6cs of Roach in Caring for Conscientious Objection and Abortion - Book Report/Review Example

Roach's 6cs Of Caring In Relation To Conscientious Objection And Abortion The health profession, as a whole, is based on care and compassion; it is like a framework through which health personnel implement the art and science of their professional practice. Care is therefore and integral part of the nursing profession. It can be described as the vehicle through which nurses interact with their clients. Such interaction includes the ability to help patients cope with their pains and suffering associated with ill health, to help them find meaning and purpose in their experiences, to help promote health and wellness and when all these fail, to help patients die with integrity. According to Benner and Wrubel (1989), "caring is action that nurtures; action that fosters growth, recovery, health and protection of those who are vulnerable", adding weight to this assertion, Roach stated that "Caring is the empowering of those for whom care is given". I would like to state here, that this essay takes confidentiality into consideration, and shall uphold it with diligence. Further emphasising the importance of care in the provision of nursing care, Roach categorised the attributes of care to what can be referred to as the 6C's of care in the health profession. The attributes of care, as illustrated by Roach include: Compassion, Competence, Conscience, Commitment, Comportment and Confidence (Roach, 2002) Let's take a look at each of these attributes as described by Roach. Compassion: Compassion means to be with another in their suffering. It is empathy and sensitivity to human pain and joy that allows one to enter into the experience of another. It is the understanding of whom that person truly is, for whom one is caring. "With compassion, one becomes a colleague of humanity" (Roach, 1992). Compassion is an essential component of the nurse/client relationship. Competence: Competence is acquiring and using evidence-based scientific and humanistic knowledge and skill in the application of therapeutic interventions in the current practice of nursing. Competence is reflected in the cognitive and affective domains of learning. It is the knowledge of the role of the nurse in the health care delivery systems of the hospital and the community. Conscience: Conscience directs moral, ethical and legal decision-making. It motivates one to increase the knowledge and skills needed to respond appropriately to moral, ethical and legal issues faced by one and others. It directs one to adhere to the standards of professional nursing practice. It directs one to respond to social injustices. It is the increased awareness of local, national and global health concerns and current trends in health care that affect all ages and populations. It is the sense of accountability, responsibility and leadership for patient care. Confidence: Confidence is trust in one's ability to care for others. It is the belief that one's skilled, professional presence can make a difference. Confidence is necessary to effectively implement the roles of the nurse as caregiver, teacher, counsellor, advocate, leader, manager, and researcher. Confidence in one's ability to create a caring environments serves as a catalyst for change. Confidence empowers oneself and others to define and accomplish goals. Confidence is developed through the successful utilization of knowledge and experience. Commitment: Commitment is maintaining and elevating the standards and obligations of the nursing profession and assuring the delivery of excellence in nursing care. Commitment is the loyal endeavour to devote oneself to client welfare. It assures that care will be part of every nurse-client interaction. It is a conscious effort to grow within the nursing profession through dedication to continuing education, life-long learning, and becoming more skilled, socially conscious, ethical, politically competent and caring. Comportment: Comportment is the professional presentation of one's self to others in behaviour, attitude, appearance, dress and language that communicate a caring presence. It includes the need for self-awareness, awareness of impact of self on others, and accepting responsibility for one's actions. This extends to responsibility for the healthcare environment and the behaviour of others who contribute to it (Roach, 1992). However, despite this huge task of care that nurses have to ethically and morally assume, several controversial and contentious area, such as physician assisted suicide and abortion are two areas of treatment where conscientious objections i.e. the right to choose not to participate in treatment, seems quite reasonable. Abortion became legalised by the Abortion Act 1967, which was amended in 1990 by section 37 Human Fertilisation and Embryology Act. By legalising abortion, the Abortion Act serve to protect women and their health professionals from prosecution for illegal abortion under an older law; the Offences Against the Person Act 1861. The grounds for abortion to become legal were spelt out in the act and once any of these criteria was met, the termination of a pregnancy did not constitute an offence. The text of the Act reads thus: (1) Subject to the provisions of this section, a person shall not be guilty of an offence under the law relating to abortion when a pregnancy is terminated by a registered medical practitioner if two registered medical practitioners are of the opinion, formed in good faith-- [(a) that the pregnancy has not exceeded its twenty-fourth week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family; or (b) that the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman; or (c) that the continuance of the pregnancy would involve risk to the life of the pregnant woman, greater than if the pregnancy were terminated; or (d) that there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.] (Abortion Act 1967) After the Act was amended by the Human Fertilisation and Embryology Act 1990, the restriction was removed and it became legal to terminate a pregnancy at any gestation, provided the criteria was met and certified by two medical doctors, "acting in good faith". However, The Abortion Act 1967 also included a conscientious objection clause which permits doctors or nurses to refuse to 'participate' in terminations of pregnancy though, they are obliged to provide necessary treatment in an emergency when the woman's life may be jeopardised. The rights of nurses to conscientious objection to termination of pregnancy has been supported and upheld by several health institutions and in legal authorities. For instance, it is against the BMA's policy to marginalize or harass doctors who hold conscientious objection to termination of pregnancy (Wicclair, 2000). The conscientious objection clause, in the 1967 Act was given further legal backing when it was clarified by a Parliamentary answer in December 1991. It was made clear that conscientious objection applies to participation in treatment involving termination of pregnancies in anyway. Although, hospital managers were asked to, at their discretion, apply the principle, by extension, to auxiliary staffs who are involved in the handling of foetuses and foetal tissue. Such extension in the application of the conscientious objection clause, in the 1967 Act would further give meaning to the principle. As a student who spent six weeks in a gynaecology ward where terminations of pregnancy was carried out almost everyday, I know what it means to have to see and handle dead foetus on such a large scale against one's personal values and beliefs. Afterall, irrespective of the responsibilities of care and compassion on the side of a nurse, it will not still be beneficial for women undergoing termination to be cared for by nurses who feel distressed or unhappy about their involvement in the procedure. Considering this situation objectively, one will be forced to draw a line between the legal issues, moral and ethical obligations involved in abortion. From the legal point of view, some actions fall outside the scope of the conscientious clause, such as completion of the form for abortion, or typing the referral letter, as is evidenced in House of Lords' decision in the case of Janaway v Salford Health Authority in 1988 when a doctor's secretary (Janaway) refused to type the referral letter for an abortion and claimed a conscientious objection under the Act. The House of Lords, in interpreting the word "participate" in this context, decided to give the word its ordinary and natural meaning - that is, that in order to claim conscientious exemption under section 4 of the Act, the objector had to be required to actually take part in administering treatment in a hospital or approved centre. In the same case the judge went on to say that "The regulations do not appear to contemplate that the signing of the certificate would form part of the treatment for the termination of pregnancy". One can objectively assert, on moral grounds, that these actions, since they are relevant to the process of abortion, are also an integral part of the abortion procedure, thus exemption of grounds of conscience should also be allowed, though discretionally. The principles of care, as envisioned by Roach apply to both parties. The nurse is supposed to be confident, composed and committed. These attributes may be missing if the nurse has to carry out the duty of caring for a patient under distress and against personal values and belief system (Roach, 1997). References. Wicclair MR (2000). Conscientious objection in medicine. Journal of Bioethics. 14(3):205-27. Benner, P. & Wrubel, J. (1989). The primacy of caring: Stress and coping in health and illness. Menlo Park, California: Addison-Wesley Publishing Co. Kozier, B., Erb, G., Berman, A. & Burke, K. (2004). Fundamentals of nursing: Concepts, process, and practice (7th ed.). Upper Saddle River, New Jersey: Prentice Hall Health. Roach, M. S. (1992) The human act of caring: A blueprint for the health professions. (Rev. ed.). Ottawa, Canada: Canadian Hospital Association Press. Roach, M.S. (1997). Caring from the heart: The convergence of caring and spirituality. New York, New York: Paulist Press. Read More