Registered nurses protect and promote health, prevent illness and injury and alleviate suffering. We apply critical thinking and the latest evidence, and follow standards, policies and procedures and rules and regulations. Yet what’s central to our practice is ethics. Nurses’ code of ethics helps shape our decision-making and allows us to stay true to their professional values. That’s why the American Nurses Association applauded the recent decision by the United States Navy not to pursue further action against a Navy nurse who — based on professional ethical obligations — refused to force-feed detainees at the Guantanamo Bay Detention Camp in Cuba. The nurse, who had faced dismissal from the military after his distinguished 18-year career, will now be allowed to return to work.
The decision reflects the Navy’s recognition of the right of nurses to make independent, professional judgments and to object to participating in treatment they find unethical, without facing retaliation. The decision also recognized that — first and foremost — the nurse’s duty is to the well-being of the patient, regardless of who employs them or where they’re caring for someone. There is no doubt this action to recognize and support moral agency has far-reaching implications for all health-care professionals.
Registered nurses face ethical dilemmas every day. Whether in a hospital, doctor’s office or outpatient clinic, nurses have to make tough decisions about the care of patients on a regular basis. For example, what should a nurse do who witnesses a member of the medical team pressuring a patient to consent to the use of an experimental drug, or when dealing with conflicting wishes between a patient and family member about end-of-life care? In the military, a nurse may be asked to clear soldiers for deployment or redeployment when they may not be physically or mentally ready. Or a nurse could be urged to give different treatment to an enemy combatant based on the availability of resources, such as medication.
Health-care providers in the military often face the most difficult of challenges — the conflict of dual loyalties, one to the military code of conduct and the other to their professional code of ethics. Societal interest dictates that the delivery of ethical patient care must be the nurse’s priority. And indeed, this Navy nurse demonstrated the moral courage to follow that code.
In March, the Defense Health Board’s Medical Ethics Subcommittee — which advises the secretary of defense on health policy — recommended in the report Ethical Guidelines and Practices for U.S. Military Medical Professionals that the Pentagon allow medical personnel to opt out of performing any procedures they find ethically or morally questionable.
Many of the recommendations closely align with ANA’s recommendations to the committee:
- Create an office within the Department of Defense dedicated to ethics leadership, policy and oversight;
- Establish specific education and training programs in the area of ethics;
- Form policies that recognize that the military health professional’s first ethical obligation is to the patient; and
- Develop mechanisms that allow excusing health professionals from participating in medical procedures that violate their professional code of ethics.
While the Navy’s decision is a victory, there is more work to be done. On behalf of patients, who have consistently ranked nursing as the most honest and ethical profession for 13 consecutive years, and the nation’s military health-care professionals, we urge Secretary of Defense Ashton Carter and the Department of Defense leadership to swiftly adopt and implement these recommendations.