Guest Editorial
Nursing ethics in times of conflict
Nursing Ethics 2014, Vol. 21(8) 859–860 ª The Author(s) 2014 Reprints and permission: sagepub.co.uk/journalsPermissions.nav 10.1177/0969733014546436 nej.sagepub.com
Yukiko Kusano The International Council of Nurses, Switzerland
The International Council of Nurses (ICN) Code of Ethics for Nurses1 states, Nurses have four fundamental responsibilities: to promote health, to prevent illness, to restore health and to alleviate suffering. The need for nursing is universal. [ . . . ] Nursing Care is respectful of and unrestricted by considerations of age, colour, creed, culture, disability or illness, gender, sexual orientation, nationality, politics, race or social status.
However, fulfilling such professional responsibilities is not always fully supported and, in some situations, can be dangerous.2 Indeed, as recent events in multiple locations have shown, in times of armed conflict, healthcare workers, facilities and ambulances are often attacked or threatened. In some cases, healthcare workers are coerced to give certain patients priority but not according to the urgency of the cases. Some are arrested because they provided healthcare to the wounded who are members of an anti-government group.3 We know that ‘the nurse’s primary professional responsibility is to people requiring nursing care’,1 and this does not change in times of peace or armed conflict. Attacks against healthcare facilities, personnel and medical vehicles, performing their exclusively medical tasks, are strictly prohibited under international humanitarian law. However, in reality, we know that international humanitarian law is often swept aside and there is a need to be prepared to face such ethical dilemmas. ICN works with national nurses associations, other health professional associations, international organisations and others to ensure healthcare workers are protected and able to perform their ethical and professional duties during armed conflict. One example is the Health Care in Danger project4 led by the International Committee of the Red Cross (ICRC), which aims to improve efficiency and delivery of effective and impartial healthcare in armed conflict and other emergencies. Related ICN activities include contribution to expert consultations and technical workshops to develop practical recommendations, development of common ethical principles for healthcare professionals, information dissemination, advocacy and lobbying The World Health Organization (WHO) and governments. Besides these international and national efforts, it is important that individual nurses have ‘the core capabilities of ethical competence’. As described by Ann Gallagher in the inaugural address at the launch of the International Care Ethics (ICE) Observatory,5 these are the capabilities that they can ‘see’ or ‘perceive’ well, recognising ethical issues when they arise; that they can ‘think’ well, drawing on a range of concepts and arguments to help them reflect on the ethical aspects of their practice; that they can act well, having the confidence and courage to consistently do the right thing; and, if you favour a virtue ethics account, that over time they develop moral qualities that contribute not just to the flourishing of those they provide care to but also to their own flourishing.
Knowledge of their ethical and professional responsibilities and their rights can help nurses’ ethical preparedness to deal with difficult situations. Useful resources include the following: Corresponding author: Yukiko Kusano, International Council of Nurses 3, Place Jean Marteau 1201 - Geneva, Switzerland. Email: [email protected]
Downloaded from nej.sagepub.com at UNIV OF GEORGIA on June 13, 2015
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Nursing Ethics 21(8)
The ICN Code of Ethics for Nurses,1 which serves as the standard for nurses worldwide, guides nurses in everyday choices and supports their refusal to participate in activities that conflict with caring and healing. Health care in danger: the responsibilities of health-care personnel working in armed conflicts and other emergencies,6 a guidance document for health personnel, setting out their rights and responsibilities in conflict and other situations of violence. To summarise, we must always remember that the nurses’ responsibility goes beyond caring for the sick and the wounded. Advocacy, promotion of a safe environment, research, participation in shaping health policy and management of inpatient and health systems are also key nursing roles.7 The work of researchers and the ICE Observatory can help inform policy decisions, and involvement of nurses in decision making can contribute to the development of appropriate and effective health policy.8 ICN will maintain its efforts to support nurses who continue caring for people in need in difficult situations. References 1. ICN. ICN Code of Ethics for Nurses, http://www.icn.ch/about-icn/code-of-ethics-for-nurses/ (2012). 2. ICRC. Health care in danger: violent incidents affecting the delivery of health care January 2012 to December 2013, https://shop.icrc.org/health-care-in-danger/health-care-in-danger-violent-incidents-affecting-the-delivery-of-health-carejanuary-2012-to-december-2013.html (2014). 3. ICN. Bahrain health workers, http://www.icn.ch/news/bahrain-health-workers/ 4. The International Committee of the Red Cross. Health Care in Danger project, http://www.icrc.org/eng/what-we-do/ safeguarding-health-care/ 5. Gallagher A. The International Care Ethics (ICE) Observatory. The ICE Observatory launch inaugural welcome speech, http://www.surrey.ac.uk/fhms/research/centres/ICE/events/ICELaunch_InauguralWelcome_Gallagher.pdf (2014). 6. ICRC. Health care in danger: the responsibilities of health-care personnel working in armed conflicts and other emergencies, https://shop.icrc.org/health-care-in-danger-the-responsibilities-of-health-care-personnel-working-inarmed-conflicts-and-other-emergencies-1114.html (2012). 7. ICN. Definition of nursing, http://www.icn.ch/about-icn/icn-definition-of-nursing/ (2010). 8. ICN. ICN Position Statement. Participation of nurses in health services decision making and policy development, http://www.icn.ch/images/stories/documents/publications/position_statements/D04_Participation_Decision_Making_ Policy_Development.pdf (2008).
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Downloaded from nej.sagepub.com at UNIV OF GEORGIA on June 13, 2015
Nursing ethics in times of conflict
Nursing Ethics 2014, Vol. 21(8) 859–860 ª The Author(s) 2014 Reprints and permission: sagepub.co.uk/journalsPermissions.nav 10.1177/0969733014546436 nej.sagepub.com
Yukiko Kusano The International Council of Nurses, Switzerland
The International Council of Nurses (ICN) Code of Ethics for Nurses1 states, Nurses have four fundamental responsibilities: to promote health, to prevent illness, to restore health and to alleviate suffering. The need for nursing is universal. [ . . . ] Nursing Care is respectful of and unrestricted by considerations of age, colour, creed, culture, disability or illness, gender, sexual orientation, nationality, politics, race or social status.
However, fulfilling such professional responsibilities is not always fully supported and, in some situations, can be dangerous.2 Indeed, as recent events in multiple locations have shown, in times of armed conflict, healthcare workers, facilities and ambulances are often attacked or threatened. In some cases, healthcare workers are coerced to give certain patients priority but not according to the urgency of the cases. Some are arrested because they provided healthcare to the wounded who are members of an anti-government group.3 We know that ‘the nurse’s primary professional responsibility is to people requiring nursing care’,1 and this does not change in times of peace or armed conflict. Attacks against healthcare facilities, personnel and medical vehicles, performing their exclusively medical tasks, are strictly prohibited under international humanitarian law. However, in reality, we know that international humanitarian law is often swept aside and there is a need to be prepared to face such ethical dilemmas. ICN works with national nurses associations, other health professional associations, international organisations and others to ensure healthcare workers are protected and able to perform their ethical and professional duties during armed conflict. One example is the Health Care in Danger project4 led by the International Committee of the Red Cross (ICRC), which aims to improve efficiency and delivery of effective and impartial healthcare in armed conflict and other emergencies. Related ICN activities include contribution to expert consultations and technical workshops to develop practical recommendations, development of common ethical principles for healthcare professionals, information dissemination, advocacy and lobbying The World Health Organization (WHO) and governments. Besides these international and national efforts, it is important that individual nurses have ‘the core capabilities of ethical competence’. As described by Ann Gallagher in the inaugural address at the launch of the International Care Ethics (ICE) Observatory,5 these are the capabilities that they can ‘see’ or ‘perceive’ well, recognising ethical issues when they arise; that they can ‘think’ well, drawing on a range of concepts and arguments to help them reflect on the ethical aspects of their practice; that they can act well, having the confidence and courage to consistently do the right thing; and, if you favour a virtue ethics account, that over time they develop moral qualities that contribute not just to the flourishing of those they provide care to but also to their own flourishing.
Knowledge of their ethical and professional responsibilities and their rights can help nurses’ ethical preparedness to deal with difficult situations. Useful resources include the following: Corresponding author: Yukiko Kusano, International Council of Nurses 3, Place Jean Marteau 1201 - Geneva, Switzerland. Email: [email protected]
Downloaded from nej.sagepub.com at UNIV OF GEORGIA on June 13, 2015
860
Nursing Ethics 21(8)
The ICN Code of Ethics for Nurses,1 which serves as the standard for nurses worldwide, guides nurses in everyday choices and supports their refusal to participate in activities that conflict with caring and healing. Health care in danger: the responsibilities of health-care personnel working in armed conflicts and other emergencies,6 a guidance document for health personnel, setting out their rights and responsibilities in conflict and other situations of violence. To summarise, we must always remember that the nurses’ responsibility goes beyond caring for the sick and the wounded. Advocacy, promotion of a safe environment, research, participation in shaping health policy and management of inpatient and health systems are also key nursing roles.7 The work of researchers and the ICE Observatory can help inform policy decisions, and involvement of nurses in decision making can contribute to the development of appropriate and effective health policy.8 ICN will maintain its efforts to support nurses who continue caring for people in need in difficult situations. References 1. ICN. ICN Code of Ethics for Nurses, http://www.icn.ch/about-icn/code-of-ethics-for-nurses/ (2012). 2. ICRC. Health care in danger: violent incidents affecting the delivery of health care January 2012 to December 2013, https://shop.icrc.org/health-care-in-danger/health-care-in-danger-violent-incidents-affecting-the-delivery-of-health-carejanuary-2012-to-december-2013.html (2014). 3. ICN. Bahrain health workers, http://www.icn.ch/news/bahrain-health-workers/ 4. The International Committee of the Red Cross. Health Care in Danger project, http://www.icrc.org/eng/what-we-do/ safeguarding-health-care/ 5. Gallagher A. The International Care Ethics (ICE) Observatory. The ICE Observatory launch inaugural welcome speech, http://www.surrey.ac.uk/fhms/research/centres/ICE/events/ICELaunch_InauguralWelcome_Gallagher.pdf (2014). 6. ICRC. Health care in danger: the responsibilities of health-care personnel working in armed conflicts and other emergencies, https://shop.icrc.org/health-care-in-danger-the-responsibilities-of-health-care-personnel-working-inarmed-conflicts-and-other-emergencies-1114.html (2012). 7. ICN. Definition of nursing, http://www.icn.ch/about-icn/icn-definition-of-nursing/ (2010). 8. ICN. ICN Position Statement. Participation of nurses in health services decision making and policy development, http://www.icn.ch/images/stories/documents/publications/position_statements/D04_Participation_Decision_Making_ Policy_Development.pdf (2008).
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