Capitol Beat – Page 51 – From the American Nurses Association

What No One Tells You About Torture

Prisoner being punished with cruel interrogation technique of waterboarding

Physical or mental torture against any person is never appropriate. Torture is ineffective, unethical, and harmful.

The United Nations (UN) Human Rights Office of the High Commissioner defines torture as “any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person, for such purposes as obtaining from him or a third person information, or a confession, punishing him for an act he or a third person, has committed, or suspected of having committed, or intimidating or coercing him or third person, or for any reason based on discrimination of any kind, when such pain or suffering is inflicted by, or at the instigation of, or with the consent, or acquiescence of, a public official, or other person, acting in an official capacity. It does not include pain or suffering arising only from, inherent and incidental to lawful sanctions.”

Why Does Torture Matter to Nurses?

Nurses, as leaders, have the power to effectuate a positive movement in social justice and advocate for the health, welfare, and life of all persons, including persons subject to torture. Nursing has a professional ethical obligation to care for all people. The Code of Ethics for Nurses with Interpretive Statements holds, “The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.” It is not within the role of the nurse to judge an individual’s actions or to allow the actions of others to negatively influence the delivery of care. Nursing care must be universal and delivered with compassion, comfort, skill, and competence that is unwavering for every person regardless of their actions accused or convicted.

Torture is inhuman, degrading, and contrary to the professional ethical obligations of nurses. Nurses must act to minimize patient suffering and provide healing care. The Code obligates nurses to always stress human rights protection and advocate for vulnerable populations, including refugees, prisoners, or those who are subjected to torture. Torture is not limited to just the United States, but is widespread internationally.

In 2012, the International Council of Nurses (ICN) adopted a position supporting the UN Declaration of Human Rights and strongly affirming that “nurses should play no voluntary role in any deliberate infliction of physical and mental suffering”… “To do otherwise is a clear violation of nursing’s ethical code of practice.” ICN further obligates nurses all over the world to “provide the highest level of possible care to victims of torture and other forms of cruel, degrading, and inhumane treatment, and should speak up against and oppose any deliberate infliction of pain and suffering.”

In support of the ICN position, the American Nurses Association position statement on Capital Punishment and Nurses’ Participation in Capital Punishment states that, “The ethical standards of the nursing profession require that all members of the profession refuse to use their professional skills and capabilities to kill, torture, or degrade another human being. In order to retain professional dignity and ethical stature, the nursing profession as a whole must agree not to do it.”

Nurses should not participate in torture and any allegations of torture should be investigated transparently to assure that human rights are being protected and valued. The long-lasting physical, mental, and psychological effects of torture on an individual diminish the health and well-being of patients, families, communities, and the population as a whole. When nurses are asked to participate in torture or inhuman procedures or treatment, we must adamantly refuse. Nurses must stand up for patients and advocate for the health safety, welfare, and human rights or all patients, families, and communities.

Nursing has a contract with society to compassionately care for all patients, to protect the rights of all persons and positively influence the health of patients. Torture is contrary to this societal contract and is never justified. We encourage you to sign the Health Professionals’ Pledge Against Torture as a sign of solidarity against degrading, inhuman, inappropriate, and unethical actions against humans. The pledge against torture from the Physicians For Human Rights also serves as declaration of support for health professionals who resist orders to torture or inflict harm. We stand with our health professional colleagues in support of this pledge and we encourage you not only to sign the pledge, but to continuously keep human rights at the forefront of your practice and provide universal, unwavering, compassionate care to all persons.

Another Poor Score

Today’s Congressional Budget Office (CBO) report confirms what we already suspected: despite last minute changes made prior to a misguided and party-line House vote, the American Health Care Act (AHCA) seriously threatens health coverage affordability, access, and care delivery, and would cause roughly 14 million individuals to lose coverage by 2018, and 23 million to lose coverage by 2026.

The American Nurses Association (ANA) remains opposed to the AHCA and urges the Senate to abandon the bill advanced by the House in favor of a more transparent process that truly aims to expand access to affordable quality care.

According to the report, the AHCA would allow for various waivers that would undermine protections for those with pre-existing conditions, and undercut access to essential health benefits for roughly one-sixth of the population. Taken together, these waivers would cause premiums to “vary significantly according to health status and the types of benefits provided, and less healthy people would face extremely high premiums,” according to the CBO. “Over time, it would become more difficult for less healthy people (including people with pre-existing medical conditions) in [states that make use of the waivers] to purchase insurance because their premiums would continue to increase rapidly.”

The bill also continues to pose a serious threat to those Americans who rely on Medicaid, a majority of whom are children. Rolling back state expansion of Medicaid would effectively cut off coverage for millions of low-income Americans and further upend the health care landscape.

Though today’s score was marginally better than the first assessment released in March, the negative consequences for those who need care most remain extreme. In particular, the CBO noted that “out-of-pocket spending on maternity care and mental health and substance abuse services could increase by thousands of dollars in a given year for” those not covered by group health insurance plans.

The ANA encourages the Senate to draft a comprehensive health care plan that protects Americans from being denied insurance coverage because of pre-existing conditions and provides access to affordable health insurance coverage plans that offer a minimum standard of benefits. These include preventative services and screenings, inpatient and outpatient services, prescription drug coverage, mental health, maternity services, and chronic disease management.

The American Health Care Act Threatens the Health of Our Nation’s Children

As I covered previously, the U.S. House of Representatives on May 4, 2017, recklessly passed the American Health Care Act by a 217-213 vote. They did so with little transparency, thoughtful debate, or meaningful stakeholder input. Crucially, they also passed this bill without even knowing its potential impacts on the ability of Americans to access quality health care services. Based on an analysis of the previous version of the American Health Care Act, however, this bill would likely result in the loss of health care coverage for 24 million Americans, potential restrictions for 15 million Americans with pre-existing conditions, and $800 billion+ in Medicaid funding slashed over ten years.

According to a report released on May 18 by Avalere Health, children would be significantly impacted by the proposed Medicaid changes in the American Health Care Act. Funding for children on Medicaid would be slashed by up to $43 billion over ten years under a per capita cap plan, while it would be slashed by up to$78 billion under a block grant plan (read more about block grants here). While Medicaid is often discussed in terms of an entitlement and with a particular focus on the controversial Medicaid expansion, its impact on children’s health care does not receive nearly as much attention. Children represent the largest group of enrollees covered by Medicaid, and the program covers nearly half of all births in the United States. Medicaid provides crucial health care services to children and, under Early and Periodic, Screening, Diagnostic, and Treatment (EPSDT) requirements, these children cannot be denied necessary care. This health care (or lack of) impacts the health of the child for the rest of his or her life; a healthy child is more likely to grow into a healthy adult.

As we wait for the American Health Care Act to move to the U.S. Senate for consideration, the American Nurses Association encourages all 100 senators to consider the stakes of this bill for the health of our nation’s children. Access to quality health care for children not only ensures that they are healthy in the here and now, but also ensures that we are raising a healthy and productive generation of Americans who are able to lead productive lives to the best of their abilities. ANA also urges the Senate to reject the flawed American Health Care Act – which flies in the face of our stated health care reform principles – and to undertake a deliberative, thoughtful, and transparent process which produces a piece of legislation which ensures quality health care access to all Americans.

For more information on the latest from ANA’s Capitol Hill efforts, continue to follow us on our RNAction page and ANA’s Capitol Beat.