Ethical principles of nursing in current COVID -19 situation Bc. Natálie Schuchová Seminární práce 2021 oBSAH Introduction.. 3 1....... Historical foundations of medical ethics. 4 1.1...... Four pillars of Medical Ethics. 4 1.2...... Code of Ethics for Nurses and its changes in COVID19 situation. 6 Conclusion.. 9 literature.. 10 Introduction Contemporary medical practice is inevitable part of human society and human life as such. It is crucial for all medical personnel including nurses to continually consider medical and ethical aspects of their work. They must always have on mind that ethical principles are predominantly about what is good or what is not good for a patient. And they must be aware of fact that patients can be in some moment of their lives the most vulnerable human beings because of their pain and suffering. Moreover, ethical principles usage and application of sensitive approach to patients is extremely important especially during current pandemic of COVID19. 1 Historical foundations of medical ethics The so called “Hippocratic Oath” was the first attempt to formulate basic ethical aspects for medical professionals. However, it was created in fifth century BCE and generally is not applicable nowadays. The next try to create comprehensive code of medical ethics was Formula Comitis Archiatrorum, published it the 5^th century. Similarly, to the Hippocratic Oath, it prescribed the wording of the oath which persons appointed to position of Chief physicians were supposed to take. (Nemec, 1976) Nonetheless, from perspective of current medical practice, the most important documents are “The Declaration of Helsinki”, and “The Nuremberg Code”, both published during 20^th century. The Declaration of Helsinki was developed by The World Medical Association (WMA) as a statement of ethical principles for medical research involving human subjects, including research on identifiable human material and data. The basic principles of the declaration are “The health of my patient will be my first consideration,” and “A physician shall act in the patient's best interest when providing medical care”. (World Medical Association Declaration of Helsinki, © 2021) The Nuremberg Code was written up as a consequence of World War II. Medical Tribunal in Nuremberg, Germany, delivered its verdict in the trial of 23 doctors accused of war crimes and crimes against humanity for their roles in concentration camp medical experiments. As part of its judgment, the court articulated a 10-point set of rules for the conduct of human experiments that has come to be known as the Nuremberg Code. (Moreno, Schmidt and Joffe, © 2021) 1.1 Four pillars of Medical Ethics The four pillars of medical ethics are a framework for analyzing the best action to take in a given situation. To use this approach, you must consider whether your actions are following each of these pillars. The four pillars of medical ethics are: 1.1.1 Beneficence (doing good) Beneficence means that all medical personnel have a moral duty to promote the course of action that is in the best interests of the patient. Beneficence can be considered as a process of rating the available alternatives for the patient. Medical personnel must be always concerned with scale of the medical problem, individual circumstances of the patient, patient´s expectations and mainly the best option solving the medical issue. Moreover, it is very important to have on mind that what is beneficial for one patient may not necessarily be good for another. Speaking about nurses they approach to patient should be professional with a deep ethical judgment. Nurses must ensure human rights and privacy of a patient in accordance with patient´s preferences especially nowadays when mass media are searching for an exclusive information concerning COVID19 patients in order to spread panic and to publish a daily set of COVID19 sensational information. Generally, nurses are in some way defenders of patient´s rights a privacy. They must still have on mind that COVID19 patients are enormously scared and therefore extremely vulnerable. They must be treated cautiously. 1.1.2 Non-maleficence (to do no harm) Non-maleficence means that medical personal must not harm a patient by mistreatment. That means treatment of a patient must not cause more harm than good. Consequently, all medical personnel must consider the best way of treatment for a particular patient based on his/her current situation and if possible, accepting patient´s wishes and preferences as well. Nurses must be prepared and well educated regarding COVID19 patients despite the situation is generally new and irregular. It is crucial for nurses on all levels to identify lessons from COVID19 situations and to apply those lessons in future activities in order to avoid mistakes and mistreatment in future eventually. 1.1.3 Autonomy Autonomy means that a patient is an inevitable part of decision-making process concerning his/her future treatment and cannot be excluded from the process. Patient has always freedom to choose, he/she can even refuse the proposed treatment. This rule applies always except a patient is not capable to make any decision due to his/her mental situation or during an emergency situation. All nurses must have on mind that patient has an ultimate decision-making possibility. In order to facilitate patient’s situation, nurses are obliged to ensure that patient is correctly informed and receive understandable, sufficient, and timely information. The same applies regarding patient´s family and relatives. Nurses should inform them properly in an appropriate manner. This is very important in current situation due to a fact that there are many rumors and misleading information related to covid19 pandemic. Additionally, if one person from a family or community was found positive and moved to a hospital, it brings many difficulties even for his/her relatives. They should be informed properly about necessity of PCR testing, limitation of future contacts and many more. Nurse can be person competent to help and support them as much as possible. Since their situation can influence patient´s decision making process and overall treatment progress. 1.1.4 Justice Justice means than not only ethical aspect of medical care is important. All decisions made by medical personnel, their proposals and practical steps regarding treatment must be in conformity with rules of law and patient´s rights. Moreover, there must be always balance between ethical aspects and requirements of law. We can find one more aspect of justice in medical care which is extremely important in current COVID19 situation. And this is equal access to healthcare for everybody. Unfortunately, we can see a different situation nowadays. Some of our politicians, journalist and sometimes even doctors and nurses try to divide public in the Czech Republic into two groups - vaccinated and unvaccinated. We can hear voices declaring that unvaccinated should not have the same level of medical care as vaccinated. Some people propose unvaccinated should pay extra money for medical treatment etc. This everything is in contradiction to justice as an important aspect of medical care. And similar statements deny ethical principles and application of sensitive approach to patients. It is crucial for all nurses to demonstrate values as justice, respect and empathy to all patients. Nurses must be in the front line to fight for equity in access to health care particularly in time of pandemic. (Medical Ethics, © 2021) 1.2 Code of Ethics for Nurses and its changes in COVID19 situation An international code of ethics for nurses was first adopted by the International Council of Nurses (ICN) in 1953. It has been revised and reaffirmed at various times since, most recently with this review and revision completed in 2012. Preamble of 2012 Code of Ethics for Nurses states following: Nurses have four fundamental responsibilities: to promote health, to prevent illness, to restore health and to alleviate suffering. The need for nursing is universal. Inherent in nursing is a respect for human rights, including cultural rights, the right to life and choice, to dignity and to be treated with respect. Nursing care is respectful of and unrestricted by considerations of age, color, creed, culture, disability or illness, gender, sexual orientation, nationality, politics, race or social status. Nurses render health services to the individual, the family and the community and coordinate their services with those of related groups. (The ICN code of ethics for nurses, © 2012) The 2012 ICN Code of Ethics for Nurses contains four basic elements that define the standards of ethical conduct. 1. Nurses and people The nurse’s principal responsibility are people needing nursing care. In their work, nurses provide necessary care as well as promote human rights and values of patients and their families. The nurse supports social justice and equal access to health care and other social and economic services. The nurse demonstrates professional values such as respectfulness, responsiveness, compassion, and integrity. 2. Nurses and practice The nurse maintains her own competencies by continual learning. The nurse guarantee providing of care is not compromised. The nurse ensures that use of technology and scientific advances are consistent with the safety, dignity, and rights of people. The nurse promotes ethical behavior and open dialog. 3. Nurses and the profession The nurse implements adequate standards of clinical nursing practice, management, research and education. The nurse is active in developing of professional knowledge that supports evidence-based practice. The nurse creates fair social and economic working conditions in nursing. 4. Nurses and co-workers The nurse maintains a cooperative and respectful relationship with co-workers in nursing and other fields. The nurse safeguards individuals, families, and communities when their health is endangered by any person. The nurse advice co-workers regarding ethical conduct. (The ICN code of ethics for nurses, © 2012) Everything what was written and mentioned above was valid in standard medical situation. Unfortunately, condition started deteriorating at the end of 2019. World noticed first information concerning COVID19 infection before Christmas of 2019 and it was obvious that something terrible is approaching. Based on development of epidemiologic situation the World Health Organization (WHO) declared a public health emergency on 30 January 2020 and pandemic emergency on 11 March 2020. Since the situation was completely new it was clear that all medical personnel and even global medical organizations must fundamentally change their approach to their work. International Council of Nurses understood that even Code of Ethics for Nurses must be changed in order to reflect lessons learned from one year fight against COVID19 pandemic. Consequently, newly revised Code of Ethics for Nurses (CEN) was launched on 20 October 2020. Updated Code of Ethics for Nurses underscore necessity of participation in national and international associations to promote cooperation and favorable socio-economic and working conditions for all nurses. Revised Code of Ethics for Nurses emphasizes values such as human rights and right to universal access to health for all. It considers as very important dignity, freedom and worth of all human beings and strictly oppose all forms of exploitation. Revised Code of Ethics for Nurses considers as very important collaboration with other health and social care professions to advocate principles of justice, human rights, equity and fairness as well as promoting the public good. Considering global perspective International Council of Nurses promotes human rights effort, helping vulnerable populations, universal education and mitigation of hunger and poverty. (Revised ICN Code of Ethics for Nurses reflects lessons learned from the COVID-19 pandemic, © 2021) Conclusion The topic of the essay is “Ethical principles of nursing in current COVID-19 situation”. It is important to be mentioned COVID19 pandemic influenced and changed every aspect of human life. We can see everyday that even basic foundations of our society are being changed or even trampled. Traditionally, functioning of our democratic society from perspective of people of the Czech Republic is based on Chapter of Fundamental Rights and Freedom. It states ...” all people are free and equal in their dignity and rights. The fundamental rights are inherent, inalienable, non-prescriptible and irrepealable”. (Czech Republic, Chapter 1, Article 1, 1993) The most obvious attempt to make changes of society foundations is to subdivide our people to two - vaccinated and unvaccinated. It is necessary to say it happens not only in the Czech Republic, but it also becomes common practice in European Union as such. Therefore, it is extremely important International Council of Nurses understood complexity of the situation and published revised Code of Ethics for Nurses. Promoting equal access to healthcare for everybody, principles of justice, human rights, equity and fairness as well as the public good is crucial. It can be used as an example for politicians, media workers and extremist calling for punishment of unvaccinated and their separation from our society. Nurses from the Czech Republic recognized updated Code of Ethics for Nurses, launched by International Council of Nurses (ICN) therefore it is their obligation to serve everybody who need their help. literature 1. NEMEC, Jaroslav, 1976. Highlights in medicolegal relations. NEMEC, Jaroslav. Highlights in medicolegal relations [online]. Second. Bethesda: Department of health education and welfare, s. 10-11 [cit. 2021-12-10]. ISBN 017-052-00170-1. Dostupné z: https://collections.nlm.nih.gov/bookviewer?PID=nlm:nlmuid-7703021-bk 2. World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects, © 2021. JAMA Network [online]. Chicago: American Medical Association [cit. 2021-12-10]. Dostupné z: https://jamanetwork.com/journals/jama/fullarticle/1760318 3. MORENO, Jonathan, Ulf SCHMIDT a Steve JOFFE, © 2021. The Nuremberg Code 70 Years Later. JAMA Network [online]. Chicago: American Medical Association [cit. 2021-12-10]. Dostupné z: https://jamanetwork.com/journals/jama/fullarticle/2649074 4. Medical Ethics, © 2021. The medical portal [online]. London: Dukes education [cit. 2021-12-10]. Dostupné z: https://www.themedicportal.com/application-guide/medical-school-interview/medical-ethics/ 5. Revised ICN Code of Ethics for Nurses reflects lessons learned from the COVID-19 pandemic, © 2021. International Council of Nurses [online]. Geneva: International Council of Nurses [cit. 2021-12-10]. Dostupné z: https://www.icn.ch/news/revised-icn-code-ethics-nurses-reflects-lessons-learned-covid-19-pandemic 6. The ICN code of ethics for nurses [online], © 2012. Third. Geneva: International Council of Nurses [cit. 2021-12-10]. ISBN 978-92-95094-95-6. Dostupné z: https://www.icn.ch/sites/default/files/inline-files/2012_ICN_Codeofethicsfornurses_%20eng.pdf 7. CZECH REPUBLIC, 1993. CHARTER OF FUNDAMENTAL RIGHTS AND FREEDOMS: RESOLUTION of the Presidium of the Czech National Council of 16 December 1992 on the declaration of the CHARTER OF FUNDAMENTAL RIGHTS AND FREEDOMS as a part of the constitutional order of the Czech Republic. In: Prague: The Presidium of the Czech National Council, ročník 1993, číslo 2. Dostupné také z: https://www.usoud.cz/fileadmin/user_upload/ustavni_soud_www/Pravni_uprava/AJ/Listina_English_versio n.pdf