Nursing Code of Ethics Stands with Human Rights and So Do I

  

I am writing today to express support for all of the nurses who advocate for the rights of all human beings.  I am Liz Stokes, a Senior Policy Advisor for the ANA Center for Ethics and Human Rights, and have been a nurse for many years.  I spend each day informing, elevating, and advancing nursing ethics and human rights.  I stand with nurses in the fight for human rights with two things in my arsenal: (1) my stethoscope (because nurses do wear stethoscopes) and (2) the Code of Ethics for Nurses with Interpretive Statements (the Code).   When I became a nurse, I took an oath to commit to the tenets of the profession, including the Code.   “Nurses must always stress human rights protection with particular attention to preserving the human rights of vulnerable groups such as the poor, the homeless, the elderly, the mentally ill, prisoners, refugees, women, children, and socially stigmatized groups.” Interpretive Statement 8.4

What this blog is not:

  • A post about my political affiliation
  • My personal perspective on religious affiliation

This post is a reminder to my fellow nurses that we have an ethical obligation not only to stress human rights protection, but also to care for all.  We do not get to choose who we care for.  The word “patient” does not include identifying factors such as race, ethnicity, status, economic worth, criminal history, sexual orientation, gender, gender identity, immigration status, physical appearance, spiritual belief, disability, mental health, culture, or any other measure.  When a patient is in need, we answer the call of duty that we all were trained for.  We do so with compassion and respect and without bias or discrimination (intentional or unintentional).  This means that we have to be aware of our own biases in order to overcome them.  Take this opportunity to self-reflect.  What are your implicit biases? Take this moment to refresh yourselves with the Code that binds us and affirms, “A fundamental principle that underlies all nursing practice is respect for the inherent dignity, worth, unique attributes, and human rights of all individuals.” Interpretive Statement 1.1

Our profession is incredible.  We are the most trusted profession.  The power and influence we have on our patients, communities, and the world is profound.  Even when our personal perspectives vary- and they undoubtedly will- we must live up to our ethical obligations and be unified in our fight for equality in the treatment of all patients and zealous protection of human rights.

Over the last few weeks, many nurses across the world have expressed fear, uncertainty, sorrow, anger, and powerlessness on behalf of their patients and themselves.  Journaling, blogging, and other forms of written expression can be effective and therapeutic methods of dealing with intense emotions.  Please feel free to comment below and share your stories of advocacy and protection of our primary commitment- our patients.

 

GOP Meets for ACA Strategy Session and Senate Alternatives

  

Last week, there was flurry of activity and chatter on Capitol Hill surrounding the ACA’s repeal-and-replace. Much of the focus surrounded Congressional Republican’s three-day retreat in Philadelphia, where House and Senate Republicans were expected to plot their legislative agenda for the 115th Congress.

Congressional leaders held a special session on Thursday morning to try to reach a consensus on how to move forward on an ACA repeal and replacement strategy; unfortunately, no consensus was reached, which seemed to suggest that House and Senate Republicans were more divided on how to move forward than previously thought.

In the House, Speaker Ryan (R-WI) suggested on Thursday a more piecemeal approach towards health reform that’s focused on a “repeal and repair” of the system. Chairman Greg Walden (R-OR), a close Ryan ally, later this week will consider four separate bills that affect changes to the individual market in the House Energy and Commerce Committee. The changes would permit insurers to tighten enrollment periods, an attempt to try to ensure coverage for pre-existing conditions, and consideration on a measure to allow insurers to charge seniors higher rates. The committee will also examine potential reforms to the Medicaid program.

In the Senate, Senators Cassidy (R-LA) and Collins (R-ME) introduced the Patient Freedom Act. Hoping to chart a path that gives states options for reform, the bill would allow states to either 1) keep the ACA as is, 2) switch to a different insurance expansion plan that auto-enrolls individuals into a subsidized catastrophic plan, or 3) move forward with a repeal and no coverage expansion (meaning states would lose federal Medicaid expansion funds).

Senator Rand Paul (R-KY), also introduced his own bill. His legislation primarily focused on repealing the ACA’s employer and individual mandates, which includes a repeal of the ban on pre-existing conditions. The plan includes a two-year open enrollment period in which individuals with pre-existing conditions cannot be denied, but by and large the bill emphasizes tax credits and a more deregulated health market as an alternative to the ACA.

Stay tuned for more activity on Capitol Hill this week on the healthcare reform front.

Anxiety Over ACA Repeal Grows as Negative Impacts Become Apparent

  

Anxiety among both the public and lawmakers continues to rise as House and Senate Republicans last week took the first step toward their ultimate goal of repealing the Affordable Care Act.  At least 5 Republican Senators have stated their support for having a replacement plan to go along with any repeal legislation. Several Republican governors who have expanded Medicaid under the ACA have also expressed their concern over a model that does not include replacement legislation. Governors John Kasich and Rick Snyder of Ohio and Michigan, respectively, have been particularly vocal; their states stand to lose a combined $86 billion in federal funding if the ACA is repealed.

Efforts to repeal the ACA were further muddied on January 17th, when the Congressional Budget Office released its report which details the impact of repealing the ACA without replacement legislation. The CBO is the non-partisan Congressional office tasked with providing independent analyses of budgetary and economic issues to support the Congressional budget process. Highlights of the report include:

  • 18 million people could lose their health insurance coverage within the first year, and 32 million could lose coverage within ten years, between Medicaid and the individual insurance market
  • Destabilization of the individual insurance market due to the elimination of the individual mandate and premium subsidies for low-income individuals resulting in a “death spiral”
  • Half of the country would be living in areas with no insurer in the individual market in the first year, and three-fourths would live in such areas by 2026
  • Premiums for health insurance coverage purchased on the individual market would be 20 percent to 25 percent higher in the first year

Congress has a daunting landscape as it moves ahead with its plans to repeal and replace the ACA. It is a near certainty that the Affordable Care Act will be altered in some way. It is less certain what those alterations might look like. ANA stands by its core principles and demands that any replacement legislation reflect our principles: universal access to a standard package of essential health benefits for all citizens and residents; utilization of primary, community-based and preventative services while supporting the cost-effective use of innovative, technology-driven, acute, hospital-based services; the economical use of health care services with support for those who do not have the means to share in costs; and a sufficient supply of a skilled workforce dedicated to providing high quality health care services.