Background:Prisons are contexts where nurses are required to have specific skills to ensure that, in a setting designed for the expiation of crime, prisoners receive the same type of care as anyone else. But this is not always the case, giving rise to ethical issues.Research questions:‘How do correctional nurses describe their working experience in prisons? What issues emerged?’Methodology:This is a qualitative descriptive study. Following purposive sampling, we conducted five focus groups. Thematic analysis was used to analyse the data.Participants and research (...) context:Our sample included 31 correctional nurses in seven prisons in Northern Italy.Ethical considerations:The scientific merit of this study was recognized by the Academic Board of the University of Genoa. Approval to conduct the study was obtained from the Liguria Regional Government that funded this study and from the Local Health Authority that was the prison nurses’ employer. Formal consent was obtained from all the nurses who volunteered to participate in this study.Findings:Five themes emerged from the focus groups: prisoners’ healthcare needs, negotiation between custody and care, satisfaction of working in prisons, obstacles to quality care and safety. ‘Manipulation’ was a transversal theme that emerged from all the focus groups.Discussion:The problems generated by the clash between prison security and nursing care priorities did not enable nurses to practice autonomously and provide the best possible to care prisoners, giving rise to ethical issues and moral distress. This in turn causes high nursing turnover rates that negatively impact continuum of care.Conclusion:In Italy, correctional nurses urgently require specific education interventions with the participation of all those who work in prisons. Interventions based on the post-modern concept of restorative nursing could offer prison nurses the opportunity to both resolve ethical issues and reduce moral distress. (shrink)

In the United States, information about a person’s criminal history is accessible with a name and date of birth. Ruth Crampton has studied nurses’ care for prisoner-patients in hospital settings and found care to be perfunctory and reactive. This article examines whether it is morally permissible for nurses in hospital settings to access information about prisoner-patients’ criminal histories. Nurses may argue for a right to such information based on the right to personal safety at work or the obligation to provide (...) prisoner-patients with the care that they deserve. These two arguments are considered and rejected. It is further argued that accessing information about a prisoner-patient’s criminal history violates nurses’ duty to care. Care, understood through Sarah Ruddick’s account as work and relationship, requires nurses to be open and unbiased in order to do their part in forming a caring relationship with patients. Knowledge of a prisoner-patient’s criminal history inhibits the formation of this relationship and thus violates nurses’ duty to care. (shrink)

Nursing practice in correctional settings is ethically unique. Its premise is the contradiction between causing harm (the purpose of imprisonment) and acting for patients’ good (the purpose of health care). I describe three ethical regions in which correctional nurses can practise, based on different philosophies: punishment as retribution, as rationality, and as paradox. Retribution and rationality resolve the ethical contradiction by relegating offenders to intractable otherness. Restorative nursing based on paradox is an oppositional practice that preserves the contradiction, (...) making engagement possible between prisoner and nurse. Endorsement by nursing of one of the three philosophies of punishment could redefine care for the entire profession. (shrink)

Prisoners signify: a political discourse analysis of mental illness in a prison control unitIncreasingly, US prisoners diagnosed with mental illness are housed in control units, the most restrictive form of confinement in the US prison system. This situation has led to intense debate over the legal, ethical and clinical status of mental illness. This is a semiotic struggle with profound effects, yet most related work treats mental illness as a neutral, individual variable. Few analyses locate mental illness within (...) a larger sociopolitical context. Fewer still focus on discursive practice. None critically analyze the accounts of control unit prisoners, who talk about extreme marginality and risk for victimization. This paper has two aims: (i) to develop a systematic method of analysis that accounts for signification as discourse‐in‐action; and (ii) to show how prisoners’ signification of mental illness articulates agency through and against marginalizing discourse. Political discourse analysis demonstrates how control unit prisoners with psychiatric diagnoses signify mental illness, and articulate safer identifications in the process. (shrink)

Background: Older, frail patients with multimorbidity are at an especially high risk for disease severity and death from COVID-19. The social restrictions proved challenging for the residents, their relatives, and the care staff. While these restrictions clearly impacted daily life in Norwegian nursing homes, knowledge about how the pandemic influenced nursing practice is sparse. Aim: The aim of the study was to illuminate ethical difficult situations experienced by Norwegian nurses working in nursing homes during the COVID-19 pandemic. (...) Research design and participants: The research design involved semistructured individual interviews conducted with 15 nurses working in 8 nursing homes in 3 health regions in Norway, within both urban and rural areas. Ethical considerations: Oral and written information about the study was provided before the participants gave their written consent. The transcribed interviews were de-identified. The study was approved by the Norwegian Centre for Research Data. Findings: Four ethical difficult situations were identified: (a) turning the nursing home into a prison; (b) using medication to maintain peace and order; (c) being left alone with the responsibility; and (d) s. impact on decision-making. Conclusions: The nurses’ ethical challenges were intertwined with external factors, such as national and local guidelines, and the nurses’ own internalized factors, which were connected to their subjective professionality. This duality inflicted emotional distress and gave nurses few opportunities to perform nursing in a professionally sound and safe manner. (shrink)

This volume recognizes and addresses the health care issues of prisoners, to establish best practices and to learn about approaches to these challenges from around the world. It presents new evidence on several emerging and classical prison health issues. The first goal of this volume is to address emerging issues related to health in prison. Second, it presents the most recent research-based evidence and translates it to the practice. The third goal, is that it allows for sufficient diversity (...) while also incorporating updates of some important already recognized prison health. The volume discusses prisons and the life and well-being of prisoners and staff, after growing problems as drug misuse (incl. tobacco smoking), infectious diseases (HIV/AIDS, hepatitis, STIs and TB), psychiatric problems, inadequate and unhealthy living conditions (incl. nutrition), overcrowding of prisons. These are addressed adequately in order to meet the international requirements of equivalence of health care. The scope of this volume is at the same type specific and diverse enough to cover the interests of a large audience that includes many types of practitioners involved in health-related issues in the field of prison health care, such as psychologists, nurses and prison administration officers responsible for health care, legal professionals and social workers. (shrink)

Health care is provided in many contexts—not just hospitals, clinics, and community health settings. Different institutional settings may significantly influence the design and delivery of health care and the ethical obligations and practices of health care practitioners working within them. This is particularly true in institutions that are established to constrain freedom, ensure security and authority, and restrict movement and choice. We describe the results of a qualitative study of the experiences of doctors and nurses working within two women’s prisons (...) in the state of New South Wales (NSW), Australia. Their accounts make clear how the provision and ethics of health care may be compromised by the physical design of the prison, the institutional policies and practices restricting movement of prisoners and practitioners, the focus on maintaining control and security, and the very purpose of the prison and prison system itself. The results of this study make clear the impact that context has on professional practice and illustrate the importance of sociology and anthropology to bioethics and to the development of a more nuanced account of professional ethics. (shrink)

The Republic of the Ukraine has a huge prison population and a large prison health care system. Like all other public services in that country it is lacking in sufficient funds to operate adequately and with due respect to the human rights of the prisoners and its health care employees. This report and observations are based on my knowledge of the Ukrainian health care system and a visit to a Ukrainian prison hospital. It includes some ethical reflections (...) stemming from this experience. Although problem-solving exercises can often help to point to areas of potential intervention that could ameliorate a troublesome situation, in this case prison health care conditions cannot be substituted for economic growth, political stability or increased awareness of societal moral obligations. (shrink)

This book brings together a collection of social justice scholars and activists who take Foucault’s concept of discipline and punishment to explain how prisons are constructed in society from nursing homes to zoos. This book expands the concept of prison to include any institution that dominates, oppresses, and controls. Criminologists and others, who have been concerned with reforming or dismantling the criminal justice system, have mostly avoided to look at larger carceral structures in society. In this book, for (...) example, scholars and activists question the way patriarchy has incapacitated women and imagine the deinstitutionalization of people with disabilities. In a time when popular sentiment critiques the dominant role of the elites, the state’s role in policing dissenting voices, school children, LGBTQ persons, people of color, and American Indian Nations, needs to be investigated. A prison, as defined in this book, is an institution or system that oppresses and does not allow freedom for a particular group. Within this definition, we include the imprisonment of nonhuman animals and plants, which are too often overlooked. (shrink)

A paper was published in 2003 discussing the ethics of nurses participating in executions by inserting the intravenous line for lethal injections and providing care until death. This paper was circulated on an international email list of senior nurses and academics to engender discussion. From that discussion, several people agreed to contribute to a paper expressing their own thoughts and feelings about the ethics of nurses participating in executions in countries where capital punishment is legal. While a range of opinions (...) were presented, these opinions fell into two main themes. The first of these included reflections on the philosophical obligations of nurses as caregivers who support those in times of great need, including condemned prisoners at the end of life. The second theme encompassed the notion that no nurse ever should participate in the active taking of life, in line with the codes of ethics of various nursing organisations. This range of opinions suggests the complexity of this issue and the need for further public discussion. (shrink)

In Pabon v. Wright, the Second Circuit held that the Fourteenth Amendment right to refuse medical treatment contained a corollary right to the information necessary to make an informed decision. Plaintiff, William Pabon, was an inmate at Green Haven Correctional Facility in New York. He named two groups of defendants: his doctors and nurses at Green Haven and his doctors at Dutchess Gastroenterologists, P.C..In October 1996, a laboratory test indicated that Plaintiff may have contracted Hepatitis C. The Green Haven doctors (...) referred Plaintiff to Dutchess for additional testing, where additional tests confirmed that Plaintiff had Hepatitis C. In July 1997, Plaintiff returned to Dutchess for additional evaluation, and the physicians told him that he must undergo a liver biopsy in order to receive treatment for his condition. (shrink)

The aim of this article is to investigate how life in Norwegian nursing homes may affect experiences of dignity among persons with dementia. The study had a qualitative design and used a phenomenological and hermeneutic approach. Participant observation in two nursing home units was combined with qualitative interviews with five residents living in these units. The study took place between March and December 2010. The residents feel that their freedom is restricted, and they describe feelings of homesickness. They (...) also experience that they are not being seen and heard as individual autonomous persons. This lack of freedom, experiences of homesickness and feelings of not being confirmed and respected as individual autonomous persons may be a threat to their personal dignity. In order to protect and enforce the dignity of persons with dementia living in nursing home, we should confirm them as whole and as individual persons, and we should try to make the nursing homes less institutional and more home like. (shrink)

The aim of this article is to bring to the attention of the international nursing community the discrepancy between a pervasive ‘caring’ nursing discourse and a most unethical nursing practice in the United States. In this article, we present a duality: the conflict in American prisons between nursing ethics and the killing machinery. The US penal system is a setting in which trained healthcare personnel practice the extermination of life. We look upon the sanitization of deathwork (...) as an application of healthcare professionals’ skills and knowledge and their appropriation by the state to serve its ends. A review of the states’ death penalty statutes shows that healthcare workers are involved in the capital punishment process and shielded by American laws (and to a certain extent by professional boards through their inaction). We also argue that the law's language often masks that involvement; and explain how states further that duplicity behind legal formalisms. In considering the important role healthcare providers, namely nurses and physicians, play in administering death to the condemned, we assert that nurses and physicians are part of the states’ penal machinery in America. Nurses and physicians (as carriers of scientific knowledge, and also as agents of care) are intrinsic to the American killing enterprise. Healthcare professionals who take part in execution protocols are state functionaries who approach the condemned body as angels of death: they constitute an extension of the state which exercises its sovereign power over captive prisoners. (shrink)

Background Respect for human rights and bioethical principles in prisons is a crucial aspect of society and is proportional to the well-being of the general population. To date, these ethical principles have been lacking in prisons and prisoners are victims of abuse with strong repercussions on their physical and mental health. Methods A systematic review was performed, through a MESH of the following words (bioethics) AND (prison), (ethics) AND (prison), (bioethics) AND (jail), (ethics) AND (jail), (bioethics) AND (penitentiary), (...) (ethics) AND (penitentiary), (prison) AND (human rights). Inclusion and exclusion criteria were defined and after PRISMA, 17 articles were included in the systematic review. Results Of the 17 articles, most were prevalence studies (n.5) or surveys (n.4), followed by cross-sectional studies (n.3), qualitative studies (n.1), retrospective (n.1) and an explanatory sequential mixed-methods study design (n.1). In most cases, the studies associated bioethics with prisoners’ access to treatment for various pathologies such as vaccinations, tuberculosis, hepatitis, HIV, it was also found that bioethics in prisons was related to the mental health of prisoners, disability, ageing, the condition of women, the risk of suicide or with the request for end-of-life by prisoners. The results showed shortcomings in the system of maintaining bioethical principles and respect for human rights. Conclusions Prisoners, in fact, find it difficult to access care, and have an increased risk of suicide and disability. Furthermore, they are often used as improper organ donors and have constrained autonomy that also compromises their willingness to have end-of-life treatments. In conclusion, prison staff (doctors, nurses, warders, managers) must undergo continuous refresher courses to ensure compliance with ethical principles and human rights in prisons. (shrink)

Since the era of deinstitutionalisation, many clinical approaches have emerged to enable the care and treatment of people suffering from mental illness. In recent years, the use of coercive approaches in the community (e.g., outpatient commitment or community treatment orders) has also increased internationally. Although nurses' role regarding these coercive approaches is central and significant, few empirical and theoretical writings have tackled this controversial nursing practice. The purpose of this paper is to analyse coercive nursing care through the (...) lens of French philosopher Gilles Deleuze's concept of ‘societies of control’. Taking up Michel Foucault's work on disciplinary power, Deleuze explores how the move from the striated spaces of closed institutions to the smooth spaces of societies of control took place since the middle of the 20th century. According to Deleuze, the overall objective of ‘societies of control’ is no longer simply to govern deviant behaviour in closed environments (e.g., psychiatric hospitals and prisons) but to ensure a regime of unrelentless surveillance in the open spaces of our communities. (shrink)

In Pabon v. Wright, the Second Circuit held that the Fourteenth Amendment right to refuse medical treatment contained a corollary right to the information necessary to make an informed decision. Plaintiff, William Pabon, was an inmate at Green Haven Correctional Facility in New York. He named two groups of defendants: his doctors and nurses at Green Haven and his doctors at Dutchess Gastroenterologists, P.C..In October 1996, a laboratory test indicated that Plaintiff may have contracted Hepatitis C. The Green Haven doctors (...) referred Plaintiff to Dutchess for additional testing, where additional tests confirmed that Plaintiff had Hepatitis C. In July 1997, Plaintiff returned to Dutchess for additional evaluation, and the physicians told him that he must undergo a liver biopsy in order to receive treatment for his condition. (shrink)

In Pabon v. Wright, the Second Circuit held that the Fourteenth Amendment right to refuse medical treatment contained a corollary right to the information necessary to make an informed decision. Plaintiff, William Pabon, was an inmate at Green Haven Correctional Facility in New York. He named two groups of defendants: his doctors and nurses at Green Haven and his doctors at Dutchess Gastroenterologists, P.C..In October 1996, a laboratory test indicated that Plaintiff may have contracted Hepatitis C. The Green Haven doctors (...) referred Plaintiff to Dutchess for additional testing, where additional tests confirmed that Plaintiff had Hepatitis C. In July 1997, Plaintiff returned to Dutchess for additional evaluation, and the physicians told him that he must undergo a liver biopsy in order to receive treatment for his condition. (shrink)

This paper opens with first‐hand accounts of critical care medical interventions in which detainees, in the custody of U.S. Immigration and Customs Enforcement (ICE), are brought to the emergency department for treatment. This case dramatizes the extent to which the provision of ethical and acceptable nursing care is jeopardized by federal law enforcement paradigms. Drawing on the scholarship of Michel Foucault and Giorgio Agamben, this paper offers a theoretical account of the power dynamics that inform the health care of (...) patients who find themselves caught in the custodial scaffolding of a vast immigration and detention apparatus. It offers an analysis of the display of sovereign and biopolitical power over the lives (and deaths) of detainees (Foucault), as well as the ways these individuals are reduced to “bare life” under the political pretext of an emergency or “state of exception” (Agamben). Our purpose here is both theoretical and practical: to better understand the often hidden agency or impersonal “will” exercised by the immigrant detention system, but also to equip clinicians in these and cognate facilities (e.g., prisons) with the critical tools by which they might better navigate incommensurable paradigms (i.e., care vs. custody) in order to deliver the best care while upholding their ethical duties as a care provider. This is all the more pressing because hospitals are not sanctuaries and given the incursion of federal law enforcement agents, nurses may find themselves conscripted as de facto agents of the state. (shrink)

The aim of this study was to generate knowledge about how parents who have been part of an ethical decision-making process concerning a son or daughter in a neonatal unit experience life with a severely disabled child. A descriptive study design was chosen using 30 hours of field observations and seven in-depth interviews, carried out over a period of five months with parents who had been faced with ethical decisions concerning their own children in a neonatal unit. Strauss and Glaser’s (...) constant comparative method was used for the analysis. The findings seem to indicate that these parents have an extremely tough life. Their relationships with their children are somewhat ambivalent. The children are very dependent on their parents, who in some ways both love and hate them. Too little rest and sleep and feeding the children are the most serious problems. The parents require respite facilities. The home can seem like a prison, from which it is impossible to escape. It is like having a baby who never grows up. (shrink)

Derek Nurse looks at variations in the form and function of tense and aspect in Bantu, a branch of Niger-Congo, the world's largest language phylum. Bantu languages are spoken in central, eastern, and southern sub-Saharan Africa south of a line between Nigeria and Somalia. By current estimates there are between 250 and 600 of them, as yet neither adequately classified nor fully described. Professor Nurse's account is based on data from more than 200 Bantu languages and varieties, a representative sample (...) of which is freely available on the publisher's website. He devotes substantial chapters to the analysis and comparison of the different tense and aspect systems found in Bantu. He also examines the verbal categories with which they interact, including negation and focus. Synchronic and diachronic perspectives are interwoven throughout the book. Following a brief history of Bantu over the last five thousand years, the final two chapters look systematically at the history of tense and aspect in Bantu. The first deals with the reconstruction of the earlier forms from which contemporary structures, morphemes, and categories are derived, and the second with the processes of change, including grammaticalization, by means of which older analytical structures and independent lexical items moved as they became incorporated as grammatical inflections and categories. (shrink)

The renowned Nobel Prize-winning scientist's elegant and concise explanation of the fundamental ideas in biology and their uses today. Hailed by Philip Pullman as "a great communicator" who is also "as distinguished a scientist as there could be," Paul Nurse writes with delight at life's richness and a sense of the urgent role of biology in our time. With What Is Life? he delivers a brief but powerful work of popular science in the vein of Carlo Rovelli's Seven Brief Lessons (...) in Physics. Nurse takes readers on a wondrous journey through five fundamental biological ideas-the Cell, the Gene, Evolution by Natural Selection, Life as Chemistry, and Life as Information-introducing the scientists who made the most important advances and taking us into his own lab to give us a sense of the thrill of scientific discovery. In a final chapter, Nurse addresses biology's most pressing ethical issues (including gene-editing, genetic testing, and genetically modified crops), and he concludes with a stirring encomium to biology's role in tackling infectious disease. (shrink)

Life is all around us, abundant and diverse, it is extraordinary. But what does it actually mean to be alive? Nobel prize-winner Paul Nurse has spent his career revealing how living cells work. In this book, he takes up the challenge of defining life in a way that every reader can understand. It is a shared journey of discovery; step by step he illuminates five great ideas that underpin biology. He traces the roots of his own curiosity and knowledge to (...) reveal how science works, both now and in the past. Using his personal experiences, in and out of the lab, he shares with us the challenges, the lucky breaks, and the thrilling eureka moments of discovery. To survive the challenges that face the human race today - from climate change, to pandemics, loss of biodiversity and food security - it is vital that we all understand what life is. (shrink)

Despite achieving broad acceptance of the moral case for treating animals fairly, the animal rights movement has reached an impasse concerning legal rights for animals. Zoopolis proposes a new approach to addressing this failure: integrating animal interests into human society via political institutions and practices. Zoopolis’s central theory that humans owe animals citizenship rights in a shared human-animal society, but that acceptance of responsibilities by animals also is required, has merit for the advancement of animal rights discourse. But its anthropocentric (...) approach, which itself exerts power over animals, necessitating suppression and policing of animals’ natural behavior, is problematic. (shrink)

Three major aspects of G1 regulation acting at START in fission yeast are discussed in this review. Firstly, progression towards S phase in the mitotic cycle. This is controlled by the activation of transcription complexes at START which cause cell cycle‐dependent activation of genes required for DNA synthesis. The second aspect is the regulation of developmental fate occurring during G1. Passage through START appears to inhibit sexual differentiation because the meiotic and mitotic pathways are mutually exclusive. This is brought about (...) because the meiotic pathway is inhibited by the same gene functions that are required for S phase onset. Thirdly, distinct checkpoint, or dependency, controls operate both pre‐ and post‐START in the mitotic cycle to inhibit mitosis in the absence of replicated DNA, and also to limit rounds of DNA replication to one per cell cycle. (shrink)

In the yeasts Saccharomyces cerevisiae and Schizosaccharomyces pombe, the initiation of DNA replication is controlled at a point called START. At this point, the cellular environment is assessed; only if conditions are appropriate do cells traverse START, thus becoming committed to initiate DNA replication and complete the remainder of the cell cycle. The cdc2+ / CDC28+ gene, encoding the protein kinase p34, is a key element in this complex control. The identification of structural and functional homologues of p34 suggests that (...) it has a role in the control of DNA replication in all eukaryotes. The WHI1+, CLN1+ and CLN2+ gene products, identified in S. cerevisiae, are positive regulators that function at START and may interact with p34. Determining how passing the START control point leads to the initiation of DNA replication is a major outstanding challenge in cell cycle studies. (shrink)

In this article, we will consider how the regulation of populations is not just a feature of prisons, but of all institutions and organisations that control members though hierarchies, divisions and norms. While nurses and other allied health professionals are considered to be predominantly self‐regulatory, practice is guided by a code of conduct and codes of ethics that act as rules that serve to uphold the safety of the patient, whether they are a sick person in a hospital bed or (...) an inmate in a prison. The codes of conduct espouse a number of rules that to a certain extent govern the behaviour of individual and groups of practitioners through reciprocal rewards and punishments. Supervision is one method of monitoring the effectiveness of the codes of conduct and ethics while regulating both the minimum standard of individual practice and of training organisations. It is posited that one of the possible effects of clinical supervision is to make the person effectively self‐regulatory as, an autonomous practitioner. We take the view that professional autonomy is a highly problematic concept requiring closer examination. (shrink)

The concept of vulnerability has been the topic of considerable discussion in research bioethics, largely because of dissatisfaction with early constructions of the concept that were based on subpopulations of research subjects. These subpopulations have attributes likely to undermine their capacity to provide autonomous informed consent: persons who are relatively or absolutely incapable of protecting their own interests through negotiations for informed consent. Several subpopulations were seen as requiring special protections, including children, pregnant women, prisoners, racial minorities, the economically disadvantaged, (...) the very sick, and the institutionalized. Recent years have witnessed the identification of other subpopulations with attributes that could render them vulnerable, as well. For example, the Council for the International Organization of Medical Societies has named such potentially vulnerable groups as the homeless, nursing home residents, patients with incurable diseases, patients in the emergency department, employees, students, and members of communities who are unfamiliar with modern medicine. (shrink)

People in isolation or quarantine, and people confined in nursing homes, insane asylums, prisons, and refugee camps are cut off from the outside world, where the coronavirus invisibly drifts. It besieges our homes. And the virus invades, through heating ducts and on packages delivered. Our home is no longer a refuge of rest, tranquility, substance, and sustenance, no longer the place of hospitality. And the coronavirus pursues the homeless, sleeping in municipal shelters or under bridges and overpasses.

The acceptance of military directives violating medical ethics and international covenants encouraged by the demonisation of the enemy by the US president in 2002 has effectively removed the right of medical personnel to refuse participation in internationally proscribed actionsMedicine and its traditional ethic of care is today a victim of the current conflict in Iraq and Afghanistan, its uniquely humanising mission rejected by US President George W Bush and his advisors. In denying the applicability of international agreements guaranteeing medicine’s ecumenical (...) role in this conflict they have transformed medicine into just another weapon of tactical significance. The result, predictable in retrospect, has been to make military physicians and nurses complicit—actively or passively—in what Litton calls an “atrocity-producing situation”, resulting in detainee or prisoner abuse.1From the first revelations of detainee torture in US detention camps to recent allegations of continued abuse , the focus of international attention has shifted from the US prosecution of low ranking, non-commissioned military personnel to the context in which the atrocities they committed occurred. “No one up the chain of command has ever been held accountable for what is in these horrifying images,” Center for Constitutional Rights Director Bill Goodman said of recently published photographs of 2004 prisoner torture and abuse.2 “The situation in several areas violates international law and conventions on human rights and torture,” said the UN Special Rapporteur on Torture following a 2006 investigation.3The denial of international law and convention involved the overt disavowal of covenants and conventions that for almost 150 years required medical personnel in the US military to act within the guidelines of a Hippocratic vision of medicine. To understand how fundamental this change has been requires a brief review of the history of medicine’s previously protected status and then a description of …. (shrink)

Force-feeding of detainees at Guantánamo BayIn April, the US Department of Defense reportedly sent 40 additional military medical personnel, including doctors and nurses, to the Guantánamo Bay Naval Base to carry out the force-feeding of detainees on hunger strike.1 By the end of June, up to 104 of the remaining 166 individuals held in US military detention at Guantánamo were refusing food. The protest against conditions at the base, and the fate of those being held there—including those already cleared for (...) transfer or release—began in February 2013. In June, it was reported that as many as 44 of the hunger strikers were being force-fed by military medical teams.2The response by the US authorities to the hunger strike prompted expressions of outrage from the international medical community.3,4 In April, the American Medical Association wrote to the US secretary of defense, insisting that ‘forced feeding of [competent] detainees violates core ethical values of the medical profession.’5 Adding the voice of the profession in the UK to these calls, at its annual conference in June, the British Medical Association condemned the participation of doctors and nurses in the force-feeding, calling on governments worldwide to ensure that all prisoners have access to confidential, independent medical treatment, and supporting any clinician who challenged cruel, inhuman or degrading treatment. Also in June, the BMA Chairman wrote to President Obama and US secretary of defense, Hagel, urging them to immediately suspend medical involvement in force-feeding at Guantánamo, and to institute an urgent inquiry into how the current situation was allowed to develop.Force-feeding mentally competent adults who are refusing food is a clear violation of medical ethics and is unjustifiable, as articulated by the World Medical Association's Declaration of Malta.6 Doctors with dual loyalties, including military doctors, are bound by the same …. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Abortion to Abolition: Reproductive Health and Justice in Canada by Martha PaynterRebecca Simmons (bio)Abortion to Abolition: Reproductive Health and Justice in Canada by Martha Paynter Winnipeg, MB: Fernwood Publishing, 2022Martha Paynter's Abortion to Abolition: Reproductive Health and Justice in Canada is a bold, ambitious work that seeks to not only catalog Canada's meandering and often backtracking path toward reproductive justice, but to act as a manifesto for Paynter's (...) own ideas and goals for reproductive justice. The book takes the form of an anthology of stories, divided into chapters, that are grouped according to a certain right; for example, the right to bodily autonomy. This format effectively guides the reader from abortion to abolition. Paynter adroitly starts the book with white feminist favorites such as bodily autonomy and not having children. Then she logically progresses to more radical ideas such as parenting in prison and the total abolition of prisons. The stories in this book are accompanied by warm, colorful illustrations by Julia Hunt. These drawings help the reader visualize the person behind the story and the very real life that was affected by reproductive law and/or social norms. Paynter holds a PhD in nursing, and it is from this background that she writes, seeking to educate nurses and other healthcare professionals alongside a broader readership garnered through her clear, approachable writing style.Chapter 1 introduces the reader to many of the book's key themes by considering the right and need to have bodily autonomy, and the multiple ways this manifests itself in ordinary (and less-ordinary) life. Paynter considers the disparate stories of five women, all fighting in some way for bodily autonomy. The stories cover events of gender-based gun violence, sexual assault, transgender rights in prison, the legalization of sex work, police violence, and institutional racism. Each story recounted by Paynter catalogs tragedies and injustices with blunt and brutal honesty—perhaps to an unnecessary extent. Every horrific fact is laid bare for the readers as they uncover the intricacies of gender-based, imperialist, and racist violence. Paynter has chosen these stories to display the multitude of ways in which people—especially Black, Indigenous, people of color (BIPOC) and minoritized genders—can be willfully wronged by the state and [End Page 209] the criminal justice system, such that the reader must begin to confront the fact that these structures don't seem to exist to benefit or protect the most marginalized in society.Chapter 2 approaches the right not to have children through a number of stories related to contraception, abortion, and family planning. Paynter sketches some of the key points in Canada's journey toward the decriminalization of abortion, from paradoxical trailblazers, such as Dr. Emily Stowe in the 1800s, to the viral memefied content of art protestor iamkarats. While the unequivocal legality of abortion in Canada suggests incredible progressiveness and support for women's rights, Paynter paints a more complex picture through her chosen narratives. Crucially, the inequitable geographical access to abortion, in particular, throughout the huge landmass of Canada suggests that the right to not have children in Canada is not universal. Moreover, Paynter suggests that access is also bounded by financial constraints, finite public funding, and the limited availability of inclusive clinics that prioritize healthcare for LGBTQ2S+ people.Chapter 3 considers the topic of having children; in particular, the right to reproductive technologies and freedom from forced sterilization. Paynter quickly makes clear that while many white feminists might see having and not having children as diametrically opposed, they are two equally essential parts of reproductive justice. Paynter draws attention to the Sexual Sterilization Act of 1928 that was only overturned in 1972. She describes it as part of the "genocidal colonial project" (84), a collection of laws and policies aimed at fulfilling eugenicist, neoimperial ideals of increasing production of the white "race" and promoting the genocide of Indigenous peoples. Furthermore, Paynter argues that evidence of forced sterilization of Indigenous peoples, and other physical violence and neglect, persists to the present day and must be stopped and reparations made for previous harms. Paynter then considers the complex, often-debated case of commercialized surrogacy, which she defines... (shrink)

William Booth, the founder of the Salvation Army, initially preached in Methodist Churches, later left this position and formed a social and religious formation called the "Christian Mission". This movement was named "Salvation Army" in 1878. The Salvation Army, organized in many countries, has established nursing homes for elderly, women and children and continues to attract attention and increase its reputation both locally and internationally with aid organizations, rehabilitation of prisoners, natural disasters, fight against human trafficking and aid to (...) refugees. In every region where The Salvation Army is located, there is an administrative centre known as the regional headquarters. Headquarters are headed by the district commander at the international headquarters in London. Smaller districts are run by colonels, larger districts by commissars. Resembling the Catholic Church due to its episcopal structure, the Salvation Army accepts the same beliefs as this church at the point of belief. Although the movement has also the appearance of a Protestant and evangelical church, it approaches the sacraments from a different aspect. In this research, the history, organizational structure, activities, belief principles and practices of the Salvation Army have been tried to be revealed. Descriptive, comparative and chronological methods have been used while conveying the aforementioned issues in order of importance. In addition, the literature was scanned and various sources belonging to the emergence period of the Salvation Army and especially those belonging to them were examined. (shrink)

Initial writings and moral distress research focused on nursing, however, it soon became clear that others in healthcare also experienced moral distress. The narratives discussed in this commentary show this variation not only in the authors’ multiplicity of disciplines (psychologists, nurses, an ethicist, and physicians), but also in their workplace environments (prisons, hospitals, and homecare) and their roles, from students to well accomplished professionals. In other words no one is immune. By looking through the lens of time the author (...) shows that the experience of moral distress is not isolated in time, but in fact continues to be lived over time. Other important themes drawn out here are: isolation, powerlessness, failure, regret, undermined potential and the way feelings are experienced. It is also noted that despite the pain and angst, there is a sense of gratitude in these stories. They touch our own woundedness, remind us of our own resiliency and give us hope for the redemptive power of the experience and reflection. (shrink)

Violence is an extremely prevalent problem in the United States and throughout the world, and it is a major contributing factor to increased mortality and mortalityty. These facts are well documented in the recent Report on violence and Health published by the World Health Organization. This report, which is likely to become a landmark document in the public health community, defines violence broadly as: The intentional use of physical force or power, threatened or actual, against oneself, another person, or against (...) a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation. This World Health Organization definition encompasses three types of violence: 1) suicide and selfharm, 2) collective violence, and 3) interpersonal violence.Interpersonal violence is defined asviolence inflicted by an individual or small group of individuals and includes youth violence, violence between intimate partners, other forms of family violence such as abuse of children and the elderly, rape and sexual assault by strangers, and violence in institutional settings such as schools, workplaces, nursing homes and prisons. (shrink)

Violence is an extremely prevalent problem in the United States and throughout the world, and it is a major contributing factor to increased mortality and mortalityty. These facts are well documented in the recent Report on violence and Health published by the World Health Organization. This report, which is likely to become a landmark document in the public health community, defines violence broadly as: The intentional use of physical force or power, threatened or actual, against oneself, another person, or against (...) a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation. This World Health Organization definition encompasses three types of violence: 1) suicide and selfharm, 2) collective violence, and 3) interpersonal violence.Interpersonal violence is defined asviolence inflicted by an individual or small group of individuals and includes youth violence, violence between intimate partners, other forms of family violence such as abuse of children and the elderly, rape and sexual assault by strangers, and violence in institutional settings such as schools, workplaces, nursing homes and prisons. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:If You’re Not Part of the Solution...Sarah GilesI worked on an island that lured people to their deaths. I have come to realize that there are certain resources that every population must have in order to continue to exist. Health care providers are needed if a group is to continue to reside in one place. Without nurses and doctors, people tend to refuse to go to a location or (...) choose not to stay. Perhaps if doctors like me refused to work in places where people have their basic human rights ignored, those places would cease to exist. It’s wishful thinking, but it’s the only way I can imagine the events of December 15th, 2010, could have been prevented. [End Page E11]Australia has a large offshore detention center on Christmas Island, a tiny dot in the middle of the Indian Ocean. Housed in a collection of prison–like facilities are men, women, and children who have come to an Australian Island claiming they are refugees. They have paid an average of $10,000 (U.S. dollars) to be smuggled by boat from nearby Indonesia and are then, usually, intercepted by the Australian navy or coast guard, and brought to the island to await processing. This processing can take two to four years and, even then, it can end with deportation. The asylum seekers spend years in a massively overcrowded and unstimulating purgatory.To say that I was not familiar with the political situation on the island would be a farcical under-statement. As a Canadian family doctor, I went to work on Christmas Island because of its exotic location and reputation for world–class SCUBA diving. It sounded like a dreamy place to do a locum. The little research I had done told me that there was a detention center on the island, but I had been told that I would only deal with those patients if they were sick enough to come into hospital. I didn’t imagine that I would end up feeling culpable for the deaths of 48 people who dreamed of restarting their lives in Australia.On December 15th, 2010, a rickety boat carrying approximately 100 asylum seekers somehow slipped past the navy and coast guard into the water just off of Christmas Island. The weather was foreboding and the waves were massive. As the boat approached the island, it lost power and, horrifically, smashed into the cliffs, leaving an estimated 48 men, women, and children to drown and an almost equal number in need of rescue and medical attention. My name was on the call schedule that day. All survivors were brought to the hospital. Our worlds collided.At the time, I thought it was good luck there was an extra doctor on the island that day. I was relieved that we were able to cope with the mass casualty situation and that only few survivors were sick or injured enough to require evacuation to the main land. Three years later, I wonder if the accident would have happened at all had we not been there.I had felt smug providing care in the public hospital, believing it was morally superior to working as a mercenary at the detention center. But I now realize that all of the health care providers had a role in allowing the tragedy to occur. What would have happened if all of the doctors refused to work with people held under those conditions? If that critical infrastructure of health care were not available on the island, the detention center could not be there. If the detention center weren’t there, the government would stop processing people there and perhaps desperate people would stop risking their lives to get to Christmas Island. Maybe the women and men who lost their children or the children who lost their parents would never have gotten on that boat. Maybe.Parts of that awful day stay with me. My job as a doctor prevented me from offering the compassionate care I wanted to provide and forced me to turn into a medical conveyor belt. When a young patient was laid in front of me, I assessed her, started... (shrink)

This book brings into sharp relief the extent to which the medical profession has enabled or participated in actions that are at moral crossroads. Physical and psychological abuse and violations of medical codes have already been brought to light by concerned bioethicists responding to ethical lapses of the “war on terror.” This book goes to the next level by looking at three areas that also merit our attention and call us to speak out against abuses. These are dehumanization, non-consensual forced-feeding, (...) and solitary confinement. Each area raises important questions for the medical profession. Author Wanda Teays calls upon doctors and nurses to reflect on the role they play in the unethical treatment of prisoners and detainees by crossing moral boundaries around each of these areas. In the process, we are reminded that bioethics is global, not local — and the concerns of the discipline encompass issues with a wider scope. (shrink)

The legal environment -- Regulation of nursing practice -- Nurses in legal actions -- Standards of care -- Defenses to negligence or malpractice -- Prevention of malpractice -- Nurses as witnesses -- Professional liability insurance -- Accepting or refusing an assignment/patient abandonment -- Delegation to unlicensed assistive personnel -- Patients' rights and responsibilities -- Confidential communication -- Competency and guardianship -- Informed consent -- Refusal of treatment -- Pain control -- Patient teaching and health counseling -- Medication administration -- (...) Clients with AIDS and HIV testing -- Abusive situations -- Reproductive services -- Restraints -- Emergency psychiatric admissions -- Organ and tissue donation and transplantation -- Discharge against medical advice -- The medical record and documentation standards -- Electronic health information and communications -- Interdependent nursing functions: verbal orders and telenursing -- Event reporting and compliance -- Quality and safety in nursing practice -- Forensic issues -- Employer and employee rights -- Contracts -- Corporate liability -- Employment contracts and unionization -- Employment status liability -- Staffing issues and floating -- Americans with Disabilities Act -- Employees with AIDS/HIV infection and exposure to bloodborne pathogens -- Impaired nurses -- Sexual harassment in the workplace -- Violence in the workplace -- Intentional torts -- Environmental health and safety -- Ethical decision making -- Professional boundaries and patient relationships -- Moral courage and patient advocacy -- Social media and online professionalism -- Reporting illegal, unethical, or unsafe conduct -- Maternal versus fetal rights -- Futility of care -- Advance directives and end-of-life decisions -- Assisted suicide. (shrink)