Nurses and vulnerable populations: Ethics and social justice
Thursday, December 14, 2017
In a politically charged era when the Affordable Care Act (ACA) is consistently on the chopping block, health disparities run rampant and the future of American healthcare is wholly uncertain, nurses must honor the American Nurses Association (ANA) Code of Ethics as powerful advocates for vulnerable populations and the rights of all patients.
Health disparities and social justice
Even as enormous corporate tax cuts are pondered in the halls of Congress, the potential for millions of Americans to lose their healthcare coverage is an ongoing and stark political and socioeconomic reality.
We all know that some immigrants completely avoid the healthcare system altogether due to fears of deportation. We can also readily recognize that myriad health disparities disproportionately impact certain vulnerable populations.
Whether it's access to nonjudgmental healthcare for transgender patients, the lack of high-quality primary care in the inner city or disparities faced by communities of color, nurses are on the front lines of the intersection between care delivery and social justice.
The Code of Ethics hits home
In 2015, the ANA published its new Code of Ethics for Nurses With Interpretive Statements. Within that document, certain provisions call on nurses to stand up for human rights and social justice, and to address health disparities.
Provision 8 of the revised ANA Code of Ethics states that "the nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities."
Under Provision 8, nurses must advocate for all vulnerable populations to receive equal treatment despite sexual orientation, gender identity, socioeconomic status, immigration status or other factors. Human rights and the right to healthcare cannot be separated, and nurses are powerful moral agents who can keep these important aspects of human dignity justly aligned.
Provision 2 states that "the nurse's primary commitment is to the patient, whether an individual, family, group, community, or population." This statement calls on nurses to prioritize service to patients and communities, not law enforcement or other entities seeking to undermine patients' rights through questionable actions.
Earlier in 2017, Salt Lake City nurse Alex Wubbels was caring for an unconscious patient injured in a motor vehicle accident. When police demanded that the patient's blood be drawn for purposes related to the investigation, Wubbels refused, explaining that she could not draw the blood of an unconscious patient without a warrant or court order.
Despite printing a copy of the hospital's policy and the intervention of Wubbels' supervisor, this heroic nurse was physically restrained, handcuffed and unlawfully detained in a squad car. In this instance, Wubbels was clearly honoring Provisions 2 and 8 of the Code of Ethics.
Across the country, nurses must stand up to law enforcement, resist pressure from immigration officials and otherwise advocate for patients' rights, often under duress.
Ethical dilemmas loom large
When transgender patients enter a healthcare facility, they are immediately vulnerable to ridicule, judgment and unethical treatment. If an African-American male exhibits slurred speech or uncoordinated ambulation, he will likely be dismissed by staff as drug-seeking or addicted, even if the reality may be that he is suffering from an insulin reaction.
If a nurse's colleague verbalizes a plan to call local law enforcement concerning a patient's immigration status, it is the nurse's duty to remind her colleague that their first obligation is to the patient, not the authorities.
Ethical dilemmas may arise related to patients' inability to pay for care or obtain medically necessary medications. A nurse may find himself in a moral dilemma when faced with patients seeking care that their insurance plan is sure to deny.
Assessing for signs of hunger, food insecurity, domestic violence, human trafficking and other ills of our society often falls on nurses. Gathering such data, the nurse is morally obligated to intervene on behalf of the patient, seeking strategies to address the issues at hand.
Defenders of dignity, protectors of rights
In the 21st century, there is no shortage of ethical and moral dilemmas to which nurses must respond. At a time of great political uncertainty and societal upheaval, nurses can play the part of peacemaker, change agent and protector of human rights.
While we cannot accurately predict the direction our country and our politics will take, we can choose to intervene in the interest of the rights and dignity of our vulnerable patients and at-risk communities.
The origins of the modern nursing profession are steeped in social justice and the support of those who need it most. Nurses can serve as defenders of dignity and protectors of rights. In fact, they always have.
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