Kari was a registered nurse for almost 25 years. She spent most if those years in the operating room.
A moral objection is a disagreement based on an individual's beliefs concerning what is right and what is wrong. Unlike religious objections, moral objections vary from individual to individual. One person may have a moral objection to something, but another may have no problem with it. Our beliefs on right and wrong are very individualized.
Our morals are founded in our upbringing, life experiences, and societal norms. While we may have some morals in common with other people, we also may have some morals that are our own.
Moral: A person's standards of behavior or beliefs concerning what is and is not acceptable for them to do.
Example: 2017 Rules on Preventive Care
President Donald Trump, on May 4, 2017, issued an Executive Order "Promoting Free Speech and Religious Liberty." In this document, he requested that the Secretary of the Treasury, the Secretary of Labor, and the Secretary of Health and Human Services review and amend the preventive care mandate found in section 300gg-13(a)(4) of title 42, United States Code. The suggested amendment would change the code to include "conscience-based objections." (Conscience-based objections is another way of saying moral objections.)
On October 6, 2017, the Departments of Health and Human Services, Treasury, and Labor put forth amended rules for preventive services that obligate employers to pay for approved contraception medication and devices, abortifacients, and sterilization procedures. In these new rules, companies with sincere religious beliefs against contraception, abortifacients, and/or sterilization procedures are exempt from having to pay for insurance to cover these things.
But President Trump not only exempted companies with religious beliefs against these things, he also exempted companies who have a moral objection to these services. The moral objection does not have to be based on any type of religious belief.
The Slippery Slope
I believe that including moral objections may be a slippery slope. What if someone has a moral objection to spending money on employees? They may have a very strong moral objection. This company may have a history of low pay and OSHA-related fines. These actions would be congruent with their objection to spending money on their employees. Would their strong moral objection be cause for them not to pay for preventive services?
Brief History of Moral Objection in the USA
The beginning of moral objections in the USA government involved the military draft. Some people had religious and moral objections to war. When considering these objections, the federal government ensures there is a deeply held conviction against all war, not just an objection to the current war.
The objector may object to any type of combat position. These will be given a civil job that supports the war effort. Other objectors may object to the killing of individuals. These will be put into non-combatant posts such as medic.
How Does the Federal Government Define Moral Objection?
In United States v. Seeger 380 U.S. 163 (1965), it was stated, "A person can have conscientious objector status based on a belief that has a similar position in that person's life to the belief in God." This ruling allowed people to have a moral objection not based on religion.
This does not really address how to determine if someone has a moral objection to being made to provide employees with contraceptives and abortifacients.
How California Distinguishes Moral Objection From Personal Preference
The State of California Employment Development Department uses three guidelines to determine if an objection is on moral grounds or just personal preference.
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The first question they ask is, "Does the claimant contend that working under the objectionable conditions would conflict with his or her basic convictions or is the restriction based primarily on other personal reasons?"
For this question they give an example of a man who is offered a job selling tickets at an adult theater. His wife does not want him to take this job. Since the objection is his wife's this would not count as a moral objection. If he, himself, felt that pornography was vile, the objection would be a moral one.
The second question is, "Is the claimant’s conduct consistent with his or her alleged beliefs?"
They use the example of a man offered a job in a casino. The man states he has a moral objection to gambling. However, this same man buys a lottery ticket every week. The incongruity between the man's statement and the man's habits brings his moral objection into question.
The third question is, "Does the claimant belong to or support any organization which advocates or opposes the principles upon which his or her restriction is based?"
The person's relationship with a group who supports his/her objection gives more weight to the argument of moral objection. However, the person does not need to belong to any organizations.
Nursing and Moral Objections
Nursing has a history of determining if there is a moral objection or just a personal preference. The American Nursing Association (ANA) maintains the "Code of Ethics for Nurses With Interpretive Statements". This code of ethics guides nurses in a variety of settings. Provision 5.3 is about preservation of integrity. It states, "Conscious-based refusals to participate exclude personal preference, prejudice, bias, convenience or arbitrariness."
Moral objections must have certain characteristics:
- Is the Objection a Serious Violation of Deeply Held Convictions?
- Is There a Plausible Rationale?
- Is it a Treatment Considered Essential to Your Work?
- Does it Cause Undue Burden to Patients?
- Does it Cause Undue Burden to Colleagues and Health Care Institutions?
- Does it Support Nurse and Physician Values?
These characteristics help to define if the objection has a moral rational versus a rational of convenience. Nurses have to consider the patient in all moral objections. The patient is a nurse's primary concern. Once care of a patient is accepted, the nurse may not abandon the patient until other nursing care is provided for.
Is the Objection a Serious Violation of Deeply Held Convictions?
One of nursing's main responsibilities is nonmaleficence (to first do no harm). All actions by a nurse must be for the patient's benefit, not harm. A nurse may believe that euthanasia (assisted suicide) goes against the responsibility of nonmaleficence. The nurse has a deeply held conviction that assisted suicide harms the patient. This nurse would have a moral objection to euthanasia.
Is There a Plausible Rationale?
The nurse with a moral objection to euthanasia has a plausible rationale. Assisted suicide is helping patients kill themselves. This nurse is against killing the patient. This is a plausible rationale.
Is It a Treatment Considered Essential to Your Work?
Assisted suicide is not a function in all types of nursing. The nurse with a moral objection to euthanasia could not work in hospice where this action may be required.
If a nurse has a moral objection to working with patients who have AIDS, she should find another profession. Patients with AIDS are found in all types of nursing care and care for these patients is essential to being a nurse.
Does It Cause Undue Burden to Patients?
Would the nurse with a moral objection cause undue burden on the patient. It depends on how long the patient's treatment is held up to find another nurse. Will the patient die? Will there be another nurse to accept the assignment without holding up the treatment unduly? Will there be extra expense for the patient due to the hold up?
These are all questions that the nurse needs to answer. The nurse's first responsibility is to the patient. At times the nurse may need to compromise.
Does It Cause Undue Burden to Colleagues and Health Care Institutions?
Going back to the nurse who states she has a moral objection to working with AIDS patient. This may cause undue burden to both colleagues and institutions. Say a unit is 100% full and 70% have AIDS, it would be impossible to comply with an objection to caring for AIDS patients. This nurse would need to be sent home and another nurse would have to come in her place. This causes undue burden on both colleagues and facility.
Does It Support Nurse and Physician Values?
Nurses may have moral objections to helping perform abortions. They think abortion is killing. Killing goes against all of nursing's main values. They would have grounds for a moral objection.
Does It Uphold Nursing Standards?
If the moral objection is one that upholds nursing standards, it will have more weight. Moral objections to killing or harming patients uphold many nursing standards. These moral objections are just.
The Federal Government Needs Some Guidelines
Hopefully, as companies start to object to paying for the preventive services mentioned, the federal government will have criteria for determining if the objection is personal preference or true moral objection. Using the combination of California state law and nursing ethics I have come up with some criteria I feel the federal government can use in these situations.
Possible Criteria for Moral Objections to Preventive Services
- It must be a serious violation of a deeply held conviction.
- It must be congruent with the person's actions.
- It must not cause undue burden to the employees.
- It must exclude personal preference, prejudice, bias, convenience and/or arbitrariness.
American Nursing Association. Code of Ethics for Nurses With Interpretive Statements. (2015) Accessed on 10/11/2017 at http://nursingworld.org/DocumentVault/Ethics-1/Code-of-Ethics-for-Nurses.html
Free Dictionary, The. Conscientious Objector. Access on 10/12/2017 at http://legal-dictionary.thefreedictionary.com/Conscientious+Objector
Lachman, V. D. Conscientious Objection in Nursing: Definition and Criteria for Acceptance. (May-June 2014; MedSurg Nursing Vol. 23/No. 3) Accessed on 10/11/2017 at http://www.nursingworld.org/MainMenuCategories/ EthicsStandards/Resources/ Conscientious-Objection-in-Nursing.pdf
Marshall, C. The Spread of Conscience Clause Legislation. Human Rights (2013 Vol. 39/No. 2) Accessed on 10/12/2017 at https://www.americanbar.org/ publications/human_rights_magazine_home/2013_vol_39/january_2013_no_2_religious_freedom/the_spread_of_conscience_clause_legislation.html
Newseum Institute. Has the U.S. Supreme Court Defined "Religion?". Accessed on 10/12/2017 at http://www.newseuminstitute.org/about/faq/has-the-u-s-supreme-court-defined-religion/
Selective Service System. Conscientious Objection and Alternative Service. Accessed on 10/12/2017 at https://www.sss.gov/consobj
State of California Employment Development Department. (2017) Accessed on 10/11/2017 at http://www.edd.ca.gov/UIBDG/Able_and_Available_AA_90.htm
This content reflects the personal opinions of the author. It is accurate and true to the best of the author’s knowledge and should not be substituted for impartial fact or advice in legal, political, or personal matters.