# Situation: A public health nurse at a Rural Health Unit (RHU) provides prenatal and postpartum care. She works with barangay health workers (BHWs) and barangay nutrition scholars. A nurse at the RHU has a sincere religious objection to providing hormonal contraceptives and has declared it in advance. A woman 6 weeks after giving birth, well and with no danger signs, asks her to start the injectable method. After the Supreme Court's 2014 ruling on the Responsible Parenthood and Reproductive Health Act (RA 10354), which statement describes the nurse's position?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629610  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A public health nurse at a Rural Health Unit (RHU) provides prenatal and postpartum care. She works with barangay health workers (BHWs) and barangay nutrition scholars.

A nurse at the RHU has a sincere religious objection to providing hormonal contraceptives and has declared it in advance. A woman 6 weeks after giving birth, well and with no danger signs, asks her to start the injectable method. After the Supreme Court's 2014 ruling on the Responsible Parenthood and Reproductive Health Act (RA 10354), which statement describes the nurse's position?

## 보기

1. She must provide it, because a nurse in a public health facility cannot be an objector
2. She may decline, but she is penalized if she does not refer the woman to another provider
3. She may decline, and she is ethically expected to say where the service is available **✔ 정답**
4. She may decline, but only after the woman signs a waiver releasing the nurse from liability

**정답: 3**

## 해설

RA 10354 respects conscientious objection, and in 2014 the Supreme Court struck down both the implementing rule that barred public officers such as provincial, city, or municipal health officers, chiefs of hospital, head nurses, and supervising midwives from being objectors and the penalty on objectors who do not refer non-emergency clients. The nurse may therefore decline this non-emergency service, but she is ethically expected to tell the woman where it is available. Objection never applies to emergency or serious cases.

## 심화 해설

The nurse's position after the 2014 ruling
The Responsible Parenthood and Reproductive Health Act of 2012 (RA 10354) respects conscientious objection: a health care provider may decline to provide reproductive health services that conflict with sincere religious or ethical beliefs. In 2014 the Supreme Court struck down two provisions related to objectors. It invalidated the implementing rule that barred certain public officers from being objectors, and it struck down the penalty on objectors who fail to refer non-emergency clients. The nurse may decline this non-emergency request, and she is ethically expected to tell the woman where the service is available.

What the Supreme Court struck down

| Provision | Status after 2014 |
| --- | --- |
| Implementing rule barring public officers such as provincial, city, or municipal health officers, chiefs of hospital, head nurses, and supervising midwives from being objectors | Struck down |
| Penalty on objectors who do not refer non-emergency clients to another provider | Struck down |
| Objection in emergency or serious cases | Still not allowed; care must be given |
| Ethical expectation to say where the service is available | Remains |

Why the distractors are wrong
Saying that a nurse in a public facility cannot be an objector applies the implementing rule that the Court invalidated; a staff nurse at the Rural Health Unit may object. Saying she is penalized if she does not refer applies the penalty that was struck down; referral remains an ethical expectation, not a legal obligation backed by a penalty. Requiring the woman to sign a waiver releasing the nurse from liability has no basis in the law. Watch out! Both the second and third options say she may decline; the difference is whether a penalty attaches to not referring. After 2014, it does not.

Limits of conscientious objection
Conscientious objection never applies to emergency or serious cases. If a woman's life or health is in immediate danger, the provider must give care regardless of personal beliefs. Here the woman is well, 6 weeks postpartum, with no danger signs, and is asking to start an injectable contraceptive, which is a non-emergency service. The nurse declared her objection in advance, which allows the facility to arrange for another provider so that clients are not left without service.

Balancing two rights
Ethically, the nurse's freedom of conscience is respected, but so is the woman's right to information and access to family planning. Telling her where the service is available respects both. The nurse avoids lecturing or discouraging the woman, and she does not delay the woman's access through unnecessary steps.

Exam takeaway
After the 2014 ruling, a nurse may conscientiously object to a non-emergency reproductive health service without penalty for not referring, but she is ethically expected to say where it is available. Key point! Objection is never allowed in emergencies.

## 임상 시나리오

Conscientious Objection Under RA 10354Staff nurse asked to start an injectable method
A provider with a sincere religious objection may decline a non-emergency reproductive health service.

The 2014 Supreme Court ruling struck down the bar on public officers being objectors and the penalty for not referring.

She is still ethically expected to tell the woman where the service is available, without delay or judgment.

CautionConscientious objection never applies to emergency or serious cases.

## 핵심 개념

- **Conscientious objection** — A provider's refusal to take part in a service that conflicts with sincere religious or ethical beliefs.
- **RA 10354** — The Responsible Parenthood and Reproductive Health Act of 2012, which governs family planning services.
- **Injectable contraceptive** — A hormonal contraceptive given by injection, usually every 3 months.
- **Referral** — Directing a client to another provider or facility that can give the needed service.

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