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Public policy dictates that every nurse has a right to refuse an assignment on the grounds that is may be injurious to the public or against the public good. But what about the Nurse's Code of Ethics or personal morals or convictions? Can a nurse, for instance, refuse to treat a patient because it is against the ANA Code for Nurses or against personal philosophy?
The Superior Court of New Jersey answered this question in this case where plaintiff appealed from a summary judgment dismissing her action against defendant Toms River Community Memorial Hospital (Hospital).
Facts: The Hospital, where plaintiff had been employed for eleven years as a registered nurse, terminated plaintiff from its employment on August 6, 1982. For the three years just prior to her discharge, plaintiff had worked in the Hospital's kidney dialysis unit. It is undisputed that plaintiff was an at-will employee.
Plaintiff alleges that during the summer of 1982 her supervisor periodically assigned her to dialyze a double amputee patient who suffered from a number of maladies. On two occasions plaintiff claims that she had to cease treatment because the patient suffered cardiac arrest and severe internal hemorrhaging during the dialysis procedure. During the first week of 1982 plaintiff again was scheduled to dialyze this patient. She approached her head nurse and informed her that "she had moral, medical, and philosophical objections" to performing this procedure on the patient because the patient was terminally ill and, she contended, the procedure was causing the patient additional complications. At that time the head nurse granted plaintiff's request for reassignment.
On August 6, 1982, the head nurse again assigned plaintiff to dialyze the same patient. Plaintiff once again objected, apparently stating that she thought she had reached an agreement with the head nurse not to be assigned to this particular patient. She also requested the opportunity to meet with the treating physician, Dr. DiBello. Dr. DiBello informed plaintiff that the patient's family wished him kept alive through dialysis and that he would not survive without it. However, plaintiff continued to refuse to dialyze the patient, and the head nurse informed her that if she did not agree to perform the treatment, the Hospital would dismiss her. Plaintiff refused to change her mind, and the Hospital terminated her.
Plaintiff subsequently instituted this action alleging that she was wrongfully discharged by the Hospital without justification and in violation of public policy.
The trial court granted the hospital's summary judgment motion, concluding that "the nurse's code of ethics is a personal moral judgment and permits the nurse to have personal moral judgment, but it does not rise to a public policy in the face of the general public policies that patients must be cared for in hospitals and patients must be treated basically by doctors and doctors' orders must be carried out." This appeal followed.
Court Decision: Public policy has been defined as that principle of law which holds that no person can lawfully do that which has a tendency to be injurious to the public, or against the public good.
The Court carefully warned against confusing reliance on professional ethics with reliance on personal morals:
Employees who are professionals owe a special duty to abide not only by federal and state law, but also by the recognized codes of ethics of their professions. That duty may oblige them to decline to perform acts required by their employers. However, an employee should not have the right to prevent his or her employer from pursuing its business because the employee perceives that a particular business decision violates the employee's personal morals, as distinguished from the recognized code of ethics of the employee's profession.
Here, plaintiff cites the Code for Nurses to justify her refusal to dialyze the terminally ill patient. She refers specifically to the following provisions and interpretive statement:
The nurse's concern for human dignity and the provision of quality nursing care is not limited by personal attitudes or beliefs. If personally opposed to the delivery of care in a particular case because of the nature of the health problem or the procedures to be used, the nurse is justified in refusing to participate. Such refusal should be made known in advance and in time for other appropriate arrangements to be made for the client's nursing care. If the nurse must knowingly enter such a case under emergency circumstances or enters unknowingly, the obligation to provide the best possible care is observed. The nurse withdraws from this type of situation only when assured that alternative sources of nursing care are available to the client. If a client requests information or counsel in an area that is legally sanctioned but contrary to the nurse's personal beliefs, the nurse may refuse to provide these services but must advise the client of sources where such service is available.
-American Nurses Association, Code for Nurses with Interpretive Statements para. 1.4 at 5 (1981).
It is our view that as applied to the circumstances of this case the passage cited by plaintiff defines a standard of conduct beneficial only to the individual nurse and not to the public at large. The overall purpose of the language cited by plaintiff is to preserve human dignity; however, it should not be at the expense of the patient's life or contrary to the family's wishes. The record before us shows that the family had requested that dialysis be continued on the patient, and there is nothing to suggest that the patient had, or would have, indicated otherwise.
Recently, our Supreme Court confirmed that all patients have a fundamental right to expect that medical treatment will not be terminated against their will. This basic policy mandate clearly outweighs any policy favoring the right of a nurse to refuse to participate in treatments which he or she personally believes threatens human dignity.
The position asserted by plaintiff serves only the individual and the nurse's profession while leaving the public wonder when and whether they will receive nursing care. Moreover, as the Hospital argues, "it would be a virtual impossibility to administer a hospital if each nurse or member of the administration staff refused to carry out his or her duties based upon a personal private belief concerning the right to live....."
Accordingly, the judgment under review is affirmed.
Warthen v. Toms River Community Memorial Hospital 199 N.J. Super. 18; 488 A.2d 229; 118 L.R.R.M. 3179.