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Human Rights Discourse and Nursing's Agenda for the Future

Introduction

The current global nursing shortage crisis is an ideal starting point for a discussion of human rights issues and their implications for nurses and the nursing profession. In the United States, the global attention to the nursing workforce needs is spurring individuals, concerned patients, consumer groups, professional organizations, legislative bodies, and organized nursing to look into the root causes of the shortage. This writer contends that a full understanding of the nursing shortage phenomenon should start with a heightened awareness of the human rights issues at the heart of the nursing shortage crisis.

The primary purpose of this article is to stimulate meaningful discussion on the human rights issues embedded in the ANA's Call to the Nation: Nursing's Agenda for the Future (Agenda), (Steering Committee) (See below). Toward this end, the article is divided into three sections:

(1) Overview of the origins, nature, and scope of human rights;
(2) Identification and classification of nurses' rights implicit in the Agenda, and
(3) Strategies that nurses - individually and collectively - could pursue to advocate for these rights.

1. Overview of the origins, nature, and scope of human rights
The American Society of International Law reports that, "the concepts of humanitarian intervention, self-determination, and providing relief to the victims of armed conflict can be viewed as the roots of human rights law. Modern international human rights law dates from World War I and its aftermath". (American Society of International Law, www.asil.org/resource/humrts.1.htm, (visited 7/31/02). Current human rights treaties and covenants are supplemental to the initial codification of human rights sentiments expressed in the Universal Declaration of Human Rights, ratified in 1948. (United Nations, 1948).

For the purposes of this article, the writer offers the following definition of human rights as synthesized from the extensive literature on this subject: Human rights are a bundle of morally and legally binding expectations of individuals and groups in any given society by virtue of: (Beauchamp and Childress, 1989), (Barns and Hart, 1997), (Dworkin, G., 1994), Dworkin, R. 1966, 1981), (Feinberg, 1966, 1973), (Habermas, 1993), (Hart, 1955), (Hohfeld, 1983), (Kant, 1991), (Lyons, 1983), Mill (1991), (Nozick, 1974), (Rawls, 1971).

(a) Moral attributes of humans: This metaphysical argument posits that humans are created in the image of God, thus, by their humanity are entitled to inviolable, inalienable, and emancipatory rights to be free, to be left alone, and not be subjected to morally unacceptable acts. These rights are associated with liberty rights. Liberty rights impose restraints on others "not to do things" (prohibitions) to a particular human being.

(b) Universal recognition by contracting parties in the United Nations of social, economic, cultural, political, and civil conditions that must be sustained to maintain the inherent worth and dignity of each human being. These rights are secular in nature and are usually expressed in the form of laws, conventions, treaties and codes. These rights are associated with claim rights. Claim rights impose correlative duties on others to which the right is held (permissions).

(c) Agency - the human state of being in power; humans' capacity or ability to act intentionally e.g., social movements such as the anti-slavery movement, civil rights movement, women's rights movement, birth control and family planning movement, safe environment movement, and human rights watch are examples of men's and women's ability to act, plan for their future, and be instruments for change

In the contemporary analysis of human rights, there is consensus as to the origins, nature, and scope of human rights. Philosophers, historians, sociologists, psychologists, feminists, lawyers, ethicists, and others agree that human rights emerged as a multi-national response to dominance, e.g. armed conquest and atrocities, and power imbalances, e.g. the skewed balance of power between men and women in patriarchal societies, whereby women are considered as "means" to fulfill men's "ends." (ibid).

In a system of patriarchy, the "haves," be it in the form of power, status, or money, are usually men and the "have nots" are usually women. An example of a patriarchal system is a fundamentalist Islamic group like the Taliban, where women are confined to the "private sphere," homemaking and child-rearing, while the "public sphere" access to education, employment, and public office are exclusively men's domain. Historically, Western societies like the United States are also patriarchal. As of July 2002, the United States, a contracting party in the United Nations, has not ratified the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), McMillion 2002). This legally binding international treaty requires that women have equal rights to work, pay, and benefits. It also guarantees safe working conditions and prohibits discrimination based on a woman's political activities. Conservative groups have asserted that the treaty could be used by feminists to impose their agenda - from abortion rights to employment quotas - on sovereign nations, including the United States.

Mirroring the society in which nursing functions, its history and evolution as a profession has also been strongly influenced by the themes of "domination" and "patriarchy." In response to the injury, harm, and abuse experienced by women due to the domination of men, many nurses advanced the cause of human rights by standing up to dominance and patriarchy at various junctures in history. Florence Nightingale defied the conventions of her time and participated in the "public sphere" by educating herself, by traveling to the Crimean War front, and by applying her specialized knowledge and skills in caring for military men. Nightingale was also a pioneer in the use of statistics, documenting the impact of sanitation on public health. During the Victorian era, Margaret Sanger challenged the norms and ethos of America by advocating that women should be able to control their own bodies through birth control. (Living the Legacy: Women's Rights Movement, 1998)

According to Lyons, "rights are closely associated with justice, and the stringency of justice might explain the importance that is attached to rights" (Lyons, 1983). A taxonomy of contemporary human rights as shown in Table 1 reflects the advances that have been made in the recognition and expansion of civil and political rights, legal rights, economic, social and political rights, and collective rights, since the initial Universal Declaration of Human Rights. (Stone, 1992), (Gibson, 1996). The reader is cautioned that the thematic listing of these rights are not always consistent as to whether these rights are positive or negative rights (permissions or prohibitions).

To meet the preferred future that new millennium nurses have envisioned for themselves in an era of a chaotic global village, in a health industry driven by capitalistic ideology and practices, in a nation whose constitution remains silent on the equality of both sexes, nurses must assert their human rights. As a profession, nursing must challenge existing agents, sites, and structures of power--managed care, profit-driven hospital administrators (usually men), and physicians (usually men) who still look down on nurses as their handmaidens and a means to their professional ends. Nurses must be vigilant about overt and covert socio-cultural manifestation of power relations in their day-to-day work lives.

2. Identification of the rights expressed and/or implied in the Agenda

Three declarative statements in the Agenda are replete with expressed and implied sentiments about human rights for both nurses and the public. These rights consist of what the public and nurses should be "enabled to do" ("claim rights or demands - positive or affirmative rights"), and what "should not be done" to the public and to nurses ("negative rights").

The Agenda declares that:

"Nursing is the pivotal health care profession, highly valued for its specialized knowledge, skill and caring in improving the health status of the public and ensuring safe, effective, quality care. The profession mirrors the diverse population it serves and provides leadership to create positive changes in health policy and delivery systems.

Individuals choose nursing as a career, and remain in the profession because of the opportunities for personal and professional growth, supportive work environments and compensation commensurate with rules and responsibilities."
(ANA, 2001)

Reference Documents

• Bill of Rights FAQs
• Nursing’s Agenda for the Future (April 2002) [pdf]
• The Code of Ethics for Nurses with Interpretive Statements