Healthcare providers are occasionally asked to participate in care that conflicts with their moral, religious, philosophical, or ethical beliefs. When faced with such a conflict, an increasing number of healthcare providers are refusing to provide care, a phenomenon known as conscientious objection. Laws and policies exist at the international, national, state, and institutional levels allowing healthcare providers to abstain from providing such care. This study was designed to examine Massachusetts nurses' behaviors, attitudes, and characteristics related to conscientious objection.

The Conceptual Model of Nursing and Health Policy guided the study. A survey was sent to a random sample of Massachusetts nurses between November 2016 and February 2017. A total of 297 surveys were returned (response rate 43%).

The prevalence of conscientious objection was 14%. When considering those nurses who have encountered an objectionable situation (59%), the prevalence of conscientious objection was 25%. Analysis of theoretically controversial situations revealed abortion for failed contraception as the highest level of objection (40%) and withdrawal of artificial life support as the lowest rate of objection (3%). The majority of nurses indicating engagement in conscientious objection listed excessively aggressive treatment for the prognosis as the primary clinical situation in which conscientious objection occurred (55%).

Nurses who reported higher levels of spirituality, disagreement with professional obligations, and a master's level education were more likely to exercise their right of conscience. No other demographic factors were associated with conscientious objection. When the number of healthcare interactions between patients and nurses is considered, if nurses exercise their right of conscience in as many as 25% of objectionable situations, it is reasonable to assume that patients may experience a lack of access to care to which they are legally entitled. The results of this study suggest that for nurses, the decision to object may be due to patient advocacy rather than to moral or religious objections. As healthcare systems work to mitigate negative patient and operational consequences of conscientious objection, healthcare provider demographic data may not be useful in predicting who is likely to object. The findings of this study suggest that focusing efforts on staff who are likely to encounter specific controversial clinical situations may be the best way to identify those who are more inclined to object.