Although the American Nurses Association applauds the U.S. Navy’s decision not to pursue disciplinary action against a nurse who refused to force-feed detainees at Guantanamo Bay last year, the group will continue working to ensure RNs in military and other settings are able to do their jobs without compromising ethics.
During a May 13 press teleconference, Pamela Cipriano, PhD, RN, NEA-BC, FAAN, ANA president, called on not just the military but all healthcare leadership to join the organization in creating work environments in which the ethical code of conduct that all RNs must follow is upheld. Other panelists on the call included Ron Meister of Cowan, Liebowitz & Latman, P.C., the attorney for the nurse and Vincent Iacopino, PhD, MD, senior medical adviser at Physicians for Human Rights, a New York-based nonprofit.
After refusing to carry out orders last year to force-feed detainees, the nurse, who has not been publicly identified, was facing possible administrative discharge that would have ended his 18-year career with the Navy, Meister said during the teleconference. Force-feeding of detainees involves use of tube feedings and restraints.
“We believe this decision reflects the Navy’s recognition that the Code of Ethics for Nurses with Interpretive Statements, which has been a foundational document of the ANA for more than 60 years, supports the rights of nurses to make independent ethical judgments and to recuse themselves without retaliation from participation in care they find ethically objectionable,” Cipriano said during the teleconference. “This decision also recognizes that first and foremost, the registered nurse’s duty is to the patient, regardless of the setting of care or the employment situation.”
Cipriano expressed support for the Defense Board’s Medical Ethics Subcommittee’s efforts in reviewing military medical practice policies and procedures. Recommendations in the subcommittee’s report, titled Ethical Guidelines and Practices for U.S. Military Medical Professionals, include the creation of an office within the Department of Defense dedicated to ethics and oversight, Cipriano said, and the establishment of policies that recognized military healthcare professionals’ first ethical obligations are to their patients.
“This decision is an important step in recognizing the right of military health professionals to recuse themselves from unethical medical practices,” Iacopino said during the teleconference. “But the Navy’s decision does not squarely address the ongoing problem of medical ethics being subsumed by military objectives and policies to the detriment of ethical care.”
The force-feeding of prisoners at Guantanamo Bay Detention Center in Cuba has nothing to do with medical necessity, Iacopino said.
“As we speak, the Department of Defense instructions for healthcare professionals continues to provide a set of standards that are inconsistent with international norms,” he said. “They compel DOD healthcare professionals to force-feed detainees against their will and to enable behavioral science consultants to participate in interrogation. As healthcare professionals we cannot conduct procedures against the will of our patients. We cannot inflict pain for nonclinical reasons and we have no business assisting in interrogation.”
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