Conscientious Objection from Enforcing Treatment

I’ve been thinking about this issue quite a bit recently.
I’m grateful to you, Gary, in digging out the NMC link: https://www.nmc.org.uk/standards/code/conscientious-objection-by-nurses-and-midwives/
I’m wondering what people think of our current provision for CO? Are we asking for an extention of this? I find the business with “They must arrange for a suitably qualified colleague to take over responsibility for that person’s care” (see link) very questionable. I certainly want to discuss that further.

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I had a lecture on the MHA and in that same lecture our teacher told us about a time she had CO’d in relation to supporting someone have an abortion due to her religion. And I wondered if one day we would be able to CO to enforced treatment, coming from a human rights perspective. So I’m very excited to come across this discussion, and to not feel alone in wondering whether this could ever be a possibility. It seems so overwhelming though.

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How could we annwer the question that MH nurses can already object – and many do – by getting a community job?

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As a background, I am a Charge Nurse on an Adolescent Psychiatric Intensive Care Unit. This area of MH services is typically (I say typically, as I think assumptions are unhelpful) associated with higher rates of enforced treatment. Indeed, all of the patients who are on the ward are compelled to be there, i.e they are detained under the Mental Health Act. Thus, it could be argued that their entire treatment regime (which the courts have defined widely, to include not just medication and therapy, but also nursing care) is enforced.

For the purposes of this discussion I think it makes sense to focus to define treatment as the enforcement of coercive and restrictive interventions e.g medication, restraint, seclusion. There is a wider debate about involuntary hospitalisation as a whole, but it is important to make a distinction between enforced ‘hospitalisation’ and enforced ‘treatment’ (defined above) as they are both different things and involve very different decision making. It may be felt to be necessary for someone to be compelled to be taken into hospital, but inappropriate and unethical to enforce treatment on them.

I want to illustrate a point from my own work environment. We recently undertook a seclusion audit of our ward, which provided us with an insight into reasons for seclusion, duration of seclusion, as well as the nurse who initiated it. It was striking that some nurses did not seclude patients at all or minimally (1 or 2 instances over a 6 month period), whereas some other nurses appeared to be much more likely to (10 to 15 instances over the same time frame). Although the audit has not taken place, I am sure that the initiation of enforced medication via rapid tranquillisation would tell a similar story This is worth further inquiry. We have worked with the same patient group. We have nursed them at all stages of admission and at during times of varying acuity. No one nurse has dealt with more difficult situation than the other. So why is this happening? Despite some nurses’s attempts to reduce enforced treatment (arguably a form of pragmatic CO), there are still others who are much more likely to use it. Does this defeat the object of CO if there’s always someone else to do “the dirty work”?

I’d like to quite Peter Bartlett about this particular point: “…the decision regarding….compulsory treatment will depend to an unacceptable degree on the professional staff assessing the individual. This will in turn often depend on who is on duty when the individual is apprehended: detention, enforced treatment and human rights become a lottery.”

I wonder if CO does not necessarily achieve the necessary goal, and an individual decision not to enforce treatment does not stop someone else from doing so. Thus, violence remains central to our profession. Perhaps we need to talk about a collective decision to stop enforcing treatment all together…

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