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The piece linked below is by Pamela Cipriano, president of the American Nurses Association. It’s about the US Navy’s decision not to punish nurses who refused to force-feed prisoners at Guantanamo Bay

“Let nurses do the ethical thing: Patients’ interests should trump all other obligations.”

…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….

The tension reflected in this case — that of duty to patient vs duty to employer — is one that is common in all licensed professions. Should the engineer employed by a construction company to help design a bridge draw up plans that specify cheap materials, or materials that will be structurally sound? Should the accountant employed by an industrial corporation keep the books the way the boss says, or the way her professional standards require? In most cases, the answer is pretty clear. But these kinds of cases (and comparisons) still warrant discussion, not least because of the incredible moral stress they frequently imply for individual professionals.

Sexual contact with a patient is never a good thing. But the case cited below is an extreme one, and serves as a good reminder of just how big a problem it is, and just how many factors make it so problematic.

Nurse re-instated after sex with inmate

A NSW nurse who struck up a relationship with a mentally ill teenage inmate will be able practise again after telling a tribunal she does yoga to manage stress and has taken ethics courses…

…In a decision handed down this week, the Civil and Administrative Tribunal said the young man was “in a particularly vulnerable position as an incarcerated 19-year-old Aboriginal man with a history of self-harm and a serious mental illness”….

Women earn less, on average, than men in our society. That’s perhaps not surprising in male-dominated professions. But in nursing?

Female nurses make nearly $11,000 less per year than registered male nurses

New research shows that in America, registered nurses who are male earn nearly $11,000 more per year than those who are female. Only about half of that difference can be attributed to factors like education, work experience and clinical specialty, which leaves a $5,148 salary gap that is discriminatory towards women….

What specific factors might lead to such a gap? If it’s discrimination, at exactly what point does it operate?

By the way, here’s an explanation of the general wage gap between men and women, by Harvard economist Claudia Goldin.

Labour disputes are tough, both financially and ethically. The nurse writing the commentary below highlights the conflict between the moral obligation to fellow obligations to members of one’s bargaining unit, and the obligations more standardly referred to in relation to nursing.

California Nurses Association bullies, divides hospital staff: Guest commentary

…A CNA flier reads, it is your “moral obligation” to strike with fellow nurses.

The CNA does not know my morals. Patient safety is a moral principle to me. I am asked to understand the bigger picture in regard to patient care and why we are striking, and I did….

Today, 21 years after Sue Rodiguez’s story made the headlines, history has been made again in Canada with the striking down of the current assisted suicide laws – sections 241 and 14 in Canada’s criminal code which, essentially, prohibit aiding or counselling another person to end their life.

sue_rodriguez

Here is a link to the Supreme Court’s actual ruling which outlines that a physician may not help someone end their own life. There are specific conditions attached to this ruling: First, the person involved must be a competent adult who consents to have their life ended. Second, the person must be experiencing what they have called “endless suffering” as a result of a “grievous or irremediable” illness, disease or disability.

This ruling will now be turned over to the government, as the two sections of the Criminal Code which prevent people from consenting to their own deaths or allow others to aid in their suicide become no long valid after a year. So the government will have to draft new rules and ensure policies and safeguards in place to protect those most vulnerable while also ensuring that the new rules reflect the aims and values underpinning the ruling. They’ll also have to anticipate how this might play out as there will be both federal and provincial involvement in any new legislation. Quebec already has its own right to die law which came into effect in June 2014.  Finally, any new legislation that is eventually brought forward based on this ruling may well be appealed, again.

You can read more about the ruling here and here.

Here’s a tragic story from Cape Dorset, which is in Nunavut, a territory in Canada’s far north. Cape Dorset is a town of just 1300 people.

“Nunavut nurse admits to failing to see infant and other allegations”

A nurse the Nunavut government promoted to a top nursing job after nearly 20 complaints were filed against her has admitted to a number of the allegations, CBC News has learned.

Among the most egregious complaints against Debbie McKeown was that she refused to see a three-month-old Cape Dorset boy, Makibi Timilak, when his mother phoned her one evening in early 2012 saying the child was ill and needed attention. The boy died hours later.

Nunavut rules dictate that nurses on call in the evening must open the health centre to see an infant under the age of one who might be ill.

A CBC News investigation found that territorial government employees admitted in emails that they put the hamlet of Cape Dorset “at risk” by mishandling complaints against McKeown. She was promoted to the top nursing post in the community despite conditions on her licence preventing her from treating children. ….

It’s hard not to see the connection with the scale of healthcare operations in a wee hamlet like Cape Dorset. Yes, obviously services are bound to be limited. But consider also that in a larger place, at a larger clinic in a larger town, there would likely be much more going on in terms of formal and informal peer review and oversight.

Sometimes, the decision to offer nursing care comes at a very high price.

You can read a summary and listen to this piece from NPR, about caring for Ebola victims in the Kenema district of Sierra Leone: “When Holding An Orphaned Baby Can Mean Contracting Ebola

One day, an Ebola-infected mother brought her baby into a hospital, Purfield recalls. The mother died, and the baby was left in a box.

“They tested the baby, and the baby was negative,” says Purfield. “But I think the symptoms in babies and the disease progression in babies is different than adults.

“So the nurses would pick up and cuddle the baby. And they were taking care of the baby in the box,” she continues.

Twelve of those nurses subsequently contracted Ebola, Purfield says. Only one survived.

“They couldn’t just watch a baby sitting alone in a box,” Dynes says….

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