Editorid

OR nurses c I * *

tace decision in abortion procedures

The recent Supreme Court decision on abor- tions has profound implications for OR nurses. The recognition of abortion on request as a legal procedure during the first trimester means some OR nurses who have not previously been involved with abortions may face the decision of whether or not they alre willing to assist with abor- tion on request.

(At the AORN Congress in March, the House of Delegates approved a position statement on the nurses’ rights regarding abortion. It was published in the April Journal.)

A nurse’s right to refuse to participate in the medical termination of pregnancy has been reinforced by the Court’s decision.

In the past, nurses have sometimes been forced to assist in abortion procedures or face losing their jobs. However, as abortion on request has become legal and more widespread, most hospitals have permitted nurses and other hospital personnel to re- fuse to participate on moral or religious grounds. Many state abortion laws carry provisions to this effect.

In January, when the Supreme Court ruled on abortion, it did not strike down the provision in the Georgia law (41 LW 4233) which statez:

Nothing in this section shall require o hospital to admit any patient under the conditions hereof for the purpose of per- forming an abortion. A physician, or any other person who i s a member of, or as- sociated with, the Staff of the Hospital, or any employee of the hospital in which an abortion has been authorized, who shall state in writing an objection to such abortion on moral or religious grounds shall not be required to participate in the medical procedures which will result in the abortion, and the refusal of any such person to participate therein shall not form the basis of any claim for dam- ages on account of such refusal, or for any disciplinary or recriminatory action against such a person.’ This means that if your state law has a

similar provision, it is still valid. And unless your state specifically rules to the contrary you have a constitutional right to refuse to participate in abortion.

May 2973 13

Checking with several AORN members, we found that there i s apparently little dis- pute over the exercise of the nurse’s right of refusal.

Rose Deutschman, RN, a staff nurse at St Luke‘s Memorial Hospital, New Hartford, NY, reports that when the New York State abortion law was passed, OR nurses in her hospital were asked whether or not they wished to participate-if not, they were asked to submit the request in writing.

Ruth Backup, RN, OR supervisor at Uni- versity Hospital, Seattle, says that she asks her staff to put requests not to participate in writing. She tries to avoid assigning nurses to sterilization procedures if she knows they have objections.

At Johns Hopkins Hospital, Doris Arm- strong, RN, director of nursing, explains that the situation is somewhat different. OB/GYN procedures are performed in a separate operating room suite and nurses are hired specifically for that area. Before they are hired, they are informed that a number of abortions are performed and that they will be required to participate on a routine assignment. This i s reiterated in their letter of employment.

Swanee Anderson, RN, former president of the Nurses Association of the American College of Obstetrics and Gynecology (NAACOG), and director of nurses at St Luke‘s Hospital in Denver, believes that in virtually all hospitals in the country, nurses are able to exercise their right to refuse to participate in abortions. She recalls only one incident reported to NAACOG last year.

Nurses who are opposed to participation in abortion for religious or moral reasons who encounter difficulties may find the fol- lowing advice from the Regan Report on Nursing Law2 helpful.

What can a nurse do who wishes to retain her employment, but does not wish to participate in abortion procedures? Cer- tainly it would be wrong for her to wait

until the first abortion case presents it- self while she is on duty and at that point to adamantly refuse to assist the surgical team in accordance with her assignment. Properly, the surgical nurse who is conscientiously apposed to participating in the anticipated abortion(s) to be per- formed in her hospital, should make her moral or ethical reservations known to the Nursing Service Office so that ap- propriate arrangements can be made for substitute coverage.

The hospital’s right to refuse to perform abortions was clarified recently by a state- ment issued by the American Hospital As- sociation:

Hospitals may elect to perform abortions legally, consistent with valid state laws and the new decision. In exercising that election they should be able to present reasonable rules and regulations for pa- tient care that do not constitute “state action” outlawed by these decisions. Abortion patients should not receive sub- standard treatment.

The AHA statement also affirms the pa- tient’s right to good care. Although the nurse has a right to act within her moral and religious beliefs, the patient also has a right to medical and nursing care.

NAACOG believes that written policies should be adopted in this area of health care and has issued a statement recom- mending the following principles and guide- lines:

1. Nurses have the responsibility to pro- vide nursing care.

2. Nurses have the right to refuse to as- sist in the performance of abortions and/or sterilization procedures in keep- ing with their moral, ethical and/or re- ligious beliefs. This should not jeopardize their employment nor should they be sub- jected to harassment or embarrassment because of their refusal. d+

14 AORN Journal

3. Nurses' professional responsibility should lead them to disregard a ques- tioned moral issue in an emergency when a patient's life i s clearly endangered.

4. Nurses should not be judgmental in dealing with such patients nor try to irn- pose their views on the patients or per- sonnel.

5. Nurses have the right to expect their employer to describe to them the hos- pital's policies and practices regarding abortions and sterilizations.

6. Nurses have the obligation to inform their employer of their attitudes and be- liefs regarding abortions and steriliza- tions.

Whether or not one agrees with the recent Court decision, there seems little ques- tion that the number of abortion proced- ures will increase. Many OR nurses may have to face decisions that they have been able to avoid. They will have to decide as individuals how to resolve their moral and religious principles and their professional

obligations as nurses. 0 Elinor S Schrader

Editor REFERENCES

1. WA Regan, "Professional Nursing and the Abortion Decisions,'' The Regan Report on Nursing Law, 13 (February 1973), I.

2. /bid

Parkinson's disease enzyme isolafed Scientists a t Yale University's School of Medicine have isolated an enzyme which i s essential t o the brain's control of bodily movement and appears t o have significant implications for the treatment of Parkinson's disease. Paul Greengard, MD, Gary Petzold, MD, and John Kebabian, MD, conducted the research.

In recent years, medical scientists have produced evidence that a specific part of the brain, the caudate nucleus, plays a major role in directing movement of the body. In turn, the chemical compound dopamine i s believed to regulate the activity o f the caudate nucleus by interacting with a previously unknown chemical substance, the "dopamine receptor". Abnormalities o f the dopamine system in the caudate nucleus are believed t o be a major factor in Parkinson's disease, an illness characterized by lack of control over movement.

Dr Greengard's research team h.s now isolated from the caudate nucleus o f experimental animals an enzyme which appears t o be the dopamine receptor. I t s name, "dopamine-sensitive adenylate cyclase", describes the chemical change it produces. Activi ty o f this enzyme i s stimulated by extremely low concentrations of dopamine.

Apar t from increasing basic understanding of how the brain works, clinical implications of the Yale team's findings are far reaching. The search for new drugs useful in the treatment o f Parkinson's disease has been greatly hampered by lack of a suitabl test system. Isolation o f the dopamine receptor now makes it possible t o carry our rapid testing o f large numbers of compounds for dopamine like activity and should accelerate the discovery of new com- pounds for treatment of the disease.

A secondary yield of the research may lie in the treatment o f mental illness. Tranquil- izers such as the phenothiazines and butyrophenones produce a maior side effect in patients. They cause symptoms similar t o those seen in Parkinson's disease. Such unwanted side effects have limited the freedom of physicians t o use these drugs.

Medical scientists generally believe that the effect of these tranquilizers results from their interfering with the action of doparnine on the dopamine receptor. Greengard's group has confirmed that the tranquilizers d o interfere with the abi l i ty of dopamine t o activate the controlling enzyme isolated from the caudate nucleus. Discovering the chemical basis of a major undesirable side effect of the tranquilizers may facilitate the development o f new tranquilizer agents devoid of such side effects.

The report of the research team's findings appears in the August issue of the Pro- ceedings o f the National Academy of Sciences.

16 AQRN Journal