New Northern Ireland abortion law ‘may give health staff no choice’

Midwife voices fear for conscientious objectors if NI legislation changes

Belfast Telegraph

Allan Preston

Health workers in Northern Ireland could be left “exposed” by changes to abortion law, a lecturer in midwifery has claimed.

Debbie Duncan spent over 30 years working as a midwife in Scotland and England and now lectures at the school of nursing and midwifery at Queen’s University Belfast.

She was never obliged to take part in abortions during her career as the law allowed her to conscientiously object.

Ms Duncan said she fears “too much change with no regulation” means the same protections may not apply here. . . [Full text]

The Role of Nurses When Patients Decide to End Their Lives

Some hospitals and hospices have policies that forbid nurses to be part of the process or even to discuss end-of-life options.

New York Times

Emilie Le Beau Lucchesi

When Ben Wald, 75, was dying of cancer in 2012, he wanted to use Oregon’s Death with Dignity Act to receive a prescription for a lethal medication that would end his life. His hospice nurse, Linda, was part of the discussion and provided both information and support, said his wife, Pam Wald, of Kings Valley, Ore.

His colon cancer had spread to his lungs, and his weight dropped from 180 to 118 pounds. He struggled to speak or eat.

When he was ready to end his life, the couple wanted Linda with them, but the hospice organization she worked for did not allow it, Mrs. Wald said. The organization allowed other hospice workers, such as social workers and massage therapists, to be present, but not the doctors or nurses it employed. . . [Full text]

OCR Issues Notice of Violation to the University of Vermont Medical Center After It Unlawfully Forced a Nurse to Assist in Abortion

News Release
For immediate release

US Department of Health and Human Services

Contact: HHS Press Office
202-690-6343
media@hhs.gov

The U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR) is announcing that, after a thorough investigation and prolonged attempts to resolve the matter, OCR has issued a Notice of Violation letter finding that the University of Vermont Medical Center (UVMMC) violated the Church Amendments (42 U.S.C. 300a-7) by forcing a nurse to assist in an elective abortion procedure over the nurse’s conscience-based objections. OCR also found that UVMMC has discriminatory policies that assign or require employees to assist abortion procedures even after they have recorded their religious or moral objections to assisting in the performance of such abortions. OCR’s Notice of Violation letter asks UVMMC to conform its policies to the Church Amendments and take other corrective action, or face potential action by the HHS component from which UVMMC has received federal funding.

On May 9, 2018, a nurse at UVMMC filed a conscience and religious discrimination complaint with OCR against UVMMC, a medical center in Burlington, Vermont that receives HHS funds, contending that the nurse was forced to assist an abortion in violation of the nurse’s conscience rights. As part of its investigation, OCR contacted UVMMC repeatedly in a good faith effort to seek cooperation from UVMMC, but the hospital refused to conform its policies to federal conscience laws, provide all the documents requested by OCR, or produce witnesses for OCR interviews. Nevertheless, OCR interviewed multiple witnesses and gathered evidence concerning the allegations.

As a result of its investigation, OCR has specifically determined that:

  • UVMMC forced the nurse complainant to assist in an abortion against the nurse’s religious or moral objection. The nurse had expressed an objection for many years and was included in a list of objectors, but UVMMC knowingly assigned the nurse to an abortion procedure. The nurse was not told the procedure was an abortion until the nurse walked into the room, when the doctor—knowing the nurse objected to assisting in abortions—told the nurse, “Don’t hate me.” The nurse again objected, and other staff were present who could have taken the nurse’s place, but the nurse was required to assist with the abortion anyway. If the nurse had not done so, the nurse reasonably feared UVMMC would fire or report the nurse to licensing authorities.
  • OCR spoke with several other UVMMC health care personnel who, since at least the spring of 2017, have been intentionally, unnecessarily, and knowingly scheduled by UVMMC to assist with elective abortions against their religious or moral objections. Such personnel were often not told in advance that the procedures they were being assigned to assist with were abortions. Health care personnel who are coerced in that way suffer moral injury, are subjected to a crisis of conscience, and frequently experience significant emotional distress, even if they succeed in declining to assist in the procedure after the assignment is made.
  • UVMMC maintains a staffing policy that facially violates the Church Amendments because the policy admits to circumstances where UVMMC can and will force staff—on pain of adverse action or discipline—to participate in abortions against their moral or religious objections. The policy also violates UVMMC’s agreement, as a condition of receiving HHS funds, to comply with federal law, including the Church Amendments and HHS’s grants regulations.
  • Consequently, UVMMC is violating 42 U.S.C. § 300a-7(c)(1) of the Church Amendments by discriminating against health-care personnel who have religious or moral objections to abortion, and subjecting them to different terms or conditions of employment than other health-care personnel.

In the Notice of Violation, OCR asks that UVMMC notify OCR within thirty days whether UVMMC intends to work collaboratively with OCR to change its policies so it no longer requires health care personnel to participate in abortion against their religious or moral objections, and to take immediate steps to remedy the effect of its past discriminatory conduct. Otherwise, OCR indicates that it will forward the Notice to the Health Resources and Services Administration (HRSA), a component of HHS that provides grant funds to UVMMC, for consideration and possible additional procedures concerning UVMMC’s receipt of federal funds.  Since October 1998, UVMMC has received—and continues to receive—grants from HRSA.  For the most recently completed three-year project period, which ended April 30, 2018, UVMMC reported that it cumulatively expended $1.6 million of federal financial assistance.

Roger Severino, Director of OCR said, “Forcing medical staff to assist in the taking of human life inflicts a moral injury on them that is not only unnecessary and wrong, it violates longstanding federal law. Our investigation has uncovered serious discrimination by UVMMC against nurses and staff who cannot, in good conscience, assist in elective abortions.”  Severino concluded, “We stand ready to assist UVMMC in changing its policies and procedures to respect conscience rights and remedy the effects of its discrimination.” 

OCR is charged with helping ensure entities come into compliance with federal laws protecting conscience and prohibiting coercion in health care, including the Church Amendments.

ACLJ Vindicates Rights of Vermont Nurse Who Was Unlawfully Forced to Participate in Abortion – HHS Threatens to Pull Medical Center Funding

American Center for Law and Justice

Reproduced with permission

Jay Sekulow*

The ACLJ applauds today’s announcement by the Office of Civil Rights (OCR) of the U.S. Department of Health and Human Services (HHS) regarding a Complaint we filed on behalf of a Vermont nurse who was forced into participating in an abortion procedure against her deeply held religious beliefs.

In our Complaint, we alleged that our client, an operating room nurse at the University of Vermont Medical Center (UVMMC) in Burlington, was coerced into assisting in an abortion in 2017 even though her name was on a list of nurses who, for religious or moral reasons, were conscientiously opposed to such participation and even though other non-objecting nurses were available who could easily have taken her place.

In the more than two decades of work that ACLJ has done to defend the rights of conscience of pro-life health care workers, this is by far the most outrageous case we’ve ever seen. Our client’s most fundamental beliefs about the sanctity of life were simply brushed aside.

Worse, her superiors deliberately misled her into thinking she was assisting in a procedure following a miscarriage. But once trapped inside the OR she discovered that it was, in fact, an elective abortion and that this had been known all along by her superiors who then callously refused to relieve her. To say that she was emotionally traumatized by this event is putting it mildly.

At least four other nurses at UVMMC have confirmed that they too have been subjected to similar violations of their conscience rights. We forwarded them to OCR as part of our Complaint. And after conducting its own thorough investigation of the matter, OCR has substantiated their allegations.

In its announcement, HHS finds that UVMMC has committed violations of the federal Church Amendment – the so-called “conscience clause” – named for the late liberal Idaho Democratic Senator Frank Church. The law was enacted in 1973 as a response to the Supreme Court’s legalization of abortion in Roe v. Wade. In general, it prohibits entities that receive federal funding from discriminating against employees who refuse to perform or assist in the performance of abortions because of their moral or religious beliefs.

But, because the Church Amendment has always lacked a mechanism for enforcement by private citizens, its enforcement has depended on action taken by HHS itself. In the decades since 1973, however, such enforcement has, for all intents and purposes, been nonexistent. With today’s announcement, HHS’s Office of Civil Rights has, at long last, put teeth in a law that has lain largely dormant since its enactment.

HHS has given UVMMC 30 days to come up with a policy that will ensure that the things that happened to our client, and others like her, will not happen again. If they fail to cooperate, they lose their federal funding.

This action by HHS is an enormous step forward toward the full protection of conscience rights of all those in the health care field who recognize the sanctity of all human life. The repercussions of today’s action will be felt in every hospital and health care system in the country.

No longer should pro-life health care professionals have to fear that their values – the values of protecting, not, destroying, life – make them somehow unfit or unsuitable for the healing profession. No nurses, doctors, or other health workers should ever be deliberately trapped in a room and forced to participate in something that their employer knows those workers consider abhorrent at the core of their being.

For over two decades the American Center for Law and Justice (ACLJ) has been at the forefront of advancing and defending the right of free speech and conscientious objection when it comes to the sanctity of human life. In addition to our work with legislators and public policy makers in Washington and around the country, we have also represented dozens of individuals – women and men on the front lines of the pro-life cause – who have found themselves discriminated against because of their pro-life stands. Doctors, nurses, pharmacists, and other health care workers – we’ve gone to court for them before judges and juries from Maine to Hawaii and most points in between.

The ACLJ very much welcomes HHS’s vigorous enforcement of federal conscience rights in this case. No health care worker should be forced to abandon their career because they refuse to abandon their pro-life convictions. If you are a healthcare worker and have experienced a similar situation, please contact us at ACLJ.org/HELP.

Over 1,300 nursing and midwifery posts in Irish hospitals are being left vacant

One in six midwifery posts are being left vacant.

thejournal.ie

Rónán Duffy

THERE ARE OVER 1,300 vacant nursing and midwifery posts in Irish hospitals due to the HSE’s effective recruitment freeze, the INMO has said today.

Phil Ní Sheaghdha of the Irish Nurses and Midwives Organisation has said the figures demonstrate that the government is “refusing to fill frontline healthcare posts” and that patient care is being compromise as a result. . . [Full text]

Study Reveals Alarming Statistics on Nurse Burnout

nurse.org

Chaunie Brusie

Healthcare market research and consulting company PCR recently announced the results of its National Nursing Engagement Report. The report was based on survey findings from over 2,000 healthcare partners and revealed key data about nurses in the workforce today, as well as what the future will hold for nurses and how hospital administrators can help support nurses going forward.

The Buzz on Nurse Burnout

One of the main focuses of the study was to examine how many nurses in the workplace today report feeling burned out. According to the report, 15.6% of all nurses reported feelings of burnout, with the percentage rising to 41% of “unengaged” nurses. . . . [Full text]

Indiana bill extends conscience protection to medical abrtions

Sean Murphy*

Indiana Senate Bill 201, proposed by Senator Liz Brown, has been amended in committee and is progressing through the Indiana General Assembly. Existing Indiana law protects freedom of conscience for physicians, nurses and institutional employees in relation to surgical abortion. Bill 201 amends the statute to include medical abortion and extends protection to physician assistants and pharmacists.

Medical Assistance in Dying (MAiD): Ten Things Leaders Need to Know

Rosanne Beuthin, Anne Bruce

Abstract

The provision of MAiD will be in flux for a few years, as legislative challenges are underway. This article addresses what leaders need to know and do to support nurses today and in the future regarding care of patients choosing MAiD. Drawing on complexity leadership theory and research into nurses’ experiences in caring for persons choosing MAiD, we share 10 simple yet foundational things a leader must know. Underpinning our key messages are current evidence and familiar nursing concepts such as end-of-life care, death trajectories, conscientious objection, scope of practice, ethics, sense-making and care cultures. These key messages are embedded in a framework of leadership practices where attention to inter-relationships, emergence and innovation are highlighted. They provide nurse leaders with concrete actions to inspire a team dynamic for creating inclusive cultures of quality care. Leadership is needed across healthcare settings where MAiD is being enacted.


Beuthin R, Bruce A. Medical Assistance in Dying (MAiD): Ten Things Leaders Need to Know. Nurs Leadersh (Tor Ont). 2018 Dec;31(4):74-81. doi: 10.12927/cjnl.2019.25753.

Nurses and Midwives for Life Ireland Letter to Irish Health Minister

Dear Mr. Harris,

We are dedicated, hardworking nurses and midwives who care for patients from conception to natural death. We have a conscientious commitment to life which accords with the values inherent in Our Code of Professional Conduct and Ethics. We respect and defend the dignity of every stage of human life and we have a responsibility to make every valid or reasonable effort to protect the life and health of pregnant women and their unborn babies.

We are extremely concerned that the Health (Regulation of Termination of Pregnancy) Bill 2018, in particular, Part 3 Section 24 (3)*, will seriously impact on our ability to practise. In 2018 two Scottish midwives Mary Doogan and Connie Wood were forced to quit their jobs when they refused to oversee abortions. For the first time this legislation, which differs from the 2013 Act, will permit the intentional ending of the life of the unborn child up to birth. For us as nurses and midwives participation in termination of pregnancy defined in relation to a pregnant woman, as a medical procedure which is intended to end the life of a foetus, is morally objectionable and conflicts with our conscientious commitment to life.

Participation includes any supervision, delegation, planning or supporting of staff involved in termination of pregnancy. We do not want to be discriminated against by our employers or victimised as employees if we exercise our right to freedom of conscience.

We are in the midst of an unprecedented crisis in the Health Service and as yet there has been no effort made by you as Minister for Health to consult the nursing or midwifery professions on the clinical implications of this bill.

We are calling on you as Minister for Health:

(a) to consult our professions in relation to this legislation and

(b) to support the amendments that have been tabled to protect our right to freedom of conscience so we will not be forced out of our professions.

Yours sincerely,

Margaret McGovern RGN Vice Chair,
Catherina O’Sullivan RPN Secretary,
Fiona McHugh, Clinical Paediatric Nurse Specialist
PRO and Nurses and Midwives for Life Ireland

*Section 24 (3) A person who has a conscientious objection referred to in subsection (1) shall, as soon as may be, make such arrangements for the transfer of care of the pregnant woman concerned as may be necessary to enable the woman to avail of the termination of pregnancy concerned.

Nurses’ use of conscientious objection and the implications for conscience

Christina Lamb, Marilyn Evans, Yolanad Babenko-Mould, Carol Wong, Ken Kirkwood

Abstract

Journal of Advanced Nursing

Aims: To explore the meaning of conscience for nurses in the context of conscientious objection (CO) in clinical practice. Design: Interpretive phenomenology was used to guide this study.

Data sources: Data were collected from 2016 ‐ 2017 through one‐on‐one interviews from eight nurses in Ontario. Iterative analysis was conducted consistent with interpretive phenomenology and resulted in thematic findings. Review methods: Iterative, phased analysis using line‐by‐line and sentence highlighting identified key words and phrases. Cumulative summaries of narratives thematic analysis revealed how nurses made meaning of conscience in the context of making a CO.

Impact: This is the first study to explore what conscience means to nurses, as shared by nurses themselves and in the context of CO. Nurse participants expressed that support from leadership, regulatory bodies, and policy for nurses’ conscience rights are indicated to address nurses’ conscience issues in practice settings.

Results: Conscience issues and CO are current, critical issues for nurses. For Canadian nurses this need has been recently heightened by the national legalization of euthanasia, known as Medical Assistance in Dying in Canada. Ethics education, awareness, and respect for nurses’ conscience are needed in Canada and across the profession to support nurses to address their issues of conscience in professional practice.

Conclusion: Ethical meaning emerges for nurses in their lived experiences of encountering serious ethical issues that they need to professionally address, by way of conscience‐based COs.


Lamb C, Evans M, Babenko-Mould Y, Wong C, Kirkwood Ken. Nurses’ use of conscientious objection and the implications for conscience. J Adv Nurs 2018 Oct 16. doi: 10.1111/jan.13869