When is it offensive to heal someone?

When she’s recovering from an abortion, of course.

[The nurses’ attorney] argued that requiring the nurses to get involved before and after an abortion violated their right to refuse based on their conscientious objections.

“Nursing is a healing profession, and the law protects our right not to provide any services related to abortion,” Vinoya said at a news conference this month.

That’s right, nursing is a healing profession.  And only people who don’t violate your conscience deserve to be healed.

26 thoughts on “When is it offensive to heal someone?

  1. Did you overlook the part where “a manager told her: ‘You just have to catch the baby’s head. Don’t worry, it’s already dead’ ?” Nursing is indeed a healing profession — it attracts empaths. But corporation management, as we can see here, often attracts psychopaths. That federal law was supposed to protect people with a conscience from the crazed demands of abortionists — even if people without a conscience are “offended” by this.

  2. I did not overlook it, because it is a short article which I am capable of reading in its entirety. Nor did I overlook the fact that the full sentence, which you quoted only part of, said, “One of the nurses said a manager told her…” Further, since the suit argues for nurses not having to provide any pre- or post-operative care to the adult patient, and neither the suit nor my post is about having to participate in the abortion surgery, I decided not to excerpt the quote that did not have anything to do with caring for women.

    It is not at all clear that abortionists make “demands” which are “crazed.”

    None of the people on either side of this suit seem to be people without a conscience. The implication that offended people, those of us who mind the punitive attitude of these nurses toward women in their care, are people who lack consciences violates our commenting rules, since I am the poster and expressed offense, so further comments pursuing such insulting missives will be removed.

  3. Try developing empathy for the PATIENT, the woman who has had her own reasons to make a very personal decision. Try not to make it about you and your views, but about the PATIENT. You can’t possibly know the complexity of the 10,000 reasons that led a woman to a decision to have an abortion.

    Your statement shows evidence of splitting – saying that others’ needs can be characterized as “the crazed demands of abortionists” and claiming that those who support the right for an abortion are “people without a conscience.” No one who supports abortion rights would agree with your characterizations. It is a straw man fallacy.

    The law says that nurses are responsible for care before and after procedures and are not required to help during procedures. These nurses who filed the lawsuit want something else — denial of health care to women who need it.

  4. The article doesn’t tell us whether the nurses are really being asked to take part in providing abortions, as I read it. It suggests that they are not, but then there’s the quote about ‘catching the head’ that may or may not be fabricated. As a nurse, I fully agree with the assertion that pre- and post-operative care for women who have had other procedures is nearly identical to that provided to women who have had abortions. The one difference – and it is an important one – is the nature of the psychological support provided. If the nurses said their religious convictions prevented them from providing adequate psychological care, they may have a point.

  5. Yes, it’s rather ambiguous as to what, exactly, the hospital is requiring. The unsettling part is that on every news-website I go to, their defense attorney, Alliance-Defense-Fund’s Matt Bowman, says the law permits them to refuse taking part in “any part of the (abortion) case”, as here: http://www.huffingtonpost.com/2011/11/15/nurses-forced-abortion_n_1095913.html

    And when I read their filed brief, it does tend to refer to the “abortion case,” which occasionally seems to equivocate on the abortion (what most will assume is the surgical procedure) and the woman needing pre- and post-op care (the “case”).

  6. I hardly think this shows a “punitive attitude” on the nurses’ part toward the women involved, and I don’t think it’s a question of who “deserves” care. It’s just a function of the fact that if you conceptually parse procedures into “before”, “during”, and “after” for purposes of conscience protections, many people’s consciences are going to rebel at the loophole. Imagine if forced sterilizations, compulsory organ donations, or punitive amputations were legalized (which, depending on the part of the world you’re in, might be the case) and these things could be carried out at regular hospitals. If I were a healthcare professional being asked to participate in prepping these folks for surgery, or doing post-op work, I’m not at all certain my conscience would buy the argument that I wasn’t “participating” in the objectionable practices just because I wasn’t holding the scalpel. And if there were a conscience protection available to me by law in that scenario, I would probably want and expect that it would cover the types of things the nurses are talking about here.

    @Anonymous, when you talk about “empathy for the patient”, remember that in many of the cases these nurses work on, one of the patients IS a fetus (particularly with the rise of advanced fetal medicine and therapy in recent decades), so there’s understandably some cognitive dissonance going on for them in the situation the hospital seems to be putting them in – and not necessarily a lack of patient empathy.

  7. @Nemo: the cases you describe–forced sterilizations, compulsory organ donations, punitive amputations–just aren’t analogous to a woman choosing an abortion. You might choose to opt out of care for “patients” of these procedures because you don’t want to participate in these compulsory practices.

    Especially in the case of post-op care, I just don’t see how these nurses have a case (except in the case of psychological care mentioned above; excellent point, by the way, Teresa). Just because the women have done something that a nurse finds objectionable does not license the nurse not treating them, otherwise drunk drivers who get in accidents, atheists who have attempted suicide… all candidates for what seems to be an identical case for a nurse’s conscientious objection to participate in that person’s care. And couching this in Christian religious terms is baffling: don’t most versions of Christianity applaud helping those who have sinned? I cannot believe that this is what Jesus would do.

  8. @C, I wasn’t suggesting that those things were analogous to abortion; the extent to which they are or aren’t is beyond the scope here. I was simply trying to imagine medical practices or procedures to which I would have medical objections, in order to consider how I’d feel about what constituted “participation” in them, and particularly the argument that because my role was limited to a part of the process outside the operating room, I was not really participating in or contributing to the objectionable phenomenon. Whether an abortion procedure is actually objectionable, and why, is not too relevant to the point there. So if it’s easier, let’s just think of a medical or quasimedical “Procedure X” that is, for the sake of argument, deeply unethical from our perspective in the context in which it is being done in our hospital.

    With regard to your second point, as I already suggested, I don’t see that a desire to punish a patient, or a perception that a patient does not deserve their care, is motivating the nurses here, and for that reason counterarguments based on such considerations are probably barking up the wrong tree. I think the nurses are probably more concerned about enabling – being an accessory before or after the fact, such that their involvement facilitates the general practice to which they conscientiously object. That, at least, would be closer to my speculative feelings about “Procedure X”. I think I might also feel that although the patient deserved care, that it was better on balance for the people responsible for, or at least OK with, carrying out and perpetuating Procedure X to assume responsibility for providing that care.

    I see the topic of the thread as being less about abortion itself than about what’s going on in the plaintiffs’ heads, and that’s the purpose of my little thought experiment.

  9. Let’s say a patient arrives in a hospital with a bullet-wound, after a shoot-out with the police, after having killed 5 innocent people.

    Don’t the hospital staff have a duty to attend him or her?

    That they attend the wounded person does not imply that they condone, justify or approve of him or her having killed 5 innocent people.

    I myself do not think that abortion is wrong or involves killing a person, but some people do.

    However, my point is that the duty of medical professional is to attend patients without questioning whether their patients are good people or not.

  10. s. wallerstein has hit the key point here. Would we condone the decision of a medical professional to say “he’s a criminal, I refuse to operate on him, let him die” if a bank robber were brought in to the Emergency Room?

    Absolutely not. The media would be swamped with condemnations of the doctor for violating medical ethics.

    Then why do we, even for a moment, listen to a medical professional who doesn’t want to treat women who have had an abortion? My answer is clear: go find another job.

  11. I think that allowing medical staff to decide which legal medical procedures (that leaves out forced sterilizations, etc., which are not legal) their conscience allows them to participate in sets a very dangerous legal precedent, since what conscience dictates is very varied: my conscience might rebel at certain procedures in cosmetic surgery, for example, which convert women into supposed erotic objects.

    So if your conscience rebels at participating in legal medical procedures, you had best, as is said above, seek another career.

  12. @mediamancer – you should be careful with that broad brush. nursing also attracts psychopaths and serial killers.

  13. @s. wallerstein: As I was suggesting earlier, there is no indication that the nurses are making a judgment about whether someone in the hospital is a good person or deserves medically indicated care. So I would suggest that we avoid analogies or counterarguments that are based in part on a healthcare provider making such a judgment, as they would seem to be knocking down strawmen.

    That said, I also question on additional grounds the analogy to the bank robber. The hospital did not collude in the bank robbery, and I doubt anyone would argue that medical professionals are enablers of the bank robbery business by virtue of being around to patch up bank robbers who come in needing treatment. Also, for reasons I’ll explain in a moment, emergency room analogies are inapposite here.

    I’d like to emphasize a couple of things that I find many non-medical people (or at least non-members of traditional professions like law or medicine) aren’t aware of, and are often surprised to learn. The general rule, at least in the common law tradition, has always been that a medical professional’s ethical and legal duties flow almost entirely from the doctor-patient (or similar) relationship, which relationship is generally not created absent the prior consent of the medical professional. Relatively recently, a slight and narrow (albeit important) exception to that rule has been created by laws such as EMTALA in the United States, which requires hospitals emergency rooms and their staff to provide basic emergency care/stabilization. (Such statutes have in turn influenced codes of ethics for emergency care providers.) Of course, those laws are intended to address the specific problem of “patient dumping”, and certainly not to overturn the general rule I just outlined. So in fact, it would be the substitution of the narrow exception for the general rule that would constitute a new legal precedent. For this reason among others, let us discard emergency-room analogies.

    Thus, I think that calls for conscientious objector healthcare professionals to find another career are often rooted in misapprehensions – often tenacious ones – about the nature and duties of the profession.

    With regard to the forced sterilization issue, the fact that it is illegal (though not everywhere or always) is beside the point. Until very recently, abortions generally were too. The goal was to imagine a hypothetical situation where a lawful procedure is ethically repellent to you, the hypothetical medical professional, and then consider from that perspective the argument that your objections should only extend to participation during the actual surgery.

    As I already clarified, I offered up forced sterilization, compulsory organ donation, and punitive amputation NOT as analogies in every respect to abortion, but simply as potential candidates to make it easier to concretize the abovementioned hypothetical. I thought they might fit the bill of:

    – being deeply unethical in readers’ eyes
    – requiring pre- or post-procedure hospital care, preparation or follow-up that is at least substantially similar to that done for procedures to which readers would not have the same objections (such as for voluntary sterilization or organ donation, or for medically necessary amputation)

    If for some reason one or more of these doesn’t work for you, feel free to imagine another procedure that fits the bill. (Let’s assume the lawfulness of the procedure you imagine, since it’s not really relevant to the thought experiment whether the procedure is in fact lawful.) Then, I’d be interested to know how you approach the analysis of the argument that the scope of your objection should be limited to actually being present in the operating room.

  14. Hello Nemo:

    The U.S. law on this subject, while interesting, is neither here nor there, since we are discussing the ethical, not the legal, dimension of the subject.

    Hospitals are tricky places. Little oversights can lead to serious problems, even with relatively routine medical procedures such as abortion. Hospital staff work as a team, and so for one team member to bow out on specific procedures for reasons of conscience may lead to oversights or other problems. To have stand-by nurses, without problems of conscience, to replace the regular nurses whenever abortions are carried out is not a viable option for reasons of costs and because of the fact, mentioned above, that the hospital staff are used to working as a team, each with a specific role.

    I think that you exaggerate the scope of conscientious objection. In the military, a conscientious objecter is one who opts out of compulsory military service or who asks to
    be discharged from military service for reasons of conscience, not one who refuses to carry out regular military procedures because they go against his or her conscience. Armies, like hospital staff, work as a team; and soldiers have to be able to count on the next guy or woman to do his or her military duty according to normal procedure, within the scope of military law.

    So I suggest that nurses who are conscientious objectors to legal abortion procedures seek employment in a medical setting where abortion is not carried out or simply leave the profession of nursing.

  15. @s. wallerstein, though I mentioned the law, it was in the context of ethics – more precisely, the general rule of no duty to enter into a patient relationship – modified by the subsequently articulated narrow exception for emergency rooms – is the traditional ethical rule as well as the legal one. And more generally, it has almost always been understood as a fundamental characteristic of the profession (indeed, I would say for all of the independent learned professions), at least in English-speaking countries and possibly beyond. So it’s not just a contingent legal matter, but a basic part of what it means to be a healthcare professional in those societies.

    Conscientious objection in the healthcare context is a new name for something that is a reflection of a long-standing idea of the freedom to enter into the professional-patient relationship and exercise independent ethical judgment. Comparisons to military conscientious objection are probably inapposite here, since they relate to a context where compulsory duties are the rule, whereas for healthcare such duties are the exception until a willing professional-patient relationship has been entered into. And this is just one of many differences between soldiery and the independent professions. So the scope is naturally going to be different.

    The point stands that it has never been generally held – again, I’ll limit this to the common law countries though it’s an ethical and not merely a legal observation – that there are any circumstances under which, say, a doctor (other than an emergency room doctor providing emergency care – and that, only recently) would have a ethical duty to carry out any given procedure, treatment or care on someone he had not specifically agreed to act as a doctor for – much less be involved in abortion specifically. Indeed, until extremely recently in the history of the healthcare professions, it would have been almost universally considered unethical for medical professionals to participate in abortions. Now that abortion is legal in many places, ethical opinion in the healthcare professions is divided. I don’t mean to weigh in on the merits of that debate, but the mere fact that the list of legal procedures changes from time to time and place to place does not change the fact that a *general* duty to render care outside a consensual professional-patient relationship is just not a part of the healthcare professions.

    For that reason, suggestions that doctors or nurses who object to participating in a given procedure should consider leaving the profession make no sense to me – there is no inherent part or duty of their profession, as traditionally understood, that is incompatible with their refusal to do so. They are doing what healthcare professionals have been entitled to under the ethics of their profession since time immemorial. This comes as a surprise to many people outside the independent professions and even some within.

    All of this, I stress, is separate and apart from the *merits* of any healthcare professional’s judgment about whether participation in abortion itself (generally or in any specific case) is ethical.

    I note that you didn’t indulge my little thought experiment, which of course you are not obligated to do, but I’d be interested because I have a high regard for your input in these threads.

  16. Hello Nemo:

    I suspect that there’s a cultural difference between us in how we see the doctor-patient relationship.

    You seem to take as a paradigm the U.S. situation in which a doctor is an agent who voluntarily accepts a patient as a client.

    I take as a paradigm a situation such as Chile (where I live) in which the majority of medical procedures are carried out by the public health service and where doctors work for the state and are paid by our taxes. That is, they do not see themselves as “independent professionals” or at least as entirely “independent professionals”.

    Behind both paradigms are lots of tacit assumptions about what a doctor’s (and a nurse’s) duty towards a patient are. For example, there are a lot more analogies between military duties and those of a doctor (or a nurse) in a public health service than between military duties and those of a doctor (or a nurse) as private agents in a free market.

    Not all medical procedures are carried out by the public health service in Chile, but the
    public health service paradigm generally seems to be hegemonic in the expectations about a doctor’s duty towards a patient in Chile, although there is lots of hypocrisy about it.

    We are not debating the merits of public healthcare here, although I am in favor of much more extensive public health care than exists in the U.S or even in Chile for that matter.

    Thank for your kind words of praise. You make so many good points that I simply do not have time to answer them all.

  17. @s. wallerstein, you raise a fascinating point about differences in the way professions are viewed that, at least with regard to the professions of medicine and nursing, is probably intertwined with recent (20th century) developments in socialization of those professions in some countries.

    I located an interesting article, written by a former European Commissioner, on the differences between what he characterized as the “Anglo-Saxon” and the “Continental” views of the professions:

    Click to access jrsocmed00225-0016.pdf

    I have a suspicion (which I can’t back up right now) that these conceptions did not really begin to diverge in earnest until fairly late in the development of the professions, say the 19th century. I also suspect that the changes were most pronounced on the Continent, such that for most of the history of professions, the Western tradition hewed more to the conception which emphasizes the independence of the professions and also of the individual practitioner. Even now in the US, this idea is eroding a bit with the trend to ever-greater centralization and expansion of state power, but there is still the idea (the roots of which I think go back to the earliest professions and professional ethics in the West) that the public interest is better served in the long run by guarding the independence of professionals.

    However, I now realize that cultural/national differences in approaches to professions (even if some of those differences are of fairly recent vintage) fundamentally impact the way in which people will approach issues of professional duty. There could be several books waiting to be written (if they haven’t already) on the matters raised by your observation there; well done.

  18. “So I suggest that nurses who are conscientious objectors to legal abortion procedures seek employment in a medical setting where abortion is not carried out or simply leave the profession of nursing.”

    Wait just a minute. “Simply?” What is simple about giving up one’s profession?

    This is relevant to the current argument because when one becoming a nurse involves taking on a set of ethical standards common to the profession. The nurses who are arguing against taking part in caring for women who have had abortions are not harking to professional standards, they are arguing from the standpoint of their own personal convictions. They therefore have no standing. And leaving the profession? Well, in one sense, they have already done that.

    But please do not suggest that it is simple to give up one’s chosen profession. Nurses with associate degrees typically spend 3 years in college, those who graduate with a bachelor’s degree, 5 years. And I won’t even go into how many years of working part-time while going to school it took for me to get the coveted PhD.

  19. @Teresa, I wanted to ask for clarification on two things in your last post. First, what do you mean when you say that these nurses lack “standing”? Second, in what sense have they “already left the profession”?

  20. Nemo, I meant that these nurses are not acting in accordance with the ethical standards of the profession, which require a nurse who objects to a procedure to 1) not enter into a patient-nurse relationship, as you have alluded to, and 2) notify a superior who can make appropriate arrangements for another nurse to take care of that patient. Unless abortions are the primary service provided at their facility, this should work in their employment setting, and not require that the issue end up in the legal system. I cannot help but wonder if the employer was unwilling to make these arrangements, knowing the history of nurses’ mistreatment at the hands of health care administrators. So perhaps it’s not the nurses who are acting unethically. By “already left the profession” I meant that they have not acted in accordance with our ethical guidelines, although I admit that there’s not enough information in the article to determine that definitively.

    The American Nurses Association code of ethics states:

    “A nurse has a moral option of refusing to participate in care when “placed in
    situations of compromise that exceed acceptable moral limits or involve violations
    of the moral standards of the profession, whether in direct patient care or in any
    other forms of nursing practice.”
    “A nurse may also morally refuse to participate in care of a given individual on the
    grounds of patient advocacy when specific interventions or practices are
    intrinsically morally objectionable, are inappropriate for the patient, may harm the
    patient, or jeopardize nursing practice.”

    The way I read that, it suggests these nurses are not acting on the moral standard of the profession, but on their personal convictions, which puts them on pretty thin ice.

  21. @Teresa,

    Some of the changes in the most recent version of the ANA Code are interesting. The previous version flat-out said (in old 1.3) “If ethicalIy opposed to interventions in a particular case because of the procedures to be used, the nurse is justified in refusing to participate.” The latest version seems to want to nuance it more.

    To illustrate, and for the benefit of readers, I’d like to expand a bit the ANA Code quotation you gave:

    “Integrity is an aspect of wholeness of character and is primarily a self-concern of the individual nurse. … Nurses have a duty to remain consistent with both their personal and professional values and to accept compromise only to the degree that it remains an integrity-preserving compromise. …

    When nurses are placed in situations of compromise that exceed acceptable moral limits or involve violations of the moral standards of the profession … they may express their conscientious objection to participation. Where a particular treatment, intervention, activity or practice is morally objectionable to the nurse, whether intrinsically so or because it is inappropriate for the specific patient, or where it may jeopardize both patients and nursing practice, the nurse is justified in refusing to participate on moral grounds.” (From current 5.4)

    Even in the slightly wishy-washy formulation in the most recent version of the ANA code, I read it as encompassing the moral judgment of the individual practitioner (put another way, the ethical standards of the profession *include* a right, and perhaps indeed a duty, for the individual practitioner not to compromise his or her individual moral judgments. That’s how I read “where an intervention is morally objectionable to the nurse” (not necessarily to the profession, if we could even say that the profession has a view about whether an intervention is morally objectionable). I would submit that this has pretty consistently been the case since time immemorial with the independent learned professions in the Western tradition (at least in the English-speaking world), and that’s not undone by anything an ANA panel might draft.

    Indeed, I think we need to qualify all this by acknowledging that the most recent Code of Ethics drafted by a committee of the ANA (an organization that only a very small minority of US nurses opt to join, though it fancies itself the spokesgroup for the whole profession in the US) is not exactly last word on the ethical standards of the profession, any more than the edition they published a few years before that. Even if it could be argued that the New Jersey nurses’ conduct was not consistent with the ANA’s latest articulation of professional ethics – which I think is not exactly easy to argue – there are other groups of nurses that would likely disagree (many state nursing associations, for example, strongly support the conscience law the NJ nurses are invoking, so if it turns out that their conduct was protected by that law, those associations would presumably take the position that it was not unethical either.)

    One interesting thing from that Journal of the Royal Society of Medicine article I linked above (about defending the nature of professions) :

    “In so far as we are talking about moral issues, a clear distinction is necessary between what the profession does and what an individual practitioner does. Moral issues are ultimately individual issues. One must probably accept that an individual doctor will not do what is prescribed because he has moral reservations about, say, abortion. (The question is much more difficult whether an individual doctor should be allowed to do what is proscribed because he regards it as morally right to violate the law; here the answer might well be no.) The profession as such, however, can do no more than point out facts on which there is agreement within it. It can say that the risk of error is this in some cases … and that in others; it cannot advise on what is desirable. Once again, the final decisions will have to be taken by those who have overall social responsibility, that is the makers of laws.”

    I suppose we could say that that’s where the conscience laws, and this lawsuit, come in.

    I agree with you that, even if not all the factual allegations in the lawsuit are accurate, there is reason to suspect the employer was not making necessary arrangements – as you allude, there’s a lot of mistreatment and disrespect of nurses by hospital administrators, and it’s hard to deny a sexist element to it. Nurses are much more likely, among other things, to have their ethical autonomy and conscience rights violated than, say, physicians (though I have no knowledge that that occurred in this particular case), which obviously poses a concern from a feminist perspective.

  22. By the way, now that I have looked over the complaint (it was linked in the WaPo article, but I didn’t see it at first), I see that it sheds a little light on what’s being alleged:

    -The nurses all work in the hospital’s Same Day Surgery Unit (SDSU), which provides pre- and post-op care for non-emergency operations. A very small number of SDSU patients are at the hospital to obtain an abortion.

    -For many years, the hospital provided nursing care to abortion patients by assigning those cases to nurses who were designated and willing to work on such cases. During that time, no SDSU nurses who objected to assisting abortions were required to do so.

    -A couple of months ago, the hospital started telling all SDSU nurses that they had to assist abortions, and scheduled the objecting nurses for a mandatory training program that appears to include actually assisting at surgical abortions.

    -The objecting nurses were told that if they did not show up for training, they would be terminated.

    Again, these are just allegations at this point. But the plaintiffs did succeed in persuading a court to grant a temporary restraining order against the hospital, which typically requires satisfying a judge that there is a reasonable likelihood that the plaintiffs would prevail at a full trial.

    Interestingly – though I stress that it’s not probative of anything in this lawsuit – the institution that is the defendant in the suit (the University of Medicine & Dentistry of New Jersey) appears to have a sorry history in recent years of ethical and legal, er, misjudgments … Prosecution for massive Medicaid fraud; suspension of accreditation; nepotism, cronyism and bribery by a couple of deans; etc. Governor Christie, when just a federal prosecutor, went after them hard.

  23. Yeah, but I don’t feel in any position to visit the goodness of the institution, which is the size of the entire state’s medical professional community (I think?). And are those things they were found guilty of, or things that Christie went after them for (you know what I mean?). Ach, complicated.

    As is, of course, everything about this. There is this intuitionist part of me that doesn’t doubt the nurses’ supervisors may have totally broken the rules, it’s just so… so very possible. Nothing actually stops supervisors from breaking rules and telling one they can be fired for noncompliance with a rule-breaking demand; laws and injunctions are there to justify punishment when supervisors are caught, but can’t actually prevent them from being rule-breakers. I’ve been leaned on by those in supervisory positions to break what I considered VERY good rules.

    But note, and here I tax Nemo’s patience (gently) in order to really insist on keeping the adult women patients firmly in view: They do not provide “pre- and post-op care for non-emergency operations.” They provide pre- and post-op care for individual human beings who are patients. A person is not an operation. And even referring to the women as “those cases” again diminishes their personhood.

    I understand that from the point of view of one who finds abortion to eliminate the personhood of a fetus, my insistence that we attend to the personhood of the women patients may be less serious or just plain pedantic. But so much of the complaint, which I read before posting, was devoted to just this kind of erasure. Here I am bordering on just reiterating comment #5, so, well, ditto that all over again.

  24. @Kate, UMDNJ had a dean go to jail for a job-related bribery case (the bribed politician went to jail too). That was the case Christie successfully prosecuted. In a separate incident, dean was fired over accusations of miscellaneous ethical violations. Probably the biggest case was a huge Medicare double-billing fraud case that resulted in a “deferred prosecution agreement” – where the government agrees not to continue the criminal prosecution in exchange for paying fines, making reforms etc. (usually only done where the evidence is pretty strong and an institutional defendant knows they’re likely to be found guilty). They lost their accreditation for a while over that one, but it was later restored.

    But hey, this is New Jersey, these things happen, fuggeddaboudit! Seriously, though, you’re right that UMDNJ is a huge and diverse institution, none of the same people are involved, etc. I mentioned it because the new lawsuit is another black eye for an institution that has often been embattled in recent years. On the other hand, it can be true that an institutional culture of laxity, or a lack of good leadership, when it comes to legal/ethical compliance, can be a contributing factor toward misconduct rearing its ugly head. I wonder if something like that that might be, or have been, the case at UMDNJ.

    Your point regarding “operations” versus “patients” is very well taken, and you’re right about the use of language in the complaint – if there’s blame to be had for that, we can blame the lawyers (though I’m not sure that their language is actually inconsistent with their having the personhood of patients firmly in mind). Of course, women in that hospital getting surgical-related care in connection with abortions are patients. However, it’s worth noting that they are not patients of *these nurses*. That’s important to the discussion of ethical duties, when they attach, and by virtue of what kind of professional relationship they attach. And now that I think of it, it points to a linguistic or semantic problem that muddies the issues here. “Patients” is often used informally in a non-relational sense, by which I mean referring to, say, a sick person in a hospital *as such* – or at least without referring to that person’s relationship to a specific professional. But with respect to professional-patient duties, “patient” is a relational term: a sick person is not a patient in any absolute sense, but a patient vis-a-vis the professional(s) who have entered (via whatever mechanism applies) into a professional relationship with that person. This is true (practically by definition, I think) of all the traditional professions; for example, a lawyer has special professional and ethical duties to *her* clients – which is not to say that she owes none at all to other people, of course.

    I’ll add that in each profession, the professional relationship can sometimes be deemed to arise under circumstances where a specific mutual intent is not present. But even there, it is still the case that most individual professional duties flow from, and arise by virtue of the creation and existence of, the special professional relationship with a particular person. Not simply by virtue of the fact that someone belongs to a profession, or the fact that someone may be in a position of requiring professional help.

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