The right to conscientious objection based on religious, ethical, or cultural beliefs is quite well accepted in the health professions, though it is usually couched in terms of the right not to participate in abortions or sterilizations. Forced non-therapeutic genital cutting, including male infant circumcision, certainly falls under the same set of principles. Although training programs may vary in their policies, students should theoretically have a similar right to conscientious objection.
Nurses for the Rights of the Child has developed a brochure resource for nurses, nursing students, employers, and educators to guide discussions about conscientious objection.
Following are some sources discussing the right to conscientious objection in health care, some of which specifically relate to circumcision:
- In January 2018, the Federal Government formed a new Conscience and Religious Freedom Division in the HHS Office for Civil Rights (OCR) to strengthen enforcement of federal laws protecting health professionals’ rights of refusal in health care settings funded under the Department of Health and Human Services. Health professionals who believe that they have been discriminated against by a covered entity on the basis of conscience or religious freedom, or coerced to violate their conscience or religious beliefs, may file a complaint with the OCR.
- JCAHO (the Joint Commission that accredits hospitals) requires that hospitals have some kind of Human Resources policy in place to make reasonable accommodations to staff ethical objections, as long as patient care or treatment are not compromised.
- AWHONN (Association of Women’s Health Obstetric and Neonatal Nursing) has a statement entitled Rights and Responsibilities of Nurses Related to Reproductive Health Care (revised 2016), that supports nurses’ rights to conscientious objection.
The statement says nurses should have the right to conscientious objection to, for example, abortion, sterilization, gender reassignment surgery, or “any other procedure” (which would cover circumcision). It recommends that institutions have a written policy protecting these rights and making reasonable accommodations for nurses with such objections. It also says a nurse’s refusal to participate based on religious or moral grounds should not jeopardize the nurse’s employment or subject him or her to harassment.
- The American Academy of Pediatrics (AAP) has published an article on conscientious objection in pediatrics which lists circumcision as a potential source for ethical objection. http://pediatrics.aappublications.org/content/124/6/1689.full.pdf+html
- Several medical associations’ circumcision position statements acknowledge the right to conscientious objection to circumcision, including the British Medical Association and the Royal College of Australasian Physicians.
- Code of Ethics for Registered Nurses in Canada (applies to student nurses as well), Appendix D (pp. 43-46).
Canadian Nurses’ Association Code of Ethics 2008
“Ethical (or moral) distress arises in situations where nurses know or believe they know the right thing to do, but for various reasons (including fear or circumstances beyond their control) do not or cannot take the right action or prevent a particular harm. When values and commitments are compromised in this way, nurses’ identity and integrity as moral agents are affected and they feel moral distress.” (p. 6)
“Ethical (or moral) courage is exercised when a nurse stands firm on a point of moral principle or a particular decision about something in the face of overwhelming fear or threat to himself or herself.” (p. 7)
“Ideally, the nurse would be able to anticipate practices and procedures that would create a conflict with his or her conscience (beliefs and values) in advance. In this case, the nurse should discuss with supervisors, employers or, when the nurse is self-employed, persons receiving care what types of care she or he finds contrary to his or her own beliefs and values (e.g., caring for individuals having an abortion, male circumcision, blood transfusion, organ transplantation) and request that his or her objections be accommodated, unless it is an emergency situation.
“Ideally, nurses in positions of formal leadership would ensure that workplaces have a policy in place to deal with matters of conscience so that a nurse can be exempt from participating in procedures he or she considers morally objectionable without being penalized.” (pp. 44-45)
- Article: “R.N. Conscientious Objectors to Infant Circumcision: A Model for Nurse Empowerment” by Betty Katz Sperlich, Mary Conant and Frederick Hodges. Revolution, The Journal of Nurse Empowerment, Spring 1996: 86-89.
- Family physician Michelle Storms, MD speaks about her experience as a conscientious objector to circumcision, including discussing harassment by other health professionals. An inspiring and empowering video for all health professionals.
- Dr. James Pate, an OB/GYN and member of Intact America’s Board of Health Professionals, responds to a medical student’s inquiry about conscientious objection to circumcision.
Updated March 2018