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We get "off service" drug overdose clients who routinely take pills and call the ambulance. They are often verbally abusive, physically aggressive and require much nursing attention. Their lifestyle offends my values. Could I refuse to care for them on moral grounds?
A nurse's refusal to care for a client on moral grounds has major ethical, professional and legal implications. It is an issue that is seldom openly discussed in professional literature, perhaps partly because the underlying concerns are reasonably complex.
It is difficult to explore complex concerns in brief journal articles. However, this issue is sometimes discussed informally by nurses. In honesty, many of us may admit to having debated, at least with ourselves, whether an individual was worthy of our care. Clients who seem to have carelessly or deliberately created a situation that leads to a need for health care may have given us pause. Perhaps those who have committed socially deplorable or criminal acts have caused us difficulty. What about those who don't seems grateful for all our efforts, or "revolving door" repeaters, or those who make treatment decisions with which we don't agree?
Nurses may think about refusing to care for clients for many reasons. Refusing to care for clients on moral grounds is a major decision requiring ethical and professional justification. Is this nurse's reluctance to care a genuine refusal on moral grounds, or might it represent something else? If we were working as a colleague or supervisor of this questioning nurse, how might we assess the claim's appropriateness?
Ethical reflection requires that we critically consider the knowledge, values, and beliefs that underlie our moral judgments of "right" or "wrong." In looking at sound justifications for refusal on moral grounds, it seems wise to first consider other possible reasons behind this nurse's potential refusal to care. For example, this nurse may not want to care for the client because of lack of knowledge or skill. The situation as described undoubtedly brings questions about practice issues to our minds. Each of those issues has a moral component. This nurse's question may be only the tip of a practice iceberg. Reduced time constraints, being short-staffed, having to deal with care situations such as "off service" clients without an...