Ethics – Capitol Beat

No Pride in the Status of Health Care Rights for the Transgender Community

As we close out Pride month, it is important to reflect on the state of access to quality compassionate health care for LGBTQ+ communities. As LGBTQ+ Liberation makes a step forward, there is always a backlash right on its heels. Transgender individuals specifically face immense danger for living authentically, which includes having access to gender-affirming health care. They are more than four times more likely to experience violence, including sexual assault, than cisgender people. Instead of offering more support and services to this community, anti-trans legislation has grown exponentially. Before 2021 there were no gender-affirming care bans in law. Today 16 states ban this essential health care for young people. There are over 350 active anti-trans laws attacking access to care, instituting criminal charges for providers, child-abuse charges for supportive parents of transgender children, and much more.

The risks of violence and legislative bans have undeniable implications for high-quality, equitable health care delivery. In fact, such tactics are antithetical to nursing practice. The Code of Ethics for Nurses states that “the nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.” Nurses are not only advocates for their patients and the right for everyone to receive the health care they need – nurses practice evidence-based care. Research continues to prove that gender-affirming care improves the overall wellness of gender diverse young people. Laws banning this care are passed under the guise that they are protecting children and parents. In reality, these laws “are not grounded in reputable science” and instead promote misinformation endangering the lives of transgender people across the country.

Nurses continue to be voted the most ethical professionals and hold a unique and enduring level of trust with their patients. From schools to primary care and emergency rooms, we need to be increasing access to comprehensive and compassionate nursing care for the entire LGBTQ+ community. Nurses can ensure they are LGBTQ+ compassionate by following best practices and talking to their colleagues about barriers they witness in their workplaces. Even though June is over, the work to ensure the right of equitable health care for this community must continue year-round.

References

https://williamsinstitute.law.ucla.edu/press/ncvs-trans-press-release/

https://www.mapresearch.org/2023-medical-care-bans-report

https://translegislation.com/

https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/

https://www.nursingworld.org/news/news-releases/2023/ana-rejects-laws-against-lgbtq-care/

https://opa.hhs.gov/sites/default/files/2022-03/gender-affirming-care-young-people-march-2022.pdf

https://www.nursingworld.org/news/news-releases/2022-news-releases/american-nurses-association-opposes-restrictions-on-transgender-healthcare-and-criminalizing-gender-affirming-care/

https://www.nursingworld.org/news/news-releases/2022-news-releases/americans-continue-to-rank-nurses-most-honest-and-ethical-professionals/

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.

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.