Application of a Professional Ethical Framework to the Nursing Care of a Woman Seeking An Abortion

Background: Given the lack of a national consensus about core competencies in sexual and reproductive health (SRH) for all health professionals, many nurses lack experience in implementing professional ethics into practice in SRH care. Often there is little discussion of practical applications of ethics of SRH in either nursing education or ongoing continuing education. This interactive session provides a framework for discussing ethical clinical issues in nursing practice using the Jonson model of case analysis.  It is built on the "four topics approach" of medical indications, patient preferences, quality of life, and contextual features.  In conjunction with the Jonson model, the ANA Code of Ethics for Nurses with Interpretive Statements (ANA, 2001), AWHONN Standards For Professional Nursing Practice in the Care of Women and Newborns (7^th Ed), AWHONN’s Women’s Health Nurse Practitioner: Guidelines for Practice And Education (6^th ed.) and ACOG’s Committee on Ethics Report on The Limits of Conscious Clauses in Reproductive Medicine are discussed in developing an ethical framework for approaching nursing care.

Case: A physician in a small community provides abortions in her office-based practice. On a rare occasion, the physician chooses to perform a first trimester aspiration procedure in the hospital setting due to a patient’s complex and unstable medical history. When the case appears on the operating room schedule, the nurses are surprised by the presence of the case and decline to assist with the procedure. Each nurse invokes his/her right to refuse an assignment based on their professional right of conscience. The physician is concerned about having to cancel the case and speaks individually with each staff member, asking each nurse to value the patient’s right to care and reconsider their decision. One nurse decides to provide nursing care for the patient.

Conclusion: It is necessary for nurses to have opportunities to engage in self reflection and values clarification regarding the intersection of personal beliefs and professional responsibilities. Staffing dilemmas such as described are more likely to occur in a unit that does not frequently care for such patients. 

Nurses continue to face ethical dilemmas in reproductive health care that challenge their personal beliefs, their role of patient advocate, their belief in patient's right to care and their respect for patient autonomy in decision-making. Professional nursing organizations can provide guidance and opportunities for nurses to discuss the application of ethical frameworks to complex ethical cases.

Keywords:  ethics, professional standards, Jonsen model, abortion care