Brenda Chaney brought suit against the nursing home for complying with a resident’s request not to have any black health care workers provide care or enter her room. (She also claimed her firing had been racially motivated. The court agreed that it seemed discriminatory.) The court agreed with Chaney that by acceding to the patient’s wishes, her employer created a hostile workplace and violated her rights. The nursing home claimed it was protecting the patient’s rights and that not doing so “risked violating state and federal laws that grant residents the rights to choose providers, to privacy, and to bodily autonomy.” The court did not agree.
Of course, most people think, in the abstract at least, that it’s pernicious and wrong to believe race affects the provision of health care, and a request for treatment only by “white” staff takes racism to some bizarre extremes.
I would agree. Patients shouldn’t be able to pick their nurses on the basis of race — and yes, I have heard that request voiced more than a few times. Frankly, I don’t see the necessity of pandering to anyone’s bigotry, any more than I would tolerate racism towards a patient from my colleagues. Some behaviour crosses the line, and while nurses must treat their patients with respect and dignity, it’s also a two-way street.
While health care professionals’ indelible personal characteristics may be irrelevant to providing good care, can one apply this point of view absolutely in dealing with patients in all circumstances? Does it override one of the cornerstones of health care ethics, patient autonomy, the right of the patient to decide the course of their care? Matters are much trickier than they might first appear, for they require providers treading through a minefield of strongly held personal, religious and cultural beliefs. Then there are pragmatic aspects to consider. For example, a nurse might well hesitate before assuming care of a racist patient, on the basis the patient might be more inclined to make false complaints about his practice. Another example: as a charge nurse, I will ask female nurses, rather than my male colleagues, to perform intrusive procedures like ECGs (which require exposure of the chest) on female Muslim patients, because I believe it’s expedient to providing the best possible care for the patient. But in emergent cases, any set of skilled hands will do, for exactly the same reason, which suggests to me patient autonomy is always constrained by patient acuity, regardless of personal attitudes towards those providing treatment and care.
Some thought experiments to consider:
1. A Muslim or Hasidic Jewish patient requests same-sex nurses only, and refuses care from a nurse of the opposite sex. Is this different from refusing care because a patient is uncomfortable with a person’s race? Why?
2. A fundamentalist Christian doesn’t want to be touched by a gay male nurse, on religious grounds. Should she able to refuse care on the grounds of the nurse’s sexual orientation? Is this different from the Muslim or Hasidic Jewish patient?
3. What if it’s your ailing, elderly Gran, normally a sweet, kind lady, except for that adamant blind spot about blacks/gays/male nurses? What would you tell her? What if she was dying?