Human Rights and the Nursing Role: Ethics and Advocacy for At Risk Patient Populations

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1 Slide 1 Human Rights and the Nursing Role: Ethics and Advocacy for At Risk Patient Populations Vanderbilt Institute of Global Health Nashville, Tennessee, February 2014 Tesfamicael Ghebrehiwet, PhD

2 Objectives Discuss the relationship between health and human rights and implications for advocacy. Cite basic principles of human rights. Differentiate human rights and civil rights. Discuss human rights abuses and impact on health and wellbeing of individuals. Identify key advocacy actions for nurses and nursing organizations. 2

3 What is Human Right? Basic Concepts Human rights are: Universal: they apply to everyone, everywhere. Fundamental: to human survival, dignity and development Inalienable: cannot be taken away from a person. Indivisible: closely connected to other human rights. 3

4 Categories of Human Rights economic and social rights (e.g. the right to health, the right to education, the right to water ), civil and political rights (e.g. the right to life, the right to fair trial, the right to privacy, the right to freedom from torture ) 4

5 Nondiscrimination Non-discrimination is central to all human rights. people cannot be denied their human rights on the basis of specific grounds such as race or gender, age, disability or disease, etc. 5

6 Health as a Human Right Health is a human right. The right to health is not a right to be healthy, as health is influenced by many factors. The right to health is a right to the highest attainable standard of physical and mental health. 6

7 The Right to Health The right to health contains: A right to a range of facilities, goods, services, and conditions necessary for realization of the highest attainable standard of health. Health care. Underlying determinants of health. Safe working conditions. UN Special Rapporteur monitors this right. 7

8 Health-related Human Rights Freedom from discrimination Freedom from torture Freedom of movement The right to physical integrity The right to privacy The right to information The right to safe working conditions, etc. 8

9 Civil Rights Civil rights are the protections and privileges and rights given to all citizens by law. Civil rights are distinguished from "human rights" or "natural rights," also called "our God-given rights." Civil Rights are bestowed by nations to their citizens; while human rights are rights that individuals have by nature of being born. 9

10 Some Examples of Civil Rights the right to get redress if injured by another, the right to privacy, the right to a fair trial, the right to vote, the right to freedom of movement, and the right to equal protection. (New World Encyclopedia. 10

11 Why Nurses Need to Intervene on Health and Human Rights? Health and human rights are interrelated and nurses need to have basic knowledge of human rights. Nursing curriculum lacks human rights concepts. Nurses have an obligation to respect and safeguard human rights as these are linked to health. Inherent in nursing is respect for human rights, including the right to life, to dignity and to be treated with respect (ICN Code of Ethics for Nurses, 2012). Health and wellbeing can be harmed when people s human rights are violated. 11

12 Why Nurses Need to Respect Nurses face complex human rights issues, arising from conflict situations, political upheaval and wars. Protection of human rights should focus on vulnerable groups (women, children, elderly, refugees, stigmatised groups..) Nurses are accountable for their own actions and inactions in safeguarding human rights. NNAs have a responsibility to participate in the development of health and social policy and legislation related to patient rights.. (ICN position Statement: Nurses and Human Rights revised 2011). 12

13 Interface of health and human rights Health and human rights are closely linked. Nurses intervene at the interface with bold action. Human Rights Health 13

14 Why Nurses Need to Respect Where nurses face a dual loyalty conflict - their primary responsibility is to those who require care. This includes taking action such as whistle blowing and other bold action to safeguard human rights. (ICN position Statement: Nurses and Human Rights, revised 2011) If nurses give priority to the interests of a third party this represents a violation of patient s human rights (IFHHRO: 14

15 Illustrative Examples 1. Shackling Pregnant Inmates during labour, delivery and recovery in some states in USA Many prisons use leg irons, waist chains and handcuffs on pregnant women during delivery. Shackling increases the risk for unfavourable pregnancy outcomes. Shackling pregnant women is torture and inhuman and degrading treatment. ( Human Rights Watch: 15

16 Forced Sterilization of HIV Positive Women in Namibia Violation of reproductive rights, refusal to provide services, hostile attitudes towards HIV positive women who want to have children, stigmatization at hospitals by staff, breaches of confidentiality, testing for HIV without informed consent. (International Community of Women Living with HIV/AIDS (ICW) 2009). 16

17 Denial of Access to Pain Medicines Chronic pain causes suffering and disability (e.g. in patients with cancer and HIV/AIDS). Inexpensive and effective pain relief medicines exist. Misconceptions about fear of addiction. Inadequate training in pain management. Restrictive nursing practice acts: no prescription. Denial of pain medicines is torture and inhuman treatment. McCormack JP, Li R, Zarowny D, Singer J. Inadequate treatment of pain in ambulatory HIV patients. Clin J Pain. 1993;9:

18 Nurses Rights: Care of the Carer Care of the carer is a prerequisite for functioning health facilities. Nurses have an obligation for duty of care ; employers have an ethical duty to provide safe work environments. The protection of HCWs must be appropriate to the level of risk involved (e.g. Nurses caring for patients with M(X)DR-TB). (ICN/IHF/WMA/IFRC : Report of Inter-Professional Training Seminar. Health Care Worker Safety in the Context of drug-resistant TB in low and middle income countries. 12 / 13 November 2007, Cape Town, South Africa). 18

19 Nurses Rights Nurses have the right to practice in a positive practice environment (PPE) that: provides personal safety, provides freedom from abuse and violence, threats or intimidation, Assures there is no fear of reprisal. (ICN PPE Project: 19

20 Illustrative Examples Bulgarian nurses and doctors imprisoned in Libya for five years for allegedly spreading HIV infections despite evidence to the contrary. ICN in partnership with NNAs, WMA, IFFHRO, and Amnesty International lobbied for their release. 20

21 Illustrative Examples Nurses in Zimbabwe harassed; even raped for speaking up against human rights violations. ICN in partnership with the International Rehabilitation Centre for Torture Victims (IRCT) intervened. This lead to forming a Forensic Nursing Society that worked with lawyers, doctors and others to prevent human rights abuses including torture. 21

22 Ethical professionals facing unethical situations Nurses as most ethical professionals are facing unethical situations in their day-to-day work. In 2012 for the 13 th out of 14 years, nurses were voted the most ethical and honest profession in America in Gallup s annual survey. Since 1999 nurses had the highest ranking each year except in 2001, when firefighters ranked first after the 9/11 terrorist attacks. (ANA Press Release December 12,

23 Ethical Professionals Nurses face ethical challenges about life and death issues. We are challenged to make do with little or nothing and expected to provide quality care. Nurses find they are unable to meet their own or others' expectations. There is less and less time for our patients; patients waiting longer and longer for their treatment. This can lead to ethical distress related to quality of care, patient safety and to our personal health and safety. 23

24 Ethical Professionals Ethical/moral distress occurs: when nurses know the ethically appropriate action to take, but are unable to act upon it, or when they act contrary to their personal and professional values, This leads to loss of their integrity, authenticity, and loss of satisfaction with their work environment. AACN Position Statement: Moral Distress, Revised

25 Ethical Professionals Some ethical issues such as euthanasia are complex. Others such as FGM seem obvious but problematic. Is it ethical for nurses to tolerate FGM in the interest of cultural respect? sensitivity? Can culture be used to inflict pain, suffering? Nurses need clear direction and support on ethical decision-making such as through Codes of Ethics. Yet a study in six European countries showed most nurses had a poor understanding of their codes. Tadd, W. et al. The value of nurses' codes: European nurses' views. Nurs Ethics Jul;13(4):

26 Illustrative Example The ICN Code of Ethics guides nurses in dealing with ethical dilemmas. For example, nurses in Swaziland used the ICN code as a basis for refusing to comply with the health ministry mandate to carry guns to protect themselves against violence. Nurses in other countries have cited the code as justification for not participating in torture and other acts that violate human rights. 26

27 Conclusion Health and human rights are closely linked. Nurses have a key role in safeguarding human rights. However current nursing education generally lacks human rights concepts. The duty of care rests on ethical obligations of employers to provide PPE for nurses. The ethical distress of nurses is related to shortfalls in time, resources and quality of care for patients. Nurses human rights and the concept of care of the carer are fundamental to functioning health systems. Bold advocacy action is need by nurses and NNAs. 27

28 Linking Health and Human Rights: Walking the Talk We will now proceed to Group Work on Health and Human Rights. Divide into 2 Groups: Group 1: Shackling pregnant women; FGM Group 2: Forced sterilisation of HIV-positive women; denial of pain medicines. Review the statements and consider the Action/Advocay Points directed at: Individual nurses, Nursing organisations, Remember: Knowledge without action is useless. 28

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