When religious beliefs conflict with professional duties how do we decide what's fair? We asked Richard Rowson, the man who wrote the rules
When Lord Carey, the former Archbishop of Canterbury, argued last month that civil liberties cases involving Christians should only be heard by judges favourably disposed towards that faith, he illustrated the minefield of competing “rights” that employers are forced to navigate in order to meet their obligations to both their employees and those they serve. Carey, who subscribes to the view that Christians are being “persecuted” in Britain today, was referring to several recent high-profile rulings in which he feels Christians have been discriminated against. There’s the case of Shirley Chaplin, the nurse who was refused the right to wear a cross pendant which contravened NHS uniform code, and Lillian Ladele, the Islington registrar who lost her job for refusing to conduct civil ceremonies for gay couples. In those instances Carey, along with sections of the tabloid press, sees persecution. But when similar cases involving other religions result in favourable judgements, political correctness is seen to have gone mad. Thus after it was revealed that Muslim nurses would be allowed to cover their forearms to preserve their modesty, despite uniform regulations requiring doctors and nurses to keep theirs uncovered in the interest of hygiene, the Daily Mail despaired that “Muslim nurses CAN cover up . . . but Christian colleagues can’t wear crucifixes.”
Such dilemmas are bound to arise in a multicultural society, but how should they be resolved? We invited Richard Rowson, author of Working Ethics, who has devised a formula widely used in the public sector to settle such disputes, to explain.
As a moral philosopher I have spent much of my life not only analysing views about ethics from Plato to the 21st century, but applying them in a practical way by helping professions develop their ethics policies. People I have worked with include nurses, doctors, social workers, teachers, psychotherapists and government departments.
When I begin working with these professions two questions are always raised: “What do we mean by ethics?” and “Whose ethics should we adopt, since there are so many ethical perspectives around?” It soon becomes clear that we should not base policies on the values of any specific religious or secular perspective because members of the profession work with people of different faiths and of no faith. If we were to base policies on, say, Christian or on humanist ideas, then non-Christian or non-humanist patients, clients, students and others might fear that the professionals would not be sympathetic to their interests and might discriminate against them. Such lack of trust could prevent the profession achieving its objectives. Nurses, for instance, are more likely to bring care, comfort and cure to patients who trust them to value their wellbeing and respect their cultural views.
so how do we find values that are appropriate? The answer: within the profession’s own objectives and the context in which it operates. For instance, the basic objective of nursing is to care, comfort and promote cure for all patients regardless of their cultural affiliation, race, religion, sexual orientation or level of disability. Implicit in this objective are the ethical concerns to seek the best results for patients and to be fair by not discriminating between them. To gain the trust of patients nurses need to act with integrity towards them and to respect their informed wishes. So, the appropriate shared values for nursing are fairness, seeking the best results, acting with integrity and respecting autonomy. By rearranging the sequence of values we have an easily remembered ethical framework: Fairness, Autonomy, Integrity and Results, known as the FAIR framework. When applying the framework, employers have to balance the obligation of the profession to achieve its objective and the values of respecting the autonomy of its employees and the users of its services, seeking the best results for all affected by their decision, acting with integrity and not discriminating against employees and service users.
It has turned out to be an appropriate ethical basis for decision-making in many professions. Various institutions have adopted it, finding its guidance particularly useful when faith views impinge on professional practice. While of course decisions taken using the FAIR framework will not always please everyone, they show an approach to making decisions about faith requests which is impartial between religions. When employers refuse a request from a particular religion they do not do so because they disagree with that religion, nor because they wish to promote the view of a rival religion or to take an anti-religious stance. The FAIR values are neither specific to any religion nor are they anti-religious – they are simply non-religious.
Case study 1: A Christian nurse asks to be excused from caring for women undergoing termination of pregnancies
Here, the employer has an obligation to provide for the termination of pregnancies. It also has both an obligation to respect the autonomy of women requesting termination and a potentially conflicting obligation to respect the request of the nurse not to participate in the procedure. There is also a potential conflict between seeking the best results for the patient and those for the nurse. The integrity of the nursing service requires it to fulfil its function of providing terminations. Unfairness to employees might arise if acceding to the nurse’s request made her work load less than normal and the work load of other nurses more so.
By bearing in mind these considerations the employer decides to accede to the nurse’s request so long as nurses who do not object to terminations are available to take part in the procedures, and so long as the nurse who made the request can be fully employed in other ways. While the employer will strive to ensure other nurses are always available, if that is not possible the nurse may be required to provide support for a termination.
In this situation the employer does its utmost to respect the autonomy of its employee, so long as doing so can be made compatible with its other countervailing obligations (in this case, to provide the service which is part of its professional objective and to prevent harm to the patient); but it considers that when this is not possible, its countervailing obligations outweigh the ethical importance of acceding to the nurse’s request.
Case study 2: A Muslim nurse working in a hospital asks to wear a veil to protect her modesty
In this case, the employer allows the nurse to do so for a week and monitors how it affects her work. In the hospital the majority of patients are not Muslim and some of these – particularly the old, the confused and children – are frightened by her appearance. Some cannot relate to her because they cannot see her face. Even though she treats them well it is clear that some are not comforted or reassured by her attention. Since one of the objectives of nursing on a ward is to give care and comfort it is decided that wearing the veil interferes too much with the objectives of her work and so her request is rejected.
Case study 3: A Muslim female police officer asks to vary her uniform by wearing a hijab to cover her hair
Here, the authorities decide that though the hijab is not part of the normal uniform she should be allowed to wear it. They consider that since it does not impair the effectiveness of her work they have no obligations which conflict with that of respecting her autonomy.
Case study 4: A male police officer asks not to have to deal with homosexual members of the public
Because of his religious views, the officer says he finds it difficult to treat them with the same respect as other members of the public as is required by police regulations. The authorities consider that since it is impossible to arrange an officer’s duties to ensure he does not encounter homosexuals, if they were to try to accede to his request he could not be a fully contributing officer. Moreover, they take the view that the importance of delivering police services in a fair and non-discriminatory way outweighs the importance of respecting the officer’s views. They conclude that he must either comply with the regulation to treat homosexuals with respect or leave the service.