Michelle Kelly - Ethical Code

Critical Analysis of Ethical Issue: Ethical Basis for Nurses Treating Bin Laden

Michelle D. Kelly

Bioethics N 714 Dr. K. Lagana

July 28, 2008 Abstract Nurses have a special relationship and obligation to their clients as determined by their practice standards, yet are there ethical circumstances in which the nurse must acquiesce their moral obligations to a state authority? A critical analysis of the ethical basis for a nurse in the United States (US) faced with treating a terrorist or alleged terrorist is offered. Given the current government policy in which the state can deny suspected terrorists basic human rights, a discussion and application of the professional nursing codes of ethics and values as developed by American Nurses Association and American Association of the College of Nursing are presented. The nursing codes of ethics and professional values, which apply to nurses in the US were analogous to the ethical principles of beneficence and justice, and congruent to Kohlberg’s theory of moral development.

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Introduction It is absolutely necessary nurses to be familiar with their professional code of ethics and values in order to practice the highest level of ethical judgment and provide the best care (Barker, 2008). Since September 11th 2001 a level of hyper-vigilance and prejudice towards terrorists and alleged terrorists has become prevalent in American culture (Kulwicki, Khalifa, & Moore 2008). Recent socio-political events have shaped a judicial climate in which terrorists or alleged terrorists are denied their human rights as outlined in the Geneva Convention (de Lourdes, 2007 and Wittes, 2008)). Terrorists have been defined as enemy that threatens the US and “is unlike any enemy we have ever known” (Ashcroft, 2001). Does the political climate in the US and the handling of terrorists potentially impact nurses in their ability to practice ethically? A plethora of information on the impact of and how best to prepare for various terrorist attacks dominated the media and professional nursing journals after 2001 (Steed, Howe, Pruitt, & Sherrill, 2004), yet, in current nursing literature, discussion on the ethics and practice standards of treating terrorists or alleged terrorists are absent. If Osama bin Laden walked into an emergency room what are the ethical obligations of the nurse to provide care? Are alleged or convicted terrorists ethically eligible for care? What ethical codes guide professional nurses to care for suspected and/or charged terrorists in US? The aim of this paper is to explore the established ethical codes and practice standards to identify an ethical framework to guide the practice of nurses in the US in their approach and treatment of a terrorist or alleged terrorist. Key ethical aspects inherent in professional nursing values and ethical codes in the US that apply to nurses in their practice with

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alleged or convicted terrorists are examined. The ethics of nursing practice are discussed in relation to ethical principles and Kohlberg’s theory of moral development. Note: the authors’ intention is to create a real application, and use a well known figure in which societal prejudice and dehumanization exists. Thus Osama bin Laden or bin Laden is the client in this ethical dilemma to make the analysis more grounded. Review of Literature The profession of nursing has a strong foundation in determining standards of practice based on ethical codes which present nurses with the responsibility to make their own moral judgments (Beauchamp & Childress 2008). The primary code of ethics that applies to all US nurses is the American Nurses Association (ANA) Ethical Code (2001). The ANA Ethical Code is described as obligatory ethical principles of practice which apply to every nurse in the US and are “not negotiable in any setting” (ANA, 2001). The National League of Nursing (NLN) and American Association of the College of Nursing (AACN) are accrediting bodies for nursing education, and influence curriculum on ethical standards of practice and professional values. NLN refers to the ANA code of ethics as the choice for ethical standards and AACN has established professional values in the Essentials for Baccalaureate Nursing Education document (1989). What do the ANA and AACN provide in terms of ethical framework in providing care to bin Laden or any alleged terrorist? The ANA Ethical Code for Nurses nine ethical points, of which three are relevant the scenario of a nurse faced with treating bin Laden or any alleged terrorist. 1. The nurse in all professional relationships practices with compassion and respect for inherent dignity, worth, and uniqueness of every individual,

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unrestricted by considerations of social or economic status, personal attributes, or the nature of personal health problems; 2. the nurse’s primary commitment is to the patient, whether an individual, family group, or community; 3. the nurse promotes, advocates for, and strives to protect the health safety, and rights of the patient.

(ANA, 2001, p1.)

The ANA Code of Ethics points 1-3 apply to the nurse dealing with bin Laden or any alleged terrorist indicate that the nurse should approach bin Laden as they would any other patient, revering his human dignity, recognizing individual worth and suspending judgment of his background. The ANA Code of Ethics directs nurses make their first obligation the care of bin Laden and the second to advocated assurance of bin Laden rights as a patient are protected. The ANA Code does not address the nurses’ professional responsibilities when in conflict with legal and or governmental authority but does state the nurses primary commitment is to their patient. AACN’s Professional Values outline the essential knowledge, values and professional behaviors for schools of nursing to foster in baccalaureate nursing graduates (1998). AACN Values are the practice foundation of the professional nurses’ approach to the care of individuals, groups and communities. AACN acknowledges caring as the central concept in profession of nursing and defines caring as the nurses’ compassion, ability for human connection and the provision of appropriate interventions (1989). AACN’s five professional values are; altruism, autonomy, human dignity, integrity and social justice (1998). In employing AACN’s Professional Values the nurse would need to be empathetic and connect on a human level with the client. AACN’s Professional Values

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direct nurses to have concern for the welfare of bin Laden, as well as the welfare of the other health care providers, respect the patient’s right to make their own health care decisions, they value honesty with patients and colleagues and care based on an ethical framework. Lastly, AACN values mandates nurses to practice social justice by assuring the client receives an appropriate quality of care, and unbiased access to treatment. Discussion In the application and analysis of both the ANA code of ethics and AANC essentials of professional behavior in the US, the provision care to bin Laden or any alleged terrorist is ethically sound and in fact, an professional expectation. The profession of nursing in the US embodies the ethical principle of beneficence and the right to care of the individual despite their violation of the rights of other members of society. The principle of beneficence prompts the nurse to make moral judgments that benefit others. A subsequent ethical issue is raised in assuring and protecting the rights of bin Laden, which is in allows bin Laden the benefit of society just to those who had their rights violated by his actions? Professional codes and standards for nurses are not completely aligned with public policies and legal responsibilities which vary from state to state, are specific to different care settings and the role of the nurse. Beauchamp and Childress (2008), describe the unlimited complexity when attempting to correlate moral acts to public policy and law: ‘the judgment about morality of acts does not entail a corresponding judgment about law and policy” (p 10). What does it suggest for a nurse to make a moral decision to treat bin Laden, yet this act supersedes legal parameters and perhaps societal expectations? Is justice served? The concept of justice is considerable when one looks at the competing interests of an individual who has abused the rights of

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members of society and whether that individual is entitled to maintain their right to access care (Barker, 2008). When there is a conflict between legal and professional responsibilities Kohlberg provides a perspective of professional over societal expectations in his conceptual basis for stages of moral development. Kohlberg’s descriptions of stages of the development of morality and places fulfilling professional roles expectations over doing what society expects as a higher level of moral development (de Casterle, Roelens & Gastmans, 1996, and Crain, 1985). Kohlberg’s next stage is an environment where decisions are made outside of the law and an environment is created where everyone is cared for (Lagana 2008). Hence, using Kohlberg’s work on the levels of moral development, a nurse who is acting on behalf of their client, and in absence of both society’s expectations and the law, is highly evolved in their moral reasoning. The International Council of Nurses (ICN) position resonates with Kohlberg’s premise. The ICN clearly depicts the morally accountable nurse who faces “dual loyalty” involving conflict between their professional duties and their obligations to their employer or other authority” is obliged to serve the client’s needs (2006). In the last stage and most evolved stage of Kohlberg’s moral development, the principle of justice is served with moral reasoning. Justice is the defined as both the fairness in treatment and the provision or withholding of benefits after considering if the person is deserving or not (Beauchamp & Childress, 2008). The concept of justice is considerable in the nurse-bin Laden scenario when one looks at the competing interests of an individual who has abused the rights of members of society and whether that individual is entitled to maintain their right to access care (Barker, 2008). Belkin and

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Brant (2001) remind us that in trying to determine which ethical principle is most important, there are often clashes in client-health provider scenarios. Summary There is a lack of analysis in the realm nursing codes of ethics and dealing with suspected or charged terrorists. In examination of ANA Code of Ethics and AACN’s Professional Values, a framework of ethical obligation in treating suspected or charged terrorists was established. The client’s well being and right to care are embedded in the profession of nursing ethical foundation of care. Ethical principles of beneficence and justice where analogous with ANA and AACN ethical values and Kohlberg affirms one’s professional ethical obligations supersede state authority. Dealing with competing interests of various parties is a challenge for nurses yet the ethical obligation remains with the nurse to put the client’s need for care first.

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References American Association of Colleges of Nursing. (1999). A vision of baccalaureate and graduate nursing education: The next decade. Journal of Professional Nursing, 15(1), 59-65. American Association of the College of Nursing. (1998). Essentials for Baccalaureate Nursing Education. Retrieved from: http://www.aacn.nche.edu/Education/pdf/BaccEssentials98.pdf on June 2 2008. Ashcroft, J. (2001). Attorney General Ashcroft’s estimony to the Senate Judiciary Committee. Retrieved from: http://usgovinfo.about.com/gi/dynamic/offsite.htm? site=http://www.usdoj.gov/ag/speeches/2001/1206transcriptsenatejudiciarycommi ttee.htm on July 2008. Barker, A., (2008). Advanced Practice Nursing: Essential Knowledge for the Profession, Sudbury, MA: Jones & Bartlett Publishers. Belkin G. & Brandt A., (2001). Bioethics: Using its historical and social context. International Anesthesiology Clinics. 39(3), 1-11. Beauchamp, T., & Childress, J. (2001). Principles of Biomedical Ethics (5th ed). New York: Oxford. de Casterle, B., Roelens, A, & Gastmans, C. (1996). An adjusted version of Kohlberg’s moral theory: Discussion of its validity for research in nursing ethics. Journal of Advanced Nursing. 27 (4), 829-835. Crain, W. (1985). Theories of Development. San Francisco: Prentice Hall. International Council of Nursing, ICN Position Statement: Nurses and Human Rights Retrieved from http://www.icn.ch/pshumrights.htm on July 2 2008.

International Council of Nurses Code of Ethics 2006 Retrieved from http://www.icn.ch/icncode.pdf on July 2 2008. Kulwicki A., Khalifa R., & Moore G. (2008).The effects of September 11 on Arab American nurses in metropolitan Detroit. Journal of Transcultural Nursing, 4(2):134-9. Retrieved May 28, 2008, from CINAHL with Full Text database. Lagana,K. (2008). Bioethics in Nursing and Healthcare, N 714. University of San Francisco. de Lourdes, F. (2007). The Right to Challenge the Lawfulness of Detention: An International Perspective on US Detention of Suspected Terrorists. Journal of Conflict and Security Law, 12(2):223-260.

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National League for Nursing. (1993). A vision for nursing education. New York: Author. Steed C., Howe L., Pruitt R. & Sherrill W. (2004). Integrating bioterrorism education into nursing school curricula. Journal of Nursing Education, 43(8):362-7. Retrieved May 28, 2008, from CINAHL with Full Text database. Wittes B., (2008). Law and the Long War: The Future of Justice in the Age of Terror New York: Penguin Press

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