Weighing when personal convictions conflict with professional obligations

Q I’m a nurse in a med–surg unit. A patient I recently cared for who has amyotrophic lateral sclerosis decided to voluntarily stop eating and drinking (VSED) because she wanted to avoid death from disease progression. I consider this suicide and that by caring for this patient I was violating my deeply held personal beliefs that suicide is immoral. Can I conscientiously object to caring for this patient?

A Provision 5 of the Code of Ethics for Nurses (Code) states that, “Conscience-based objection [CBO] is an important right in order to promote personal integ­rity…” Exercising this right is important when it is focused on maintaining a nurse’s self-regarding duties of wholeness of character and integrity. The Code also states that “…nurses must render compassionate, respectful, and com­petent care.” Ethically appropriate CBOs deal with a specific procedure or act, not patients themselves.

Provision 5 adds that “A nurse may not object to care due to a patient’s unique attributes that are a part of the patient’s identity.” For example, a nurse might conscientiously object to participating in an abortion procedure but not to care for the patient prior to or after the procedure based on the fact of that patient’s choice. Similarly, a nurse may not object to caring for a patient because of their race, religion, or sexual or gender identity. Refusing to provide appropriate care based on discrimination is incompatible with the Code.

Nurses should identify where their deeply held beliefs might conflict with their work obligations. Nurse leaders should assist in supporting nurses’ wholeness of character and integrity in balance with patient needs. The ten­sion between these aims occurs when a CBO might violate a patient’s right to appropriate and legal medical treatment or care and when the refusal would perpetuate discrimination and intolerance. Additionally, when a patient might come to significant risk of harm, loss, or damage due to an absence of any nursing actions and there’s no ability to accommodate a CBO, a nurse’s primary commitment to their patient must be upheld. The patient’s health needs must come first.

Nurses also have an obligation to remain curious and learn, and in so doing examine whether a situation truly violates a deeply held belief. When nurses feel uncomfortable, they should evaluate why and learn from doing so to better care for patients and themselves. Rendering compassionate and respectful care to all patients regardless of one’s personal beliefs is key.

In this case, examine your role in the specific act. You also have a professional obligation to ensure that your patient’s autonomy isn’t violated. The patient’s choice to access VSED doesn’t require you to participate. You’re not engaging in VSED or withholding any treatment that will lead to your patient’s death; you’re respecting their autonomy over their body. Therefore, this wouldn’t necessarily be considered a CBO. I encourage you to better understand your patient’s beliefs and perspective. If after doing so you’re still struggling, it may be possible to ask your leaders about changing an assignment or seek further resources to better understand the issue.

—Response by Ian D. Wolfe, PhD, MA, RN, HEC-C, 2025 Code of Ethics for Nurses Revision Panel contributor

American Nurse Journal. 2025; 20(6). Doi: 10.51256/ANJ062536