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Balancing act: Duty to provide care vs. personal values and beliefs

A case study about conscientious objection

During change of shift report, Joy learns she’ll be caring for Ms. Downey, an off-service client admitted for treatment of a chronic medical condition.


As part of her treatment, Ms. Downey requires a blood transfusion, but administering blood products conflicts with Joy’s personal values and beliefs. While the unit is usually staffed with two RNs, today, Joy is the only RN on shift.

Before accepting a position on the unit, Joy discussed her conscientious objection to administering blood products with the manager. After confirming that Joy’s conscientious objection was based on Joy’s personal values and beliefs about administering blood products – and not personal judgments or biases about a client population or lifestyle – the manager agreed to accommodate Joy’s request.

Transfusions are a rare occurrence on the unit, and Joy’s objection has never been an issue until today. ​

 What does Joy consider?

Her professional and legal obligations

​Joy has a professional and legal obligation​ to make sure Ms. Downey receives safe, compentent and ethical care.​

The conflict with her personal values and beliefs (conscientious objection)

​Joy needs to reflect on the effect of her personal values and beliefs in providing care for Ms. Downey​, identify the conflict and how to resolve it. In this circumstance, it may be acceptable for Joy to withdraw from providing this aspect of Ms. Downey's care. 

Ms. Downey is the primary concern in providing nursing care

Joy knows she cannot allow her beliefs or values to alter or interfere with Ms. Downey recieving a blood transfusion. She must continue to provide general nursing care until another care provider is available to take over Ms. Downey's care and administer the blood product. 

Urgency of the treatment

Joy understands that, if Ms. Downey's condition unexpectedly worsens and requires urgent lifesaving action, she will need to provide the necessary care, regardless of her personal values and beliefs.

 What does Joy do?

She takes the following steps:

​Joy understands her responsibility to make sure Ms. Downey receives safe, competent and ethical care. 

  • She first confirms the urgency of the transfusion. She learns that while Ms. Downey will need the transfusion in the next 12 hours, it’s not required immediately. 
  • Joy calls her supervisor to inform him of the situation, detailing the specific treatment, the conflict with her values and beliefs about this treatment, and the accommodation she’s been granted by the unit manager. 
  • She then confirms with the supervisor that another RN will take over Ms. Downey’s care to administer the blood product later in the shift. 
  • Once she’s off the phone, Joy goes to check on Ms. Downey, letting her know when she’ll be receiving the transfusion. Joy continues to care for Ms. Downey until she hands over to the other RN.  

 What would you do?

  • ​What would you consider if you were facing a similar situation?
  • What would you do if Ms. Downey's condition required urgent or lifesaving treatment?
  • What is your experience with conflicts between client care needs and the personal values and beliefs of others?

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