DIFFICULT MORAL QUESTIONS

Question 79: Must a nurse give up her hospital job to avoid assisting at abortions?

I have been employed for seven years as a nurse at a small community hospital, which is the only hospital in this county. Not many abortions are performed here, but two doctors do them occasionally. Shortly after I came here, I was scheduled to assist in one—that is, to prepare the patient, assist in surgery, and provide aftercare—and I refused. The hospital administrator was not happy about that, but he gave in to the extent of agreeing not to schedule abortions in the afternoons and evenings, when I normally work. Still, three times in the seven years, I had to fill in for another nurse on a morning when an abortion happened to be scheduled. Each time I assisted under protest.

Though all but one of the other nurses here have been and are prolife, nobody but me has resisted. One of them told me assisting in abortions was classified as licit material cooperation in an ethics course at her Catholic nursing school, but the same professor approved of sterilization. The one who favors abortion says I lack sisterly feelings and would think differently if I had ever been pregnant. I do sympathize with women who have problems, but I cannot help feeling for the baby too and think abortion is always wrong. Being involved in any abortion bothers my conscience, and I really want to avoid it completely.

Now the hospital administrator has told me abortions no longer will be scheduled to “accommodate” me. I will be replaced unless I assist when I am on duty. I talked with a lawyer active in our state right-to-life organization. He looked into the problem and told me no statute protects nurses in this hospital who refuse to assist in abortions. I could ignore the administrator and sue the hospital if the administrator dismisses me, but I probably would not win.

Apart from this one problem, I enjoy my work and get along fine with almost everyone, even the difficult patients. Must I give up my hospital job?

If I quit or am let go, I will not be able to move where I could get another hospital job, since I live with my elderly mother, and she could not bear leaving the home she has lived in for sixty years. But the public high school here needs a nurse for its dispensary, and the job does not involve giving out contraceptives or anything else that would be a problem. The principal would like me to start immediately, but has given me until next week to decide. The hours would not be so good, since on school days, which are about half the days of the year, I would have to work during the hours my mother needs me most. Changing jobs also would mean benefits a lot less adequate and a reduction of about forty percent in annual take-home pay. But I could make up some of that during the summer, and we could get by, since my mother still has enough income to pay her share of the bills.

Analysis:

This question concerns cooperation in wrongdoing. The questioner says being involved in abortion “bothers my conscience.” If that means she chose to assist at abortions despite judging it morally wrong, she should repent having done so, and may not again assist at an abortion unless further reflection leads her to judge it morally permissible. Though recent Church teaching might be taken to mean that a nurse may not assist at abortions, I do not think that teaching should be interpreted as forbidding it if the usual requirements for morally acceptable cooperation are met. Under certain conditions, a nurse’s involvement could be formal cooperation, but this nurse may be able to avoid it. If formal cooperation is excluded, however, the usual norms regarding material cooperation must be applied. The steps the questioner would need to take to avoid scandal and bear witness to the truth about abortion might well lead to her dismissal unless the other prolife nurses cooperate with her. Unless they do, therefore, it seems to me she should accept the available alternative employment.

The reply could be along the following lines:

You are right in holding that abortion itself is always gravely wrong.²⁵⁶ In saying that being involved in it “bothers” your conscience, perhaps you mean only that assisting at abortions has given you guilt feelings, even though you thought it morally permissible to do it under the circumstances. In that case, your involvement was not sinful. But perhaps you mean you thought it morally wrong to assist at the three abortions, but did it anyway. In that case, your involvement was sinful, and you should repent it. Even if what one does is not objectively wrong, one always sins in choosing to do what one believes morally wrong.

Of course, if you need to repent, you must have a firm purpose of amendment. Does that mean committing yourself never again to assist at an abortion, regardless of the consequences? Not necessarily. You must commit yourself never again to act contrary to your conscience, regardless of consequences. But, as I shall explain, it could be morally permissible for you to assist at abortions, and, if you already believe it is or become convinced of that, choosing to assist would not be sinful. If it still made you feel guilty, that feeling would not be appropriate, though feelings of regret and sadness would be. Any false guilt feelings would then have to be dealt with in the same way as feelings of anxiety when there really is nothing to be afraid of.

Someone might argue that recent Church teaching provides a clear answer to your question. John Paul II, listing those who share responsibility for abortion, says: “Doctors and nurses are also responsible, when they place at the service of death skills which were acquired for promoting life” (italics added).²⁵⁷ And speaking of the responsibilities of health care personnel, including nurses, he says: “Absolute respect for every innocent human life also requires the exercise of conscientious objection in relation to procured abortion and euthanasia.”²⁵⁸ Moreover, having pointed out that one may not conform to laws allowing abortion, the Pontifical Council for the Pastoral Assistance of Health Care Workers says: “As a result, doctors and nurses are obliged to be conscientious objectors. The great, fundamental value of life makes this obligation a grave moral duty for medical personnel who are encouraged by the law to carry out abortions or to cooperate proximately in direct abortion.”²⁵⁹

Plainly, these statements absolutely exclude doing abortions and wrongly cooperating in them. They also call for the exercise of conscientious objection, which, however, can take different forms. When called on to do anything intrinsically immoral, one must refuse no matter what the consequences. When called on to assist in an abortion, nurses and other health care workers should bear witness to the truth about abortion by objecting and taking advantage of laws and regulations that protect them against sanctions for refusing to be involved. However, I do not think these statements directly address your question. You have conscientiously objected, and relevant laws and regulations apparently give you no protection. Some faithful Catholic moralists—ones who did not dissent from any teaching of the Church—held that in such a case a nurse’s assisting in abortion could be morally acceptable material cooperation.²⁶⁰ It seems to me that if recent teachings were meant to exclude that opinion, they would have done so more clearly. Therefore, it is reasonable to suppose that your question remains to be answered.

Ordinarily, when nurses assist in any procedure they intend it to be carried out successfully. Your involvement in abortion would be absolutely wrong if you chose to assist with that end in view. That would be so if, in doing at least something that you did, you intended to help bring the abortion about. It also would be so if you had some discretion about your contribution to the procedure and had to make one or more choices in view of the goal of getting the abortion done. For example, suppose a physician decided to do an abortion by inducing labor before the fetus was viable, and you were directed to administer medication to induce labor, beginning with a certain dosage and increasing it gradually until it had the desired effect; or suppose you were assisting at a surgical abortion and were required to use your judgment in selecting implements or regulating a machine in order to help bring about the abortion. You could not carry out such directives without intending to effect the abortion, which nothing could ever justify.

Clearly, however, you do not want any abortion to be done. And when you are assigned to assist at an abortion, perhaps you have no choice about what you are to do. That is so if your involvement consists either in following routines (for example, in preparing the patient) or in obeying particular orders (hand me such-and-such an instrument, adjust the light)—in either case, behavior you could perform without making any choice regarding abortion. If so, you could do all the things you do without knowing an abortion was taking place, except, perhaps, for the fact that the word abortion may be used in naming a routine (for example, in preparing the patient or setting up the operating room), no element of which, considered in itself, need be directed by you toward bringing about the abortion. Under these conditions, even if the abortion could not be done without your doing your duties as a nurse, in performing them you need only accept, and in no way intend, the bad use of your services, which will remain good in themselves.

Yet even such limited involvement in abortion often is wrong. That is so when it is likely to lead one into a wrong intention or choice, when it is likely to scandalize others, when it is unfair to the baby who will be killed, or when it impairs the witness one should give to the truth about abortion.

A person’s limited involvement in abortion would be likely to lead to intending the abortion if she or he regarded abortion as somehow desirable (for example, supported so-called reproductive freedom or made a living by working at an abortion clinic) or if the limited involvement were likely in some circumstances to compel the person either to intend abortion or to choose an extremely repugnant alternative (for example, if a gynecologist could not continue after beginning an abortion, a resident involved by assisting at it would be compelled to choose either to finish destroying the baby or to refuse and accept the consequences). Plainly, your involvement in abortion is not likely to lead you in either of these ways to intending it.

A nurse’s involvement might scandalize others—that is, lead them to commit the sin of abortion—if it seemed to manifest approval of abortion. That would be so if the nurse’s involvement included behavior that contributed with physical directness to bringing about the abortion, for instance, if he or she switched on the suction machine or administered the abortion pill. However, what nurses do in preparing abortion patients, assisting in surgery, and providing aftercare need not manifest approval. Moreover, women who seek abortion, physicians who do it, and others involved who intend it generally have made their choices before nurses start to carry out their duties.

Still, a real and important possibility of scandal remains in the case of women who are ambivalent about getting an abortion. Such patients may not be easy to recognize; and the behavior of nurses who carry out their routine duties just as if they were participating in health care rather than homicide could provide them with reassurance that there is nothing exceptionable about abortion. Nurses who, like you, reluctantly assist at an abortion could forestall scandal in such cases only by clearly stating their position to each patient and anyone else involved who seems to assume or desire their approval, encouragement, and/or psychological support. But that might well be judged to violate patient care standards and lead to your dismissal.

Applying the Golden Rule makes it clear that a nurse’s involvement would be unfair to the baby being killed if the nurse’s refusal to be involved would not merely briefly delay the abortion but prevent it and save the baby’s life. That probably does not apply in your case. Assisting at abortions also is unfair, in my judgment, for those who offer no resistance. But unlike the other prolife nurses, who have no problem being involved in abortion, you have resisted. Assisting also is unfair for nurses who could avoid it without making a significant sacrifice. On the one hand, if you lose your job for refusing to assist, some important benefits will be lost. You will no longer engage in hospital nursing, for which you seem to have a special gift, and, though you have been pressed to participate in abortion on three occasions in seven years, almost all your work in the hospital serves genuine human goods in an important way. You will have to give up a substantial part not only of your income but of your capacity to meet your mother’s needs. On the other hand, you do have the offer of a job that would be adequate, and working in the school’s dispensary might afford you many opportunities to be a good influence on young people.

Finally, a nurse’s involvement impairs the witness he or she should give to the truth about abortion if it prevents communicating that truth credibly. You could take advantage of your reluctance to assist at abortions to give credible witness.

To begin with, you might try to help the other prolife nurses see that assisting at abortions should be a problem for them and that they should join in your protest. If they do not, I doubt you will be able to bear witness to the truth about abortion without giving up your job at the hospital. If they do, however, you could work out a common policy about what to say to a woman as one of you prepares her for an abortion or provides aftercare. Beforehand, certainly, no encouragement should be given to proceed. It would be appropriate to talk with the patient to make sure she understands what abortion is and knows about its many possible bad effects on her. If a woman expresses any hesitations, she should be assured that she can change her mind and will be supported. Moreover, it might become clear in some cases that the woman is less than wholehearted, is ignorant of what abortion does, or has not thought about alternatives, so that appropriate information and support can be offered. Afterwards, no assurance should be given that everything bad about the abortion is past; and, if a woman expresses any remorse, she should be encouraged to repent and assured that divine forgiveness is available. A nurse who has listened sympathetically to the motives and regrets of a woman who has rid herself of her baby often will have an opportunity to suggest tactfully that she seek the spiritual healing she needs.

You also could write a letter to the hospital administrator, with copies to the physicians who perform abortions, stating that from now on you will assist when assigned, but under protest and only because of the administrator’s ultimatum; and that you regard the ultimatum as unjust inasmuch as it requires you to assist in killing babies—not only a great injustice to them but a betrayal of the commitment of every health care professional. The hospital administrator probably will not dare to take action against you for writing that letter. The injustice of retaliating against a frank statement of your position would be manifest even to many people who would not see the injustice of compelling you to assist at abortions. If you think being discharged from your present job would prejudice future employment, however, you might judge the risk of protesting excessive, even if in itself not great.

In sum, your involvement when assigned to assist in abortion might not require you to intend the abortion or choose to do anything wrong in itself. But the steps that would be necessary to prevent scandal and bear witness to the truth about abortion might well lead to your dismissal, especially if the other prolife nurses do not join in your protest. Moreover, you can obtain other adequate employment, and so, unless you do everything you can to prevent scandal and bear witness, assisting in abortions might well be unfair to the babies who will be killed.

Only you can say whether you can entirely avoid sinful intentions and choices, take the steps necessary to both prevent scandal and bear witness to the truth, and assist in killing unborn babies without violating the Golden Rule. However, if you seriously try to meet all those requirements, I think you very likely will be dismissed unless the other prolife nurses join you in resisting abortion and dealing with women obtaining abortions along the lines I have sketched out. Therefore, unless you reasonably hope to obtain their cooperation, I believe you should accept the job as a school nurse.

The law should include provisions to protect everyone, including nurses and other health care workers, from being pressured into assisting in abortion and other procedures they consider morally wrong—sterilization, assisted suicide, artificial insemination, the taking of organs for transplantation from people who are still alive, and so forth. Ideally, these provisions should not require that the moral judgment be based on religious faith, but simply that it be a serious judgment based on deeply held convictions. They should protect not only against criminal and civil liability, but also against loss of any public benefit, or of one’s job or professional status, or of any opportunity for education or employment or professional advancement. In view of the advice you received from the prolife lawyer you consulted, I assume there are no such provisions in your state’s law, and that the relevant federal statute does not apply to your hospital.²⁶¹ You should enlist others’ help and do all you reasonably can to get your state legislature and, if possible, the U.S. Congress to act on the matter. Your own experience will be a valuable source for your testimony. Even if you fail, you will call many people’s attention to the injustice both of abortion and of pressuring people to be involved in it. That will encourage resistance and probably save at least some babies’ lives.

256. See John Paul II, Evangelium vitae, 58–63; AAS 87 (1995) 466–74, OR, 5 Apr. 1995, xi–xii; LCL, 488–505.

257. Op. cit., 59, AAS 468, OR, xi.

258. Ibid., 89, AAS 502, OR, xvi.

259. Pontifical Council for Pastoral Assistance to Health Care Workers, Charter for Health Care Workers (Boston: Pauline Books and Media, 1994), 143 (p. 123).

260. See, e.g., Gerald Kelly, S.J., Medico-Moral Problems (St. Louis: The Catholic Hospital Association, 1958), 332–35.

261. While the lawyer’s advice may be sound in this particular case, in many places nurses enjoy a right to refuse to participate in abortion, either under a state law or under a federal statute that protects all health care personnel whose employers receive moneys under certain federal programs: 42 U.S.C. 300 A–7. Therefore, any nurse pressed to participate in abortion should ascertain whether such a legal right exists where she or he works and, if it does, should take appropriate steps to exercise it.