Conscientious Objection: A neglected legal right of nursing profession in Iran

One of the most important values of the nursing profession is commitment to the professional obligations, responsibility and conscientious at work. Conscientious objection (CO) to perform unethical interventions is an old concept in developed countries; however, it is a neglected concept in developing countries such as Iran. CO in health care has been defined as to avoid doing some interventions by health care professionals when these intervention are incompatible with the values, morals and cultural of doer. In nursing, this concept refers to the objection of nurse to perform an intervention or to participate in a situation based on the own informed conscience. CO includes three features: it is an internal sensation of distinguishing the right from the wrong; is internalizing of the family and social norms; is a reflection of moral integrity and sovereignty. Violation of these features could lead to ethical conflict because of threating of the individual integrity. The importance of maintaining moral integrity is one of the fundamental rights for conscientious objection. According to some instances of non-objection of unethical intervention in national nursing services, it seems that the rights of nurses to object conscientiously doing illegal interventions are neglected and nurses have knowledge deficit about their rights, including conscientious objection. Therefore, it is recommended to take this important concept scrutinized by researchers. Various aspects such as the frequency of its events, admission criteria, moral conflicts resulting from its acceptance and its risk factors through qualitative and quantitative research warrant further research.
Save the life of every human being in any situation is the duty of every Muslim. Moral includes principles and values that lead the individual behaviors. Ethics affects most medical sciences fields that will serve the people such as medicine and nursing. Ethical challenges of these professions have been a part of the daily care of patients. Therefore, health personnel need to know the knowledge of ethics of their profession (1). Today, with significant progress made in the treatment and care of patients, ethics in nursing care has become as an integral part of the nursing profession. Not resuscitation of patients with terminal illness, euthanasia, physician-assisted suicide, disconti-nuation of life procedures, palliative treatments, discontinuation of nutrition and hydration, and organ donation after cardiac death are examples of ethical issues with ethical challenges. The main task of nurses is taking care of patients, but they are legally and morally vulnerable due to the multidimensional aspect of job, complexity nature of the job, being a follower of orders for physicians and other factors. One of the most important values of the nursing profession is commitment to the professional obligations, responsibility and conscientious at work. Based on the nursing codes of ethics, nurses must be sensitive and responsible to the challenges and ethical issues in the workplace environment and society that undermined the sanctity of nursing care. They must be ready to respond appropriately when necessary (2). Conscientious objection to perform unethical interventions is an old concept in developed countries; however, it is a neglected concept in developing countries such as Iran.
The conscientious objection in health care has been defined as to avoid doing some interventions by HCP, when these intervention are incompatible with the values, morals and cultural of performer (3). In nursing profession, this concept refers to the objection of nurse to perform an intervention or to participate in a situation based on the own informed conscience. The conscientious objection includes three features: it is an internal sensation of distinguishing the right from the wrong; is internalizing of the family and social norms; is a reflection of moral integrity and sovereignty (4).
Violation of these features could lead to ethical conflict because of threating of the individual integrity. When a person listens to his/her inner conscience, hears only one answer "Do what you have to do". Respecting the conscience is similar to the ethical principle of respecting his/herself. Therefore, conscientious objection is one's commitment to the ethical principles or inner beliefs. The importance of maintaining moral integrity is one of the fundamental rights for conscientious objection.
Magelssen stated multiple situations for refusing to act conscientiously including: providing nursing care seriously violate his/her beliefs and moral integrity; have a valid moral and religious reasons, the proposed interv-entions are not as an essential part of professional work; burden of intervention to the patient is small. For example, the patient's condition is not life threatening, objection do not exclude patients to receive appropriate treatment; Burden to coworkers and health institutions is significantly small; the objection is rooted in nursing profession values; medical procedures are new or their moral status is unknown (5). According to some instances of non-objection of unethical intervention in national nursing services, it seems that the rights of nurses to object conscientiously doing illegal interventions are neglected and nurses have knowledge deficit about their rights, including conscientious objection.
A recent example of deception in this right was removing the sutures on the face of a child by nurse due to the inability of parents to pay fees. Patient dispel out of hospital with bleeding wound on the chin. State media reported this as a disaster. Of course in this case is quite clear that patients' rights are not respected by the medical team so this illegal and immoral act and was sentenced by the court. Therefore, it is recommended to take this important concept scrutinized by clinical investigators. In addition, various aspects such as the frequency of its events, admission criteria, moral conflicts resulting from its acceptance and its risk factors needed to be cleared through qualitative and quantitative research.