal Of Advanced Nursing , 66 (4), 849-857. doi:10.1111/j.1365-2648.2009.05213.x
Kade, K., Kumar, D., Polis, C., & Schaffer, K. (2004). Effect of nurses' attitudes on hospital-based abortion procedures in Massachusetts. Contraception, 69(1), 59-62. Lachman, V. D. (2014). Conscientious objection in nursing: definition and criteria for acceptance. Medsurg Nursing: Official Journal Of The Academy Of Medical-Surgical Nurses, 23(3), 196-198. Lipp , A. (2008). A review of termination of pregnancy: prevalent health care professional attitudes and ways of influencing them. Journal Of Clinical Nursing , 17 (13), 1683-1688. doi:10.1111/j.1365-2702.2007.02205.x Magelssen , M. (2012). When should conscientious objection be accepted ? Journal Of Medical Ethics , 38(1),18-21.doi:10.1136/jme.2011.043646