Professional Documents
Culture Documents
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
development.
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Introduction
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
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
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
Review of Literature
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
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.
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unrestricted by considerations of social or economic status, personal attributes,
group, or community;
3. the nurse promotes, advocates for, and strives to protect the health safety, and
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’
(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
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
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
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
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
Summary
There is a lack of analysis in the realm nursing codes of ethics and dealing with suspected
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
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References
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.
International Council of Nursing, ICN Position Statement: Nurses and Human Rights
Retrieved from http://www.icn.ch/pshumrights.htm 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.
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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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