Can Spiritual Care Be Coercive?
In each of these scenarios, the nurse introduces personal religious beliefs or practices. Indeed, the religious nurse cannot stuff her spirituality into a locker. But when does the introduction of the nurse's spiritual or religious (S/R) beliefs and practices become forced, even coercive, contributing to unethical care?
In Provision 5.3 of the American Nurses Association's (2015)Code of Ethics, nurses are admonished to preserve the “wholeness of [their] character” by respecting their personal moral viewpoints, while also supporting moral discourse among clients and colleagues, when the clinical situation merits it. In this context, the following counsel is found:
When nurses are asked for a personal opinion, they are generally free to express an informed personal opinion, as long as this maintains appropriate professional and moral boundaries and preserves the voluntariness or free will of the patient. Nurses must be aware of the potential for undue influence attached to their professional role. Nurses assist others to clarify values in reaching informed decisions, always avoiding coercion, manipulation, and unintended influence. (p. 20)
This statement recognizes key ethical principles for introducing personal religiosity during patient care: 1) the autonomy or freedom of the patient must be respected; and 2) nurses must recognize the inherent power differential in the nurse–patient relationship and seek to avoid abusing their power (Taylor & Fowler, 2011).
Nurse scholars have addressed intersecting personal and professional boundaries in spiritual care (French & Narayanasamy, 2011; Pesut & Thorne, 2007; Polzer Casarez & Engebretson, 2012; Taylor, 2012). All agree the nurse should never impose personal religious beliefs or practices. Most nurses know this. But where does the boundary line in the sand get drawn? Distilling these scholars' thinking leads me to offer this guidance:
Were the nurses in the scenarios coercive? It is likely that the first nurse was, and possible that the other two were also—if they did not apply the above guidance.