Question

What does the ANA Code of Ethics have to do with a nurse’s role in clinical research?

Answer 1

The codes outline how the nurses should behave ethically as a profession, and how they should decide when encounter barriers preventing them from fulfilling their professional obligations. The codes can also support nurses in their practice and reduce their moral distress

Statement of ANA Position

The American Nurses Association believes that respect for the inherent dignity, worth, unique attributes, and human rights of all individuals is a fundamental principle (“Code of Ethics for Nurses with Interpretative Statements” [American Nurses Association, 2015, p. 1]). Nurses establish relationships of trust and provide nursing services according to need, setting aside any bias or prejudice (ANA, 2015, p. 1). This statement on ethics and human rights provides the foundation and context for all other position statements related to the practice of nursing. The protection and promotion of human rights in health and health care are fundamental functions of the American Nurses Association.

ANA supports the following recommendations:

 All nurses advocate for human rights of patients, colleagues, and communities.

Nurses advocate for the ethical and just practice of nursing by creating and sustaining environments that support accepted standards of professional practice, since the practice environment and rights of nurses influence the practice and moral context of nursing.

 Nurses strengthen practice environments by refusing to practice in ways that would create a negative impact on the quality of care.

 Through their professional organization, nurses must reaffirm and strengthen nursing values and ideals with a united voice that interprets and explains the place and role of nursing in society (ANA, 2015).

 Health care agencies pay close attention to potential for human rights violations as they relate to patients, nurses, health care workers, and others within their institutions.

 Health care agencies support policies and practices that actively maintain environments ensuring ethical nursing practice, upholding human rights and methods for reporting violations, and taking action to prevent recurrence.

 Nurses in every practice setting serve on ethics committees, work to promote the discussion of ethics and human rights among colleagues, and engage in political action to clarify and promote health policy that increases access to and equality of care.

 Nurses must examine the conflicts arising between their own personal and professional values and the values and interests of others who are also responsible for patient care and health care decisions, and they must address these conflicts in ways that ensure patient safety and promote the best interests of the patient (ANA, 2015).

 Nurses work collaboratively within the profession and with other health care professionals to create moral communities that promote, protect, and sustain ethical practice and the human rights of all patients and professional constituents (ANA, 2010).

 Nurse educators embrace the concepts of justice and caring as guiding principles in teaching students about ethics and human rights within the provision of health care everywhere — from local communities to the greater global community.

 Nurse educators must firmly anchor students in nursing professional responsibility to address unjust systems and structures, modeling the profession’s commitment to social justice and health through content, clinical and field experiences, and critical thought (ANA, 2015).

 Nurse researchers ensure that human rights are fulfilled through the process of ongoing informed consent, continual assessment of risk versus benefit for research participants, and the prevention of harm.

 Nurse researchers conduct research that is relevant to communities of interest, are guided by participation of these communities in identifying research problems, and strive to benefit patients, society, and professional practice.

 Nurse administrators incorporate ethics and human rights principles into practice by monitoring the practice environment for actual or potential human rights violations of patients, nurses, and other workers in the health care environment.

 Nurse administrators actively promote a caring, just, inclusive, and collaborative environment in their organizations and beyond to their communities.

The Universality of Human Rights The current articulation and modern interpretation of human rights emerged from the Universal Declaration of Human Rights adopted by the United Nations General Assembly in 1948. Article 25 has specific importance for those in health care. It states in part that every person has the right to a standard of living adequate for the health and well-being of his or her family, including food, clothing, housing, and medical care (UN, 1948). Ssenyonjo (2013) notes that “the UDHR has established itself as an instrument of significant moral and legal influence universally” (p. 13). Human Rights and the Code of Ethics for Nurses Benatar (2003) suggests that we must go “beyond the rhetoric of universal human rights to include attention to duties, social justice and interdependence” (p. 108). The code addresses attention to duty, social justice, and interdependence in Provision 4, “Nurses bear primary responsibility for the nursing care that their patients and clients receive and are accountable for their own practice …” (ANA, 2015, p. 15), and Provision 8, “The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy and reduce health disparities” (ANA, 2015, p. 31). Nurses advocate for equity and social justice in resource allocation, access to health care, and other social and economic services” (International Council of Nurses, 2012). Human Rights and Health The ICN also addresses the nurse’s four universal and fundamental responsibilities to promote health, to prevent illness, to restore health, and to alleviate suffering (ICN, 2012). “Inherent in nursing is a respect for human rights, cultural rights, the right to life and choice, and dignity, and to be treated with respect” (ICN, 2012). The ICN position statement on nurses and human rights is consistent with Article 25 of the UDHR when it states that the ICN “views health care as a right of all individuals … including the right to choose or decline care, the right to accept or refuse treatment or nourishment … and the right to die with dignity” (ICN, 2011, p. 1). Ethical Obligation and the Just Provision of Care Where there are rights, there are also obligations to fulfill claims to rights. For example, the right to fair and equal treatment in health care requires that nurses provide fair and equal treatment to all patients. Nurses are obligated by the code to provide fair and equal treatment that respects the “inherent dignity, worth and unique attributes of every person … regardless of the factors contributing to the person’s health status” (ANA, 2015, p. 1). “The worth of a person is not affected by illness, ability, socioeconomic status, functional status or proximity to death” (ANA, 2015, p. 1). Further, the just provision of care requires that these factors be considered, as they influence the need for care and the allocation of health care resources. Claim rights, or rights that are due to the rightholder by another, are fulfilled when health care policies are developed that require individual and group differences to be considered in the delivery of care to fulfill patients’ health care needs (U.S. Department of Health & Human Services, 2010). Health care that is congruent with the patient’s needs and with available resources can be said to be both just and caring. Such care is aimed at reducing the unfair burden of illness, suffering, and premature death of vulnerable populations resulting from social inequities and institutionalized patterns of social discrimination.

Advocacy in Health Care Settings Ethics and human rights issues emerge in health care settings when individuals are unable to assert their rights. Individuals in critical care units or psychiatric settings, or individuals who are incarcerated, might have diminished capacity for decision-making and asserting their rights. This is also true of children or individuals who are not considered to be competent in the legal sense (Committee on Bioethics, 2006; Hendrick, 2010). It is in these circumstances that human rights are vulnerable to violation and that ethical issues will emerge. Refusal to provide reasonable and necessary care also violates a patient’s human rights when he or she has a just claim to care. Examples of this would be ignoring the complaints of a patient based on a personal characteristic such as ethnicity or a situational one such as being incarcerated. Such examples not only violate ethical standards of nursing, but they also are not congruent with a relational model of human caring that provides the framework for nursing. Nurses must be fully aware of patients’ rights for all settings, ages, and developmental abilities, and they must be willing to advocate for them and to collaborate with others in finding solutions to ethical issues.