Question)The Nurse Asked to Assist in Abortion            Mrs

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Question)The Nurse Asked to Assist in Abortion

           Mrs. Betty Phelps works part time in a small suburban GTA hospital. Because she is familiar with the hospital's routines and staff, she is often asked by the nursing manager to work in patient care areas that were short staffed on a particular shift. Today, she was asked to work in recovery room. Within an hour of her shift starting, the nurse manager called and asked her to report to OR 4.

OR 4 is part of the suite of OR rooms where elective abortions are usually performed. Hesitatingly, Mrs. Phelps told the manager that she did not believe in abortion. A devout Catholic, she considered abortion to be the killing of human life and a mortal sin. Would it be possible for the manager to find someone else to help out in OR 4?

The manager was compassionate and understanding and said she would try to find another nurse. In the meantime, however, Dr. Graham needed someone to prep his patient and set up the room for the abortion. Because Mrs. Phelps was not busy at the moment, the manager asked if she would go to OR 4 and at least prep Dr. Graham's patient. Reluctantly, Mrs. Phelps agreed to this arrangement as long as the manager would send another nurse to replace her. The manager assured her that she would do this.

In OR 4, after preparing the equipment and the room, Mrs. Phelps prepped Dr. Graham's patient, a 16-year-old unmarried teenager who was approximately 8 weeks pregnant. She then told the physician that his patient was ready but that she would not participate in the proceedings. Another nurse would arrive shortly who would assist him. Dr. Graham protested, saying in an annoyed tone of voice to Mrs. Phelps, "Do you think I have all day to wait while the nursing staff puts its moralism and emotions in order? Everyone—the patient, the fetus, and the community—will be better off not having to deal with one more illegitimate child requiring public support."

When Mrs. Phelps stated that her religious and moral beliefs did not allow her to participate in performing an abortion, Dr. Graham claimed that the fetus was really just "a piece of tissue" and not really human life. Thus, there was nothing morally wrong with performing abortions early in pregnancy. Now would Mrs. Phelps please come into the room and assist him? When Mrs. Phelps declined, Dr. Graham stalked angrily down the hallway claiming it was a sad day for patients when nurses decided they would not provide needed care.

Commentary

The question of participation in an abortion inevitably raises questions about the morality of abortion itself, including the surrounding issues of when life begins and the supposed right to life. These are the issues usually contained in any conflict over abortion. They are certainly present in this case, but there are other components as well.

It may seem, at first, that the ethical conflict in this case exists between the nurse and the physician: whether the nurse should "obey" the physician's request to assist in the abortion. But the issue is really one of conflicting moral rules that direct professional acts. Although it is not obvious, Dr. Graham is responding to his patient's request for an abortion out of a Hippocratic emphasis on benefiting the patient and, in this case, a calculation of the greatest benefit, on balance, to everyone concerned with the pregnancy. The unmarried teenager will benefit by not having an unwanted child at this stage of her life. Society will benefit by not having to support another person at public expense. On balance, the benefits of aborting the teenager's unwanted pregnancy are greater than any perceived harms to the patient, according to Dr. Graham.

Mrs. Phelps, however, is not responding to the situation solely out of a benefit-producing principle. She is responding out of a personal value structure influenced by religious belief, which claims that life begins at conception, the fetus is human life, and the destruction of human life is murder and therefore a sin. Thus, abortion where the life of the mother is not in question is an unspeakable crime that the devout Catholic cannot participate in or support. She may, in fact, agree that Dr. Graham is correct in his assessment of the amount of benefit to be produced by aborting this pregnancy. However, the mere production of benefit does not make abortion right, according to her religious beliefs and personal values. She may even believe that, as a professional, she should act in the interests of a patient's welfare in all circumstances. Yet she cannot do so, in good conscience, in the case of abortion. Her religious team has come to a conclusion on the issue of abortion that prohibits her participation in professional acts involving abortion.

Dr. Graham counters the nurse's objections by claiming that he does respect human life but that the fetus in this case is not human life, and therefore it is morally acceptable to abort the product of conception in this pregnancy. But for Mrs. Phelps, the act is still not right. In fact, it is irrelevant to Mrs. Phelps whether the age of the fetus is 8 weeks or 30 weeks. Fetal age is simply not important in the face of a personal belief that all fetal life is of value and should not be aborted.

We can well imagine how fervently Mrs. Phelps hopes that the nursing manager will soon send another nurse to assist Dr. Graham. Even though she agrees with the physician and the professional patient-benefiting ethic with respect to all other aspects of health care, deciding not to assist Dr. Graham in this procedure on the basis of religious-team-directed moral rules has placed her in a very uncomfortable position. The difference between her choice of nonparticipation in the act of abortion and participation in other healthcare acts for the benefit of patients lies within the strength of the moral rule generated and supported by religious beliefs. Whether the abortion will or should be performed, with or without Mrs. Phelps's assistance, is not the important question. What is important is: On what basis and to what extent do personal values and beliefs and preservation of the nurse's integrity influence professional acts in routine nursing care?

 

1. Individually Reflect on the case and the commentary. Write down your initial thoughts/reactions.
2. Determine who is involved in the case. Name all the parties and their relationship to the patient.
3. Describe the issue. What exactly is the problem or issue to be solved?
4. Assess the situation. What is the team's "perceptions" and reflections on the situation - in short form?
5. Clarify values. What Ethical Values are involved in this story?
6. Identify ethical principles involved in the case. You can use all your reading and resources to name them.
7. Clarify legal rules. Are there any laws involved in this story?
8. Explore options and alternatives. What are some of the options to solving this problem?
9. Decide the course of action. As a team, come to a consensus on the course of action from your list in #8.