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Ethics and Human Rights

View the Code

“The Code” is a vital
tool for nurses
now and in the future.

VIEW THE CODE

Life and death decisions are a part of nursing, and ethics are therefore fundamental to the integrity of the nursing profession. Every day, nurses support each other to fulfill their ethical obligations to patients and the public, but in an ever-changing world – there are increased challenges.

The ANA Center for Ethics and Human Rights

The Center is committed to addressing the complex ethical and human rights issues confronting nurses and designing activities and programs to increase the ethical competence and human rights sensitivity of nurses. Through the Center, ANA's abiding commitment to the human rights dimensions of health care is demonstrated.

The American Nurses Association (ANA) Center for Ethics and Human Rights was established to help nurses navigate ethical and value conflicts, and life and death decisions, many of which are common to everyday practice. The Center develops policy designed to address issues in ethics and human rights at the state, national, and international levels. Through its highly visible information, activities, and programs, the Center promotes the ethical competence and human rights sensitivity of nurses in all practice settings and demonstrates ANA’s abiding commitment to human rights.

2017 Center for Ethics and Human Rights Annual Report

Contact the Center of Ethics and Human Rights at ethics@ana.org

READ MORE ABOUT THE CENTER FOR ETHICS AND HUMAN RIGHTS

The Code

The Code of Ethics for Nurses with Interpretive Statements, or “The Code”, is a vital tool for nurses now and in the future. While the foundational values of nursing do not change, The Code is regularly updated to reflect changes in health care structure, financing, and delivery. It supports nurses in providing consistently respectful, humane, and dignified care. These values are often second nature to nurses’ caregiving but are frequently challenged by the failings in U.S. health care and by negative social determinants of health.

The Code, consisting of nine provisions and their accompanying interpretive statements:

  • Provides a succinct statement of the ethical values, obligations, and duties of every individual who enters the nursing profession;
  • Serves as the profession’s nonnegotiable ethical standard; and
  • Expresses nurses' own understanding of our commitment to society.

The Code is particularly valuable in today’s healthcare environment because it clearly and eloquently reiterates the fundamental values and commitments of the nurse (Provisions 1–3), identifies the boundaries of duty and loyalty (Provisions 4–6), and describes the duties of the nurse that extend beyond individual patient encounters (Provisions 7–9).

To serve as the most useful aid in challenging situations, The Code's interpretive statements provide specific guidance for practice. The statements respond to the contemporary context of nursing and recognize the larger scope of nursing’s concern for societal health.

The Code of Ethics for Nurses with Interpretive Statements is the social contract that nurses have with the U.S. public. It exemplifies our profession's promise to provide and advocate for safe, quality care for all patients and communities. It binds nurses to support each other so that all nurses can fulfill their ethical and professional obligations. This Code is a reflection of the proud ethical heritage of nursing; one which will continue on, whatever challenges the modern health care system presents.

BUY THE CODE OF ETHICS FOR NURSES WITH INTERPRETIVE STATEMENTS ONLINE

The ANA Center for Ethics and Human Rights helps nurses navigate complex and every day ethical issues, in all practice settings.

ANA position statements on ethics and human rights

In tandem with The Code, ANA’s position statements support nurses by offering an explanation, a justification, or a recommendation for a course of action in particular situations.

Ethics and Human Rights

2018

2017

2016

2015

2013

2012

Retired ANA Position Statements

Ethics Topics and Resources

For nurses to fulfil their ethical obligations to patients, it is vital to have access to a wide range of information and to keep up-to-date with advances in ethical practices. These articles and links offer context for nurses on difficult issues and best-practice recommendations.

Social Justice

When nurses vow to protect the health and safety of patients, that promise does not end at the bedside. While social justice is a logical extension of the nursing profession, it can be difficult for nurses to navigate these divisive areas and ensure every individual receives timely and high-quality care.

Sign the Pledge Against Torture

Given the importance of ethics and the protection of human rights in nursing practice, the American Nurses Association is urging RNs to join ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, and ANA Chief Executive Officer Marla J. Weston, PhD, RN, FAAN, in signing on to the Health Professionals' Pledge Against Torture.

Physicians for Human Rights launched a pledge May 18 for health professionals across the United States to stand together in their rejection of torture, voicing the consensus that torture and cruel, inhuman, or degrading treatment are absolutely prohibited in all circumstances. Already the list of signers includes Nobel laureates in medicine, former surgeons general, prison physicians, leaders of health professional organizations, and medical ethicists who pledge never to collude in torture under any circumstances, in keeping with the ethical codes of their professions.

By uniting in large numbers behind the pledge, nurses and other health care professionals send a strong message to policymakers, health professional associations and the American public that future attempts to enlist health professionals in the design, study or use of practices that result in severe physical or mental abuse will not be tolerated. The pledge also serves as a declaration of support for health professionals who resist orders to torture or inflict harm.

For more than a decade, PHR and its network of partners have led efforts advocating against torture, documented the devastating long-term health consequences of torture, and called attention to the complicity of some health professionals in the post-9/11 U.S. torture program.

“At a time when human rights are increasingly under threat, we’ve launched this pledge to marshal the powerful voices of health professionals across the United States and reaffirm their ethical duties to honor human dignity,” said PHR Executive Director Donna McKay.

ANA’s Code of Ethics for Nurses with Interpretive Statements is essential to nursing practice, and the national association has a long history of human rights advocacy. For example, ANA successfully advocated for the ethical right of a Navy nurse to refuse to force-feed detainees at Guantanamo Bay. In January, ANA released its Ethics and Human Rights Statement emphasizing that nursing “is committed to both the welfare of the sick, injured, and vulnerable in society and to social justice.” To read more visit, Health Professionals' Pledge Against Torture.

 

Moral Courage, Moral Distress, Moral Resilience

Nurses practicing in today’s health care environment face increasingly complex ethical dilemmas. Upholding our commitment to patients and communities requires significant moral courage and resilience. It involves the willingness to speak out, whether alone or collectively, to do what is right for patients and other nurses

Documentary

The Moral Distress Education Project
Core multidisciplinary experts on moral distress from across the country were interviewed in a documentary-style media project. This project is a self-guided web documentary.

A Call To Action Report: Exploring Moral Resilience Toward a Culture of Ethical Practice

End of Life Issues

In an aging population with rapidly increasing technological interventions possible, end of life care is a vital discussion. With multiple perspectives to consider, these resources serve to convey the breadth of opinion that nurses experience, and help nurses respect individual dignity and autonomy.

Advance directives, Education, Professional Organizations, Hospice

In an aging population with rapidly increasing technological interventions possible, end of life care is a vital discussion. With multiple perspectives to consider, these resources serve to convey the breadth of opinion that nurses experience, and help nurses respect individual dignity and autonomy.

Advance directives

End of life care often starts when a person is healthy. Many people, including nurses, have specific ideas about what health care they want, or do not want, at the end of life. Advance directives are a means to allow people to convey their wishes for end of life care. This includes discussions with those who might be a surrogate decision maker, as well as documents used to express preferences.

The National Hospice & Palliative Care Organization (NHPCO)
HHPCO has a directory of advance directives that are acceptable to each statue.

Five Wishes
An easy guide for patients and families to discuss preferences for end of life care, as well as for healthcare professionals who might not be comfortable with such discussions. The guide includes prompts for discussions about how you wish to be remembered.

Education

The End-of-Life Nursing Consortium (ELNEC) 
ELNEC is a series of programs developed by the American Association of Colleges of Nursing. Current ELNEC modules include core curriculum, pediatric palliative care, geriatric, and many others. There are also train-the-trainer modules. After taking a train the trainer course, a nurse can then offer an ELNEC course. The courses are comprehensive and provide all teaching materials needed. The courses are typically offered in a block over two days.

Education in Palliative and End of Life Care (EPEC)
EPEC was originally developed as physician education but has expanded. It has both in-seat and online programs. The model includes the training of facilitators. Sessions may be given in day-long formats, or in shorter sessions, such as grand rounds.

Professional Organizations

The Hospice & Palliative Nurses Association (HPNA)
HPNA has the mission of advancing expert care in serious illness. HPNA is the professional organization for palliative care nurses and hospice nurses. HPNA provides education and certification for nurses across levels, including Advance Practice Registered Nurses (APRN), Registered Nurses (RN), RN Pediatrics, and more. HPNA has many Special Interest Groups (SIGs) with online discussion groups. The organization has also developed a series of position statements to guide professional practice. With The American Academy of Hospice & Palliative Medicine (AAHPM), HPNA has an annual assembly for professionals.

The American Academy of Hospice & Palliative Medicine (AAHPM)
AAHPM is the professional organization for hospice physicians, palliative medicine physicians, and other health care professionals (nurses, social workers, chaplains, etc.) in these fields. Their goal is to improve the care of patients living with serious illness. AAHPM provides certification for physicians in palliative medicine, as well as for hospice medical directors. AAHPM provides many options for education, online discussion groups, special interest groups, and certification. With HPNA, AAHPM has an annual assembly for professionals.

The Center to Advance Palliative Care (CAPC)
CAPC is a multidisciplinary organization that supports practice, research, and education. Hospitals can become member organization, and all employees of those organizations have extensive access to continuing education and other resources. Even non-members have access to the myriad resources of CAPC.

The National Hospice & Palliative Care Organization (NHPCO)
NHPCO is one of the oldest advocacy organizations in the fields of hospice and palliative care. Their focus is primarily on the care of patients with terminal illness, and their families. They have developed Standards of Practice and have several position statements.

Growth House
Growth House’s mission is improving care for the dying. They provide education about living with serious illness and end of life care. Their education is for lay people (including the very popular Handbook for Mortals) and healthcare caregivers (e.g. the Stanford Curriculum for end of life care), as well as disease specific education on topics such as heart disease, end stage renal disease, and cancer.

The Schwartz Center
The Schwartz Center is another organization whose goal is to improve the care of patients who are dying. One of their best known efforts is Schwartz Center Rounds, which are intended as a regularly scheduled forum for caregivers to discuss the challenges of caring for patients and families. Schwartz Center Rounds are currently held in about 550 centers in the U.S., U.K., and Canada.

Hospice

Hospice is a model of care for people who are at the end of life. Specifically, hospice care is eligible for people who are estimated to have a prognosis of six months or less. Hospice is tremendously underutilized, with about 50% of patients having a length of stay of less than 18 days, as opposed to the approximately 180 days of the hospice benefit. Misperceptions about hospice are common. A common misunderstanding is that hospice is a place (“She’s going to hospice”), rather than a model of care. Greater than 90% of hospice care occurs in patients’ homes.

The Centers for Medicare and Medicaid Services
This resource explaining the hospice guidelines is helpful for patients, families, and providers.

Elder Law Answers
This resource from Elder Law Answer is used to make the Medicare Hospice Benefit more comprehensible.

Caregiving Resources

Nurses frequently come into contact with caregivers and can provide vital support to individuals who may not come into regular contact with others due to the often all-consuming nature of providing care. It is important for caregivers to realize that they are not alone and that there’s a wealth of information and resources to improve their situation.

Links to tools and support groups for caregivers:

National Association for Home Care & Hospice (NAHC) 
NAHC is the voice of home care and hospice. NAHC represents the nation’s 33,000 home care and hospice providers, along with the more than two million nurses, therapists, and aides they employ.

Caregiver Action Network (CAN) 
Education, peer support, and resources for family caregivers. CAN serves a broad spectrum of family caregivers ranging from the parents of children with special needs, to the families and friends of wounded soldiers; from a young couple dealing with a diagnosis of MS, to adult children caring for parents with Alzheimer’s disease. 

Help for cancer caregivers 
Tools and information to improve the quality of life for caregivers. 

The American Cancer Society 
A national website with a tab on finding support for caregivers: what to expect; what you need to know when caring for a loved one at home; and tips of caring for oneself. 

The American Association of Critical-Care Nurses 
You can search for Caregivers and it links you to multiple articles on caring for the chronically critically ill. 

Patients’ Action Network 
Has a tab on advocate resources. 

Women's Institute For A Secure Retirement
Resource tab for caregivers and their families.

Caregiver support - online caregiver support 
Caregiver support for people who take care of their elderly loved ones, or have the possibility of being a new caregiver or potential caregiver. 

The Conversation Project 
Contains a toolkit to help people talk about their wishes for end-of-life care. An essential for all caregivers. 

VA Caregiver Support 
Can tell you about assistance available from VA, help you access the services, connect you to the Caregiver Support Coordinator at a VA Medical Center near you, and just listen, if that is what you need. Support line 1.855.260.3274. 

Alzheimer’s Association Caregiver Stress
Describes caregiver stress and offers tips for managing stress.

American Psychological Association
Common Ethical Issues: Supporting the Caregiver

World Health Organization
Ethical Choices in Long-Term Care: What Does Justice Require?   

Bioethics

While the consequences of Bioethics may not be felt by every single nurse, it is vital they are aware of the enormous implications of these issues, in case of crisis. From Ebola to natural disasters, through keeping aware of the very latest threats, nurses can protect patients and themselves in the face of any obstacles.

Related Resources

The NCSBN National Nursing Guidelines for Medical Marijuana
Nursing guidelines for the patient using medical marijuana

American Society of Bioethics and Humanities (ASBH)
Serves as a resource for anyone interested in bioethics and humanities by providing a group of further on-line resources and links to aid in finding other related information through the Internet.

Ethics, the law, and a nurse’s duty to respond in a disaster

National Center for Ethics in Health Care- Veterans Affairs
A resource for addressing complex ethical issues in health care.

International Council of Nurses
Ethics and Human Rights.

National Reference Center for Bioethics Literature
Offers extensive searches in Bioethics.

Nursing2015 / Issues in Nursing
“A Nurse’s Obligations to Patients with Ebola.”

United Nations Educational, Scientific and Cultural Organization (UNESCO) Bioethics

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