Catholic Nursing Questions: Medical Ethics

[dcs6f4]

I will be starting a job as a Staff Nurse at a Pediatric ICU after graduation this Spring. Obviously, many ethical issues come up in this environment, especially since it is not a Catholic Hospital. I have been doing a lot of extra studying on my own and have a few publications from the NCBC.

I feel like I have a decent handle on the majority of the issues I will encounter. However, something that is not addressed is the issue of caring for patients who have previously received medical ‘care’ that is objectively immoral. For example, if a child were to have a feeding tube removed in a situation that is not in accord with Church teaching, obviously the child would not immediately die. However, what if my employer asks me to care for this patient while they are deprived of nutrition and hydration? Am I obligated to refuse or can I care for a child in this state? (obviously it would not be the most intelligent patient assignment by management since they will be aware of my religious beliefs, but still possible).

Are there any Catholic nurses on here who would be willing to help answer questions I have?

 

[white_sheep]

You’re unlikely to encounter many such situations, but it is good to be prepared for them. I would think you aren’t allowed to removed the feeding tube in most cases, but whether you could provide care for them after that I am not sure. Probably so.

 

[Schluns]

Remember, you are the patients advocate. So, you should not turn away from the patients needs, but advocate for the patients comfort. Every decision is individual. In the example you give for the feeding tube. If your patient is suffering from organ shutdown (actively dying) then continuing tube feedings is more detrimental than continuation, if the gut is not working, then the patient becomes at risk for bloating, aspiration, perforation. However, in the case that this is not happening, then tube feedings should be continued, and you should advocate for this, trust me the parents will develop a bond with you and even ask your opinion, your responsibility is knowing when you should give it and when you should withhold it.

 

[Rence]

I will be starting a job as a Staff Nurse at a Pediatric ICU after graduation this Spring.

Congratulations!!!

Obviously, many ethical issues come up in this environment, especially since it is not a Catholic Hospital. I have been doing a lot of extra studying on my own and have a few publications from the NCBC.

I feel like I have a decent handle on the majority of the issues I will encounter. However, something that is not addressed is the issue of caring for patients who have previously received medical ‘care’ that is objectively immoral. For example, if a child were to have a feeding tube removed in a situation that is not in accord with Church teaching, obviously the child would not immediately die. However, what if my employer asks me to care for this patient while they are deprived of nutrition and hydration? Am I obligated to refuse or can I care for a child in this state? (obviously it would not be the most intelligent patient assignment by management since they will be aware of my religious beliefs, but still possible).

Are there any Catholic nurses on here who would be willing to help answer questions I have?

You should, of course, still provide care for your patient. You are not required to remove the tube if it conflicts with your conscience (but as the above poster mentioned, removing a feeding tube is not always a bad thing for a patient, especially one who is dying and can’t process food or fluids anymore). In fact, you’re not required to do anything that conflicts with your conscience, unless it’s a life and death emergency, and removing a feeding tube is not a life and death emergency… But you are still required to care for the patient. There is no reason in the world to stop caring for your patient. Continuing nursing care, even after something has been done by someone else that you are in conflict with, is not against Church teaching. This is when your patient needs you to continue care and provide comfort.

What other questions do you have?

Have you seen the directives for heathcare workers that the US Bishops have put together? nccbuscc.org/bishops/directives.shtml

 

[LemonAndLime]

You need to continue to care for patients despite what you think about the moral situation.

I would consider it immoral for you to refuse to care for a patient no matter the circumstances. You are not a doctor. You are a nurse. You will not be making many of these decisions. If you feel that you are asked to do something which is beyond your ability you are duty-bound to recognise this and pass this on to someone else. What would happen if a patient you feel you are morally unable to care for asks for your help? Would you refuse to help them because you think you are above the care you are duty-bound to give?

These are difficult questions, I myself am a student nurse. However, if you find yourself unable to work in the way you are supposed to, you should leave and find a new job. It is unfair both on you and the rest of the ward if you are going to refuse to carry out many tasks based on your beliefs.

But congratulations anyway on your new job.

 

[Big_Dummy]

Don’t be affraid to pray for the patient and family openly while caring in such a situation.

even an atheist, will think it is nice you care.

 

[dcs6f4]

Remember, you are the patients advocate. So, you should not turn away from the patients needs, but advocate for the patients comfort. Every decision is individual. In the example you give for the feeding tube. If your patient is suffering from organ shutdown (actively dying) then continuing tube feedings is more detrimental than continuation, if the gut is not working, then the patient becomes at risk for bloating, aspiration, perforation. However, in the case that this is not happening, then tube feedings should be continued, and you should advocate for this, trust me the parents will develop a bond with you and even ask your opinion, your responsibility is knowing when you should give it and when you should withhold it.

Thanks for the answer Schluns and I of course realize that as the patient’s advocate we should always be there to advocate for their comfort. I definitely understand that the removal of feeding tubes is at times the right thing to do for a patient. I suppose my question is about situations that may not be so ideal.

What if the parents/physicians do not agree with me and feel that removing a feeding tube is okay under any circumstances? If my attempts to advocate for a child no longer show any fruition… at what point do you have to ask to be removed from the situation? I am not talking about patient abandonment here… But having another nurse take over the care of the patient…? Obviously, my desire is to care for my dying patient and their family even if this patient is being denied nutrition and hydration unnecessarily.

For example, if you were Terri Schaivo’s nurse and the courts had ordered her feeding tube to be removed would you have made your case for her comfort, but then asked the doctor or another nurse to remove it and then continued caring for Terri until her death? Or would you at some point suggested that it might be better if you were not involved in her care anymore?

 

[dcs6f4]

You need to continue to care for patients despite what you think about the moral situation.

I would consider it immoral for you to refuse to care for a patient no matter the circumstances. You are not a doctor. You are a nurse. You will not be making many of these decisions. If you feel that you are asked to do something which is beyond your ability you are duty-bound to recognise this and pass this on to someone else. What would happen if a patient you feel you are morally unable to care for asks for your help? Would you refuse to help them because you think you are above the care you are duty-bound to give?

These are difficult questions, I myself am a student nurse. However, if you find yourself unable to work in the way you are supposed to, you should leave and find a new job. It is unfair both on you and the rest of the ward if you are going to refuse to carry out many tasks based on your beliefs.

But congratulations anyway on your new job.

Thanks for the reply… I do have a few issues with it though. You said, “What would happen if a patient you feel you are morally unable to care for asks for your help? Would you refuse to help them because you think you are above the care you are duty-bound to give?” There is no black and white answer to this question and I feel you are hinting that there is. Of course I want to help everyone I can and it is a little abrasive to suggest I might think I am “above the care” of any person.

For example, if a patient or a patient’s family asks me to kill them I am going to refuse that. Certain forms of euthanasia are legal in the United States… this does not mean it is right… this also does not mean I shouldn’t be a nurse because I refuse to euthanize people. I have the legal right and the moral duty to not kill my patients. Patients have been killed legally in the US before.

There are very few tasks I am not going to be able to carry out. I may never run into a single situation where I feel I can’t care for the patient. The question of whether I am a doctor or a nurse is kind of irrelevant here. My situation is not unfair to the patients or anyone who works on my unit. Again, thank you for your reply I really do appreciate it.

 

[dcs6f4]

Congratulations!!!

You should, of course, still provide care for your patient. You are not required to remove the tube if it conflicts with your conscience (but as the above poster mentioned, removing a feeding tube is not always a bad thing for a patient, especially one who is dying and can’t process food or fluids anymore). In fact, you’re not required to do anything that conflicts with your conscience, unless it’s a life and death emergency, and removing a feeding tube is not a life and death emergency… But you are still required to care for the patient. There is no reason in the world to stop caring for your patient. Continuing nursing care, even after something has been done by someone else that you are in conflict with, is not against Church teaching. This is when your patient needs you to continue care and provide comfort.

What other questions do you have?

Have you seen the directives for heathcare workers that the US Bishops have put together? nccbuscc.org/bishops/directives.shtml

Thanks! I definitely relate to your answer. I guess the question still remains that if my feelings on the topic are clear and there are other nurses available to what extent am I cooperating with evil? Don’t we have an obligation to remove ourselves from this cooperation with evil? I am really just trying to explore the issue here before I get started! So thanks for your reply I appreciate it. And thank you for the link. I do have the directives in NCBC’s Catholic Health Care Ethics: A Manual for Practitioners.

 

[dcs6f4]

Don’t be affraid to pray for the patient and family openly while caring in such a situation.

even an atheist, will think it is nice you care.

Thanks, I will be sure to pray openly for all my patients when the opportunity presents itself. That is some helpful (name removed by moderator)ut.

 

[Rence]

Thanks! I definitely relate to your answer. I guess the question still remains that if my feelings on the topic are clear and there are other nurses available to what extent am I cooperating with evil? Don’t we have an obligation to remove ourselves from this cooperation with evil? I am really just trying to explore the issue here before I get started! So thanks for your reply I appreciate it. And thank you for the link. I do have the directives in NCBC’s Catholic Health Care Ethics: A Manual for Practitioners.

Well, as long as you’re advocating for your patient, you’re not cooperating with evil. As a nurse, there’s only so much you can do. You don’t diagnose and prescribe treatment. You carry out orders and perform nursing functions (related to nursing diagnosis and implementation). Removing yourself from cooperating with evil doesn’t necessarily mean removing yourself from your patient, because someone has to still take care of that patient.

An example I can give is say that the doctor is not acting (in your opinion) in the best interest of the patient, and though you try to fight for the patient, and even suggest that the family maybe transfer him to another hospital…if they don’t, and if the poor care continues, you’re not participating in that poor care by continuing to care and comfort your patient. You’re providing the best you can for the patient. See what I mean? For your example of Terri Schiavo, many of her nurses advocated for her, until her tube was removed. Then they continued to care for her, and comfort her, until her last breath. Those nurses who stuck by her until the end were certainly not guilty of participating in her death. They took care of her. I guess I can compare it to being stuck in an elevator with two people, and one of them fatally shoots the other. Well, you didn’t shoot the second person, and if you take care of that person while they’re dying from that gunshot wound, you’re not cooperating in the evil that brought on his death. You’re picking up the pieces so to speak. Does that make sense?

However, if you are uncomfortable with a situation, I think it would always be okay to ask for a reassignment and remove yourself from the situation. I just want you to know that you’re not evil by caring for that patient, despite the fact that they may be getting care that you don’t agree with. I’ve not been a nurse for a long time, but I’ve worked in various situations in healthcare, and I’ve not seen a problem with asking for a switch – unless there was a staffing issue. If there is a staffing issue, and you can’t find a replacement, you know that you have to take care of your patient, and if you don’t, you can lose your job for patient abandonment and even your license. That patient still requires nursing care, and if you’re assigned the patient, he or she is yours until you can find a replacement. Again, it shouldn’t be a problem. Most nurses are happy to help. But it may not always be possible to just switch…

 

[vera_dicere]

If there’s one thing i’ve learnt, its not to judge the morality of the situation unless you know the whole story. As another has said, maybe a tube is coming out becuase the person is in the final stages of life and their ability to process food has ceased.

There’s no reason why you can’t care for a patient in their terminal stage, with or without a feeding tube, especially if it wasn’t your decision to remove it, or you didn’t remove it. I’ve cared for paedophiles to women who’ve had multiple abortions. At those stages the crimes had already been committed a long time before I met them.

I can’t quite see you coming up against such issues every day, probably not even one a year, but if you feel you’re in a situation wheere you can’t justifiy it, then simply handover teh patient to another - and you dont’ have to make a fuss about it, a simple “I don’t think i can adequately care for this patient due to personal reasons”. That could mean anything from a moral standpoint to you actually know them. I told my boss that once because the patient was my neighbour, she didn’t push me further for reasons but it came out eventually when the patient saw me walk passed his room.

 

[manualman]

… You said, “What would happen if a patient you feel you are morally unable to care for asks for your help? Would you refuse to help them because you think you are above the care you are duty-bound to give?” There is no black and white answer to this question and I feel you are hinting that there is. Of course I want to help everyone I can and it is a little abrasive to suggest I might think I am “above the care” of any person.

I would have taken more umbrage at this post than you, but I suspect this is not the last you will hear of this sentiment in your career. Here in Illinois, pharmacists are told to seek other kinds of employment by the government if they cannot in good conscience fill contraception or abortion ‘morning after’ drugs. Technically, they ARE allowed to open their own pharmacy and not offer those drugs, but that means being Walmart and CVS’s competitor: good luck pal.

Sadly, we live in a culture where more and more abhorrent things are being considered “health care rights.” You can still help people in need who choose those things, but avoid participating in the evil activities themselves. Tricky road to maneuver and I wish you well.

 

[rdscheirer]

LemonandLime-“you are not a Doctor” is upsetting to me as I am a Doctor and Surgeon who often, usually always relies on the Nurse to let me know what’s going on with my patient. I operate on them and see them for 15-20 minutes on rounds 'cause I have to go to the OR. The Nurse is with them for 8 hours or 12 depending on shifts- so the Nurse learns much mor about the patient, family and situation than I can in seeing the patient for an hour in my office pre-op.

 

[dcs6f4]

Well, as long as you’re advocating for your patient, you’re not cooperating with evil. As a nurse, there’s only so much you can do. You don’t diagnose and prescribe treatment. You carry out orders and perform nursing functions (related to nursing diagnosis and implementation). Removing yourself from cooperating with evil doesn’t necessarily mean removing yourself from your patient, because someone has to still take care of that patient.

An example I can give is say that the doctor is not acting (in your opinion) in the best interest of the patient, and though you try to fight for the patient, and even suggest that the family maybe transfer him to another hospital…if they don’t, and if the poor care continues, you’re not participating in that poor care by continuing to care and comfort your patient. You’re providing the best you can for the patient. See what I mean? For your example of Terri Schiavo, many of her nurses advocated for her, until her tube was removed. Then they continued to care for her, and comfort her, until her last breath. Those nurses who stuck by her until the end were certainly not guilty of participating in her death. They took care of her. I guess I can compare it to being stuck in an elevator with two people, and one of them fatally shoots the other. Well, you didn’t shoot the second person, and if you take care of that person while they’re dying from that gunshot wound, you’re not cooperating in the evil that brought on his death. You’re picking up the pieces so to speak. Does that make sense?

However, if you are uncomfortable with a situation, I think it would always be okay to ask for a reassignment and remove yourself from the situation. I just want you to know that you’re not evil by caring for that patient, despite the fact that they may be getting care that you don’t agree with. I’ve not been a nurse for a long time, but I’ve worked in various situations in healthcare, and I’ve not seen a problem with asking for a switch – unless there was a staffing issue. If there is a staffing issue, and you can’t find a replacement, you know that you have to take care of your patient, and if you don’t, you can lose your job for patient abandonment and even your license. That patient still requires nursing care, and if you’re assigned the patient, he or she is yours until you can find a replacement. Again, it shouldn’t be a problem. Most nurses are happy to help. But it may not always be possible to just switch…

Great post. This does make sense to me. Thanks Again.

 

[dcs6f4]

I would have taken more umbrage at this post than you, but I suspect this is not the last you will hear of this sentiment in your career. Here in Illinois, pharmacists are told to seek other kinds of employment by the government if they cannot in good conscience fill contraception or abortion ‘morning after’ drugs. Technically, they ARE allowed to open their own pharmacy and not offer those drugs, but that means being Walmart and CVS’s competitor: good luck pal.

Sadly, we live in a culture where more and more abhorrent things are being considered “health care rights.” You can still help people in need who choose those things, but avoid participating in the evil activities themselves. Tricky road to maneuver and I wish you well.

Doing my best to prep for the sticky road! I do not envy the position of the pharmacists, but I am certain Catholics belong in health care in this country. I am sure you are too.

 

[albertnices]

Its nice one post provides a lots of data on to the topic so keep writing such things and keep it up.