Ebola and the ethics of nursing

Walking away is never a decision to be taken lightly

Nurses from West Africa to California have gone on strike to make their concerns about the Ebola crisis known. But what are the ethical considerations that come into play when nurses take such actions while their patients may be dying?

Fundamentally, nurses are committed to caring for their patients. A strike — walking off the job and away from patients — is an extreme act, and the decision to walk away is never made lightly. It should always be the last resort.

In taking it, nurses are not just speaking up for themselves and their current patients but for their future patients as well. Research has shown that fixing a problem in clinical care "now" can help avoid more serious problems down the line; alternatively, leaving issues unresolved creates great moral distress for nurses and other clinicians who see patients put at risk to harm they feel powerless to prevent.

The crisis in West Africa has highlighted the ethical struggles faced by nurses, but they are by no means unique to Ebola care. Months before Ebola monopolized the headlines, 50 nursing leaders and ethicists participated in a National Nursing Ethics Summit at the Johns Hopkins School of Nursing to discuss ethical guidelines to help nurses deal more effectively with such issues as balancing personal risk with their ethical obligations to expose deficiencies in care.

Nurses deal with ethical issues every day, not just when Ebola strikes. Their voices must be heard and they must be able to raise ethical and other concerns in a respectful, supportive environment without reprisal or reprimand. Let's start listening to them before it gets to the picket line.

Nurses are the largest sector of the health care workforce and the backbone of the health care system — it is in everyone's best interest that their voices be heard.

Cynda Hylton Rushton, Baltimore

The writer is the Anne and George Bunting Professor of Clinical Ethics at the Johns Hopkins University Berman Institute of Bioethics and School of Nursing.

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