Category: Ethics

Navy Nurse Should Not be Punished for Declining to Force-Feed Guantánamo Detainees

PHR Welcomes American Nurses Association’s (ANA) Statement Supporting Nurses’ Professional Autonomy

Physicians for Human Rights

New York, NY – 11/19/2014

Physicians for Human Rights (PHR) today welcomed the American Nurses Association’s (ANA) statement supporting a nurse who refused to force-feed Guantánamo detainees based on his professional ethical obligations. PHR urged the U.S. Navy to end any disciplinary actions against the nurse, who has been charged with misconduct and faces potential discharge from the military.

“Nurses, like physicians, have professional duties to respect the autonomous decisions of their patients and never participate in ill-treatment or torture,” said Dr. Vincent Iacopino, PHR’s senior medical advisor. “This nurse has shown exemplary commitment to his profession’s ethics by refusing to comply with a military policy that has no clinical justification and is inherently harmful. The Navy should not punish him for refusing to compromise established ethical principles.”

Today’s statement represents the first time the ANA has spoken publicly about force-feeding at Guantánamo, signaling the wider nursing community’s interest in the nurse’s situation and the military’s treatment of medical professionals. The ANA also released communications it had with top defense officials urging them not to punish the nurse for exercising his professional rights and duties. PHR emphasized that the codes of conduct for nurses and physicians mandate respect for patient autonomy and the principle of doing no harm, and that military clinicians are legally and ethically bound to comply.

The Navy is considering holding an administrative trial that could lead to the nurse’s discharge from the Navy, in which he has served for 18 years. His decision not to participate in force-feeding was revealed through Abu Wa’el Dhiab, a Guantánamo detainee challenging his force-feeding in federal court. Dhiab’s case has shed light on the cruel and unnecessary methods used at Guantánamo, including the use of five-point restraint chairs and forced cell extractions.

“All physicians and nurses share a duty to put their patients first and act in their best interests, no matter the circumstances,” said Widney Brown, PHR’s director of programs. “Punishing this nurse for upholding the humane treatment of his patients sends a message that medical professionalism is not respected at Guantánamo.”

The World Medical Association and the American Medical Association are among the leading medical groups that prohibit force-feeding of competent adults. PHR said that health professionals should never take part, and pointed out that the main purpose of the Department of Defense’s force-feeding policy is to keep detainees from protesting over a decade of indefinite detention without charge. In response to criticism of these practices, the U.S. government has applied secrecy rules to any information regarding its treatment of hunger strikers.

PHR calls on the U.S. government to:

  • Immediately end the practice of force-feeding hunger strikers and institute policies and procedures consistent with the World Medical Association’s Declaration of Tokyo and Declaration of Malta on Hunger Strikers;
  • Ensure that no health professionals are compelled to participate in force-feeding, and that those who refuse do not face disciplinary or retaliatory actions for complying with their professional obligations; and
  • Commit to full transparency around hunger strikes at Guantánamo and medical management policies and protocols, including the release of Dhiab’s force-feeding videotapes.

Physicians for Human Rights (PHR) is a New York-based advocacy organization that uses science and medicine to stop mass atrocities and severe human rights violations. Learn more here.

Media Contact:

Vesna Jaksic Lowe, MS
Deputy Director of Communications, New York
vjaksiclowe [at] phrusa [dot] org

American Nurses’ Association supports conscientious objection by U.S. Navy nurse

ANA Statement on the Rights of Navy Nurse to Refuse to Participate in the Force-feeding of Detainees at Guantanamo Bay

Statement attributable to ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN:

ANA has been actively monitoring the force-feeding of detainees at Guantanamo Bay for more than two years, and we support the registered nurses in the military who have to make very difficult decisions related to either moving forward with or questioning any activity within a plan of care.

Professional registered nurses operate under a Code of Ethics that emphasizes the right to make independent, ethical judgments regardless of the setting in which nursing care is provided—even if this causes a nurse to experience conflict arising from competing loyalties.

The rights of registered nurses to honor their professional ethical obligations regarding force-feeding and other sensitive issues are absolutely protected and should be exercised without fear of retaliation.

We urge military leaders and health providers to uphold the ethical code of conduct to which all professional registered nurses are accountable and to be receptive to concerns raised by nurses or any other health care professional who is compelled, by an ethical commitment, to question any activity within the plan of care.

We do not believe this nurse should have to show cause for remaining in the Navy.

Judgementalism and moralising in response to Brittany Maynard suicide

Sean Murphy*

On 1 November, Brittany Maynard,  a 29 year old woman with terminal brain cancer, committed suicide in Oregon State with the assistance of a physician (and, presumably, a pharmacist), who provided the lethal medication she consumed.  Assisted suicide is legal in Oregon; that is why Maynard moved to the state.  In the weeks leading up to her death she had become a celebrity because of her public advocacy of assisted suicide, augmented by a kind of “countdown” to the date she had chosen to die. [NBC News]

It is not surprising that the announcement that she had killed herself as planned was followed by an outburst of judgementalism and moralising.

Prominent bioethicist Arthur Caplan stated, “did nothing immoral when she took a lethal dose of pills.”  He dismisses the view that “only God should decide when we die” because he finds that inconsistent with the existence of free choice, adding, “To see God as having to work through respirators, kidney dialysis and heart-lung machines to decide when you will die is to trivialize the divine.” [Brittany Maynard’s Death Was an Ethical Choice]

Chuck Currie, a minister of the United Church of Christ in Oregon, also insisted that Maynard had “made a moral choice.”  He described committing suicide under the terms of the Oregon law as taking “medically appropriate steps to make that death as painless and dignified as possible” – an appropriate exercise of “moral agency.”  Like Caplan, his theological views about the nature of God inform his approach to the issue. [Brittany Maynard Made A Moral Choice]

Writing in the New York Post, Andrea Peyser did not explicitly address either moral or theological questions, but implicit in her headline and awestruck praise for Maynard’s suicide was the premise that the young woman had done a “brave” and good thing. [We should applaud terminally ill woman’s choice to die]

In contrast, the head of the Catholic Church’s Pontifical Academy for Life in Rome, Monsignor Ignacio Carrasco de Paula, said that Maynard’s killing herself was a  “reprehensible” act that “in and of itself should be condemned,” though he stressed that he was speaking of the act of suicide itself, not Maynard’s moral culpability. [Daily News]

Those who condemn “judgementalism” and “moralising” ought to be offended by all of these commentators, because all of them –  Caplan, Currie, Peyser and de Paula – have expressed moral or ethical judgements.  To condemn suicide as “reprehensible” is surely to make a moral or ethical judgement, but moral judgement is equally involved in a declaration that suicide is a “moral” or “ethical” choice that should be applauded.

Health care workers who refuse to participate in some procedures for reasons of conscience or religion are often accused of being “judgemental” or of “moralising.”  In fact, as the preceding examples illustrate, their accusers are not infrequently just as “judgemental” and “moralistic.”   Such differences of opinion are not between moral or religious believers and unbelievers, but between people who believe in different moral absolutes.

This was one of the points made by Father Raymond De Souza during an interview about assisted suicide on CBC Radio’s Cross Country Checkup.  Interviewer Rex Murphy asked him if he thought that  “the idea of any absolute . . . even on the most difficult of questions of life and death . . . are no longer sufficient . . . for the modern world.”  Fr. De Souza’s response:

It’s a shift, Rex, I would say from one set of absolutes to the other.  And the absolute would be the absolute goodness of life, in one case, to assertion of personal autonomy, which is becoming an absolute assertion. And in fact in some of the arguments that have gone before the court, while acknowledging potential difficulties and philosophical objections, the right to personal autonomy trumps everything else.  So, in a certain sense, I wouldn’t say we are moving away from absolutes, but shifting from one set of absolutes to the other . . . [34:21- 35:24]

 

 

 

Conscience Versus the Spirit of the Age

Address to the Thomas More Lawyer’s Guild,
Toronto, Ontario, Canada (October, 2014)

Jason Kenney*

In this text of his address to the annual Red Mass dinner hosted by the Thomas More Lawyers’ Guild of Toronto in October 2014, then federal Minister of Employment and Social Development Jason Kenney called on assembled lawyers to defend conscience rights as a bulwark against the spirit of the age running roughshod over us.

It is a great honour to be invited to speak from this distinguished podium, which has been graced by people far more worthy than I, to invoke the life, legacy and lessons of our patron saint, Sir Thomas More.

I say “our” patron although I am not a member of your honourable legal fraternities at the bar and the bench. I labour in a much less august vineyard, that of the political vocation. But in the Jubilee Year of 2000, Saint John Paul II decided to add to Saint Thomas More’s already heavy burden as the patron saint of lawyers by also giving him the impossibly difficult task of acting as the patron saint of politicians.

Earlier this evening, we heard the Gospel reading, “Woe to you, lawyers!” Lest you feel put out, please remember that the most prominent politicians in the gospels are King Herod, Pontius Pilate and Caesar, so the politicians fare much worse!

Poor Saint Thomas, shining light of the Renaissance, the greatest jurist and statesman of his era, martyred for this faith—and his eternal reward is now to keep watch over politicians and lawyers. I suspect that he envies Saint Jude, who is charged only with hopeless causes. . .  [Full text]

There’s no “mushy middle” on euthanasia

Mercatornet

Margaret Somerville*

Many know the saying “You have to fish or cut bait”. Many fewer know the law’s equivalent, “You can’t approbate and reprobate”. But the Canadian Medical Association’s recent dealing with their 2007 Policy on Euthanasia and Assisted Suicide makes it seem they are unaware of the warning and wisdom these axioms communicate.

That CMA policy unambiguously declares: “Canadian physicians should not participate in euthanasia or assisted suicide.”  Despite that, a motion passed at the recent CMA General Council meeting, which ostensibly was meant only to ensure freedom of conscience, has allowed the CMA to make the following statement in its intervener factum in the upcoming appeal in the Supreme Court of Canada in the Carter case:

“As long as such practices [as euthanasia and assisted suicide] remain illegal, the CMA believes that physicians should not participate in medical aid in dying. If the law were to change, the CMA would support its members who elect to follow their conscience [either to refuse or to undertake euthanasia and assisted suicide].”

[Full text]