Is It Permissible to Conscientiously Object to Offer Care to a Criminal?

Is it permissible to conscientiously object to offer care to a criminal? This question is a remainder of the professional conflict that nurses face on a regular basis in their practice. The ethical dilemma arises from the need to feel that every patient should be worthy of the good intentions of the practice in the delivery of care. However, the very definition of professional nursing mandates that we put first the well- being of patients by preventing injury and illness to relieve any suffering, regardless of the patient’s status in the society.  The following paper critically analyses the ethical dilemma faced by nurses as to whether they should deliver care to criminals. The paper contends that it is appropriate for nurses to be judgmental to patients based on their status in the society and as such, establishes that nurses ought to be nonjudgmental when faced with this ethical dilemma.

                  Nurses and other healthcare providers readily admit facing troubles when they come into contact with patients that trigger moral judgments.  Social scientists acknowledge that morally judging patients is pervasive, and occurs not only in criminal cases but also in daily circumstances where the patients’ culpability and social worth are questionable. However, there are four primary ethical principles that underpin the healthcare practice, which nurses should abide by when encountering criminal patients; beneficence, non-maleficence, justice, and respect for autonomy. Besides, it is imperative for nurses to fully comprehend the ethical framework involved in the delivery of care, in order to offer the best quality care.

        To be able to see how these principles apply, let us assume the following fictitious case study. A post-surgery of an appendicitis is admitted to my inpatient ward during my night shift. Feeling that he is just an ordinary patient in need of care, I assure him he will get the same quality care I usually give all my patients. Later on, I recognize that the patient was on last evening news as having been released from jail after spending 20 years for double homicide charges. Subsequently, the dilemma becomes if I should offer or rather apply the same quality care and treatment I had assured him some hours before the discovery of his criminal history, or will some bias manifest itself in my care?

                  This is an ethical dilemma that most nurses and healthcare providers face on a daily basis. The principle of beneficence, however, dictates that nurses ought to act in a professional manner that ensures that the patients' safety is put first. In the above case study, I would take into account the patient's point of view, particularly if I decide not to offer the quality care and treatment that I had assured him. I will examine some of the risks that I will pose to him both in the short-term and long-term.  For instance, in the short-term, failure to offer the patient care will cause him to have a bad perception of the nursing practice thereby causing him to have difficulty in seeking medication (Stensland & Sanders, 2016). In the long-run, this may cause him further complication. Thus, in order to act in the best interest of the patient, I will have to make decisions that go against the negative attributes of the treating the patient as well as the failure to respect the autonomy of the patient, so as to deliver quality care.

            The principle of justice, on the other end, dictates that nurses have an obligation to treat everyone fairly regardless of their background. Essentially, this principle postulates that nurses are obligated to be impartial when administering care to their patient whether or not they are morally upright. The ethical dilemma that stems from this circumstance is that some nurses may feel that it is not worthy to treat a criminal patient as they may continue with their criminal activities soon after they regain their health. The law is very explicit; every individual has the right to access treatment. Thus, it is imperative to legally and morally respect the rights of the patient as put forward by the law (Epstein & Turner, 2015). Furthermore, the nursing practice is not the jury to decide if a patient with a criminal history or a patient who is a criminal is guilty of an offense. There are institutions that have been setup to administer justice if the need arises. As such, nurses should remain within their roles; the delivery of quality care to patients.

              The principle of non-maleficence dictates that nurses should not do any harm to patients. Conscientiously objecting to deliver care to a patient with a criminal history violates this principle which further violates the whole purpose of nursing practice. It is worth noting that denying after care to a post-surgery patient may result in the death of the patient thereby greatly harming the patient. Hence, such a situation calls for the delivery of care as an unfair breach of the Human Right Act 1998 may also result in a legal charge of negligence as well as professional misconduct (Epstein & Turner, 2015). Subsequently, this may also be detrimental to the image of the hospital. Other than harming the patient, the principle of non-maleficence encompasses other several moral rules including; not causing any pain and suffering to the patient, not incapacitating the patient, and not depriving patients the good of life.  Respect for autonomy, on the other end, suggests that nurses should familiarize themselves with the needs of their patients such that they make appropriate decisions. This means that just because the patient has been previously incarcerated, they affirm to prison culture. Making such personal judgments also infringes on the nursing code of ethics. Respect for autonomy is therefore not only an ideal in the practice but a professional obligation that ought to be upheld.

                      Apart from the above-mentioned ethical principles,   nurses have the duty to respect the confidentiality or privacy of the patient and as such, should not escalate vital information.  According to the Health Information Accountability Act, patients are entitled to the constitutional right of privacy with regards to their personal information. In other words, just because an individual has a criminal history, he or she should not be denied care and treatment as this information is private meaning it should not even be discussed openly. Unfortunately, the nurses and the medical community as a whole sometimes overlook these rights primarily due to the stigma that is associated with certain patients.

              It is also essential for nurses to maintain integrity and professionalism when executing their duties.  They must uphold and preserve the dignity that comes with the practice, and they must not work in ways that violate the dignity and honor of the profession. Denying treatment to a patient with criminal background degrades and violates the honor and dignity attached to the profession (McCarthy & Gastmans, 2015). The American Nurses Association further recommends that nurses should refuse to compromise professionalism. As noted, the priority of nurses should be shifted towards offering care to patients and set aside any prejudice arising from the situation of the patient.

                 The whole aim of nursing as a profession is to treat, take care of the sick, and ensure that the welfare and health of the patient are maintained until their demise. Nursing ethics, therefore, plays an integral role in the manner in which care and treatment are administered to patients with criminal histories. Thus, because of the nursing profession moral values of caring and treating the sick, nurses are obligated to face immensely challenging roles while administering care, which may take a toll on them both personally and professionally. Furthermore, nurses should uphold the Nightingale Pledge which they have sworn that proclaims that they will remain true to the profession and maintain the standards of the profession.

                      In summary, criminal patients also deserve quality care and treatment that is offered to their non-criminal counterparts. Nurses ought to abide by the ethical and moral principles that govern the profession. The principle of justice stipulates that regardless of the patient background, he or she should be accorded quality care and treatment. Furthermore, there are institutions that have been setup to administer justice if the need arises. As such, nurses should remain within their roles; the delivery of quality care to patients. Besides, from an ethical perspective, morality mandates patients should not only be treated autonomously, but we should also ensure that their welfare is fully catered for. All these beneficial actions fall under the principle of beneficence. Failing to offer care to a criminal may also damage the image of the hospital as it may result in lawsuits on grounds of negligence. Nurses have the duty to also respect the confidentiality or privacy of the patient and as such, should not worsen vital information.   The Health Information Accountability Act postulates that patients are entitled to the constitutional right of privacy with regards to their personal information. In other words, just because an individual has a criminal history, he or she should not be denied care and treatment as this information is private meaning it should not even be discussed openly.

              Ultimately, it is also crucial for nurses to uphold integrity and competence when executing their duties.  They must maintain and preserve the poise that comes with the practice, and they must not work in ways that infringe the dignity and honor of the practice. Refusing to offer treatment to a patient with criminal background degrades and violates the honor and dignity attached to the profession. The American Nurses Association further recommends that nurses should refuse to compromise professionalism. As noted, the priority of nurses should be shifted towards offering care to patients and set aside any prejudice arising from the situation of the patient.

References

Epstein, B., & Turner, M. (2015). The nursing code of ethics: Its value, its history. OJIN: The Online Journal of Issues in Nursing, 20(2).

McCarthy, J., & Gastmans, C. (2015). Moral distress: A review of the argument-based nursing ethics literature. Nursing Ethics, 22(1), 131-152.

Stensland, M., & Sanders, S. (2016). Detained and dying: ethical issues surrounding care and treatment delivery in prison. Journal of social work in end-of-life & palliative care, 12(3), 259-276.