Conscience Clause Part II

I grew up on tales of civil disobedience, I absorbed the belief that we answer to a higher standard than man’s law. I admired the Freedom Riders and Conscientious Objectors. They put their comfort, and sometimes their lives on the line.

Everything that goes around comes around. While there are many people who will follow their principles no matter what the cost, there are those who use conscience as a justification for pushing their standards on others. They feel pure, the people they are trusted to serve are subject to their judgment and bear the consequences.

The Bush administration, with its fondness for vague piety, gave cover to any pharmacist or health care provider who decided to refuse service, as long as they claimed religion. Oh, excuse me–I meant Faith. Religion is too specific, let’s not be clear when we can be evasive.

I’ve been watching this court case move slowly through the system. A nurse is being sued because she pulled out a patient’s intrauterine device without permission, and then lectured her. An IUD prevents fertilization and alters the uterine lining to make it less receptive to sperm and implantation. This is what some define as abortion. In fact, some believe that the birth control pill is abortion, and there are legal strategies in progress to separate contraception from other health care and remove it from insurance coverage.

The Freedom Riders faced dogs and fire hoses, the Conscientious Objectors went to prison or served in the hardest unwanted jobs. They stood up to power and faced the consequences. This new definition of conscience is all about the person in power exercising their conscience at the expense of the person who trusts them to provide a skilled service. Unlike the Freedom Riders and the C.O.’s, the providers are well protected by the law. But this nurse may have pushed it too far.

She could have told her employer at hire that she had a list of birth control methods she personally found unacceptable, and would not cooperate in providing care that violated her standards. She could have refused to see the patient with the IUD, and claimed conscience and let another nurse or doctor see her. She’ll have a chance now to say whether she was acting on principle, or was just clumsy. Here’s some testimony…

“[Nurse] Olona then stated, ‘having the IUD come out was a good thing.’ She asked (the plaintiff) if she wanted to hear her ‘take’ on the situation. Without receiving a response, Defendant Olona stated, ‘I personally do not like IUDs. I feel they are a type of abortion. I don’t know how you feel about abortion, but I am against them. What the IUD does is take the fertilized egg and pushes it out of the uterus.’
“Defendant Olona stated, ‘Everyone in the office always laughs and tells me I pull these out on purpose because I am against them, but it’s not true, they accidentally come out when I tug.’

The thing about conscience is that good people can disagree in important matters. I do think that medical people have a right and necessity to follow their conscience, but they have an obligation to be truthful to their patients. They do not have a right to impose their beliefs on people who are trusting them to provide care. If they need to opt out, they should make sure the patient has an alternative. Because she has a conscience too. And it’s her life and body on the line. Doctors and nurses have no right to sabotage medical procedures from some notion that they know better than the patient.

UPDATE: Apparently the case was settled out of court. Darn. I was wondering what Nurse Olona, (or Physician’s Assistant Olona in some news accounts) would have said with her hand on the Bible.

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6 responses

  1. Nurse/PA Olona crossed a line.

    She took steps w/o consulting her patient based on her own moral code. Nurse/PA Olona was not acting in a religious setting. She was acting in a medical setting. As such, she had no right to make a medical decision based on her own personal moral code.

    She clearly violated the rights of her patient.

    Personally, I don’t believe a pharmacist should have the right not to fill birth control perscriptions, for exactly that reason. It places a moral barrier in a medical context.

    There are, of course, reasons when morality should enter the medical realm. But no one is forcing anyone to become a pharmacist. It is a lucrative profession. If you don’t believe in filling birth control prescriptions, don’t become a pharmacist.

    As for an MD not doing abortions…I believe that is different, even though I’m not sure how.

  2. In the linked article the patient said that Ms. Olona tried to talk her into changing her birth control method to the pill or Depo shots. This is so wrong. Those methods are good and proven, but not right for every woman. That patient might have had medical reasons for needing the IUD.
    The standard for choosing a birth control method should be the desire and well-being of the patient. That should be the standard of care for any treatment offered to any healthy patient. Give them the best information and respect their decisions.
    If a doctor or a nurse has strong moral feelings about any aspect of care, they need to seek a workplace where their views will be understood and respected. That’s the sacrifice demanded by conscience. Shortchanging the patient on choice or information, or lying to them about what you have done to them is not an act of conscience–it is dishonorable.

  3. It sounds as if this was handled as a civil matter. To me, it was a clear case of sexual assault.

    The so-called “nurse” should be in prison.

  4. An IUD does not prevent fertilization. It prevents the implantation of the fertilized egg into the endometrium by causing a condition of chronic inflammation.

  5. The birth control pill also allows fertilization but alters the mucous of the endometrium with progesterone to disallow implantation.

  6. I am an RN who believes that abortion is taking a human life. If I participated in an abortion, I would believe that I was participating in a murder. That violates my conscience. It is not true that everyone uses the “conscience clause” as an excuse. Many, many health practitioners believe this is a grave matter.

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