BUSI 506 Week 1 Discussion Board Forum 1 Thread Example

Discussion Board Forum 1 Thread: Faith, Conscience and Health Care Ethics

BUSI 506 Legal and Ethical Issues for Health Professionals, Discussion Board Forum 1 Thread

Thread by [Student Name]

The hospital, the nurse and the case details are composites; the textbooks, Scripture and the peer-reviewed sources cited are real.

Last month on a medical intensive care unit, a hospitalist team concluded that cardiopulmonary resuscitation would not benefit an 84-year-old patient with advanced heart failure, kidney failure and recurrent sepsis. The patient could no longer speak for himself, and his daughter insisted that "everything be done." After several family meetings failed to reach agreement, the attending physician entered a unilateral do-not-attempt-resuscitation order, as hospital policy permits after a second physician's concurrence. A nurse who had worked on that unit for two decades then asked her manager to be reassigned. She did not believe the order was wrong in itself, but she felt she could not in good conscience care for the patient while his daughter believed the hospital was abandoning him. The manager called me, as the administrator on call, to ask what the hospital owed the nurse, the patient and the family. The unit was short-staffed that night, the daughter had already contacted a lawyer and two other nurses were watching to see how leadership would respond, so the answer would shape trust on the unit well beyond this one case.

Collins (2006) begins his case for belief with the Moral Law, the universal human sense that some things are right and others wrong, and with the demand for selfless altruism that seems to run against narrow self-interest. He argues that this inner law is best explained not as a product of evolution alone but as a signpost to a moral lawgiver. Whatever one concludes about that argument, it captures something every health care leader sees: clinicians feel bound by obligations they did not invent and cannot simply set aside. The nurse's request was an expression of that inner law, and a hospital that treated it as mere preference would misunderstand the moral life of its staff. At the same time, Collins's argument cuts both ways: the daughter's insistence that her father deserved every chance also flowed from a deep sense of obligation, and the physicians' refusal to impose a painful and futile procedure reflected their own conscience. The Moral Law does not tell an administrator who is right; it explains why everyone in the room felt bound by something larger than personal preference.

Pozgar (2016) frames health care ethics around principles such as autonomy, beneficence, nonmaleficence and justice, and he stresses that legal compliance is the floor, not the ceiling, of ethical conduct. In this case the principles pulled in different directions. Beneficence and nonmaleficence supported the physicians' judgment that resuscitation would cause suffering without benefit. Respect for autonomy, exercised through the daughter as surrogate, argued against overriding the family. Justice raised its own question, since unilateral orders may not fall evenly on all patients. The nurse's conscience was caught in that conflict. Legally, Pozgar notes that surrogate decision makers act on the patient's known wishes or best interests and that institutions must follow their own policies consistently, which means the hospital's handling of this case would be judged not only by its outcome but by whether it followed a fair, documented process.

Research suggests the case was not unusual. Hernandez et al. (2026) reviewed ten years of ethics consultations at a quaternary academic hospital and identified 58 consultations involving unilateral orders. In 63.7% of them the patient or surrogate actively disagreed with the code status change, and Black or African American patients were disproportionately represented among those conflict cases, while palliative care was involved in most of them. That finding should make any administrator cautious, because a process meant to prevent non-beneficial treatment can reproduce inequities if it is applied without careful review.

Nurses' experience of these conflicts is also well documented. Alghathayan et al. (2026) synthesized 15 qualitative studies from 11 countries on nurses' experiences of conscientious objection and identified recurring themes: conflict with moral, religious and personal values, conflict with policy and law, pressure from team expectations and dilemmas about how to object without abandoning patients. Their review suggests that objection is rarely about refusing work; it is usually about how to remain faithful to one's values while still caring for people.

The philosophical debate is unsettled but instructive. Snyder Belousek (2026) argues against the claim that conscientious objection is incompatible with professional obligations, showing that a conscience-based refusal can, in carefully defined cases, fulfill the profession's core duty to avoid harm as fully as a refusal grounded in professional judgment. If that argument holds, institutions should design ways to accommodate conscience rather than treat it as disloyalty.

Finally, the forum where such cases are resolved matters. Sperling et al. (2026) interviewed members of hospital ethics committees and found that committees support clinicians and sometimes patients, but that their potential was limited by training gaps, uncertain authority and their relationships with hospital leadership. An ethics committee is only as helpful as the institution allows it to be. In our case, the committee had not been consulted before the unilateral order was entered, which meant the family experienced the order as a decision made behind closed doors rather than as the result of a deliberate and fair process.

For my hospital, I would recommend four steps. First, honor the nurse's request by reassigning her, provided another qualified nurse can safely assume care, because accommodation that leaves a patient without care would violate the very duty conscience is meant to protect. Second, require an ethics consultation and palliative care involvement before any unilateral order is entered, and track the demographic pattern of such orders to detect inequity. Third, write a conscience policy in advance that explains how staff request accommodation, how managers respond and what happens in emergencies when no substitute is available. Fourth, give the ethics committee training, clear authority to convene quickly and a direct line to senior leadership. Each of these steps also reduces legal risk, since consistent processes and careful documentation are what courts and regulators look for when decisions about life-sustaining treatment are challenged. A hospital that respects conscience must also guarantee that no patient is abandoned in the name of it.

Paul wrote that even those without the written law show that its work is written on their hearts, while their conscience bears witness (English Standard Version Bible, 2001/2016, Romans 2:15). Collins's Moral Law and Paul's description point to the same reality, a conscience that health care leaders are called to respect, guide and protect within systems that keep every patient in view.

References

Alghathayan, A., Smith, Z., & Smith, M. (2026). Nurses' experiences and perspectives of conscientious objection in practice: A qualitative systematic review. Journal of Advanced Nursing, 82(6), 5771-5789. https://doi.org/10.1111/jan.70273

Collins, F. S. (2006). The language of God: A scientist presents evidence for belief. Free Press.

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Hernandez, A., Marks, A., & Firn, J. (2026). Navigating unilateral DNAR orders: Findings from a decade of ethics consultation cases. HEC Forum. Advance online publication. https://doi.org/10.1007/s10730-026-09600-0

Pozgar, G. D. (2016). Legal aspects of health care administration (12th ed.). Jones & Bartlett Learning.

Snyder Belousek, D. W. (2026). Do not harm: A minimal defense of conscientious objection in the medical profession. Theoretical Medicine and Bioethics, 47(5), 381-403. https://doi.org/10.1007/s11017-026-09759-0

Sperling, D., Doron, I., & Yakov, G. (2026). Hospital ethics committees: Responsibilities, competencies and challenges. BMC Medical Ethics, 27(1), 24. https://doi.org/10.1186/s12910-025-01365-4