Contemporary Issue Position Essay
“CH is a health worker who has long served rural community members of Vista Hermosa, Colombia. CH travels to veredas (remote, limited-resource clinical settings) as an employee of a local health organization’s outreach program, without which, hundreds of people—including ex-Revolutionary Armed Forces of Colombia (Fuerzas Armadas Revolucionarias de Colombia, or FARC) combatants—would lack access to clinical evaluations and health services.
CH is haunted by having been kidnapped by FARC members years before. “It was horrible,” CH relates. “They kidnapped and held us for 3 days without food or water. We had no idea when we would be released. They are overtaking our hospitals and have more rights than their victims.”
Despite a peace agreement, CH and other health workers traumatized by years of conflict struggle to maintain clinical neutrality and execute professional duties to care for all patients their hospital serves” (Reynolds & Sánchez Meertens, 2022).
Identify the issue and state your ethical position.
The aforementioned case study reveals two critical issues, namely resource allocation equity among victims and perpetrators and taking care of patients, particularly perpetrators, despite personal trauma experiences. My ethical position is clinical neutrality when taking care of conflict perpetrators and facilitating the equitable allocation of resources between victims and perpetrators.
How might this scenario play out or impact you in your role as a nurse practitioner?
The scenario presents an ethical dilemma. For instance, during conflicts, particularly wars, perpetrators tend to kidnap healthcare providers and destroy the resources of their victims. Similarly, during conflicts, most healthcare providers encounter and witness emotional and physical trauma with subsequent development of negative attitudes towards the perpetrators and enemies.
According to Asare et al. (2022), negative healthcare providers’ attitudes and perspectives correlate with poor healthcare delivery. As a nurse practitioner, working in a post-conflict zone is a common encounter since healthcare is a universal demand. Consequently, it is critical to emotionally and physically support healthcare providers who are victims of conflicts to ensure effective and efficient delivery of healthcare. This scenario further insists on the importance of allocation and availability of healthcare resources.
As nurse practitioners, it is fundamental to promote justice by facilitating the equitable allocation of healthcare resources and allowing equal healthcare access for all patients despite the current and previous circumstances. Finally, as nurse practitioners, the scenario outlines the importance of creating and sustaining peace to avoid conflicts that negatively impact healthcare.
Defend your position with legal, ethical, and professional evidence
My position to maintain clinical neutrality and promote equitable allocation f health resources comes after critically analyzing the contemporary issues using Jonsen’s Four Topics approach (Toh et al., 2018). For instance, maintaining clinical neutrality, allowing equitable allocation of resources, and providing care to perpetrators promote peace, improve the quality of life, and promote justice (Toh et al., 2018).
Similarly, care provision is usually for the benefit of the patients since failure to provide care could result in harm. Finally, patients usually make a decision to seek healthcare services, and hence their decision must be respected.
Similarly, the American Nurses Association, in its ethical provisions, outlines the need for nurses to practice with compassion and respect for inherent dignity, to commit to the patient, advocate for the right, health, and safety of patients, and integrate social justice (American Nurses Association (ANA), 2019). Additionally, it is an obligation of all citizens of every state to cultivate and sustain peace and ensure equitable distribution of resources.
Strategies and solutions for addressing the issues
Several strategies can be implemented to promote clinical neutrality, including providing targeted action for disadvantaged groups. This can be in the form of financial aid. Similarly, formulating and implementing policies that eliminate imbalances, such as redistribution policies aimed at reducing inequality, can facilitate clinical neutrality. Additionally, neutrality can be achieved by providing universal public services.
To facilitate effective delivery of care, healthcare providers who have been maltreated and traumatized during conflicts should be provided with the necessary physical and emotional support to facilitate their recovery. Additionally, the national healthcare system should help traumatized clinicians manage affective negative bias. Finally, healthcare providers should foster and enhance peace as they are considered agents of peace.
What other ethical issues does this case bring to light, if any?
This case brings to light several ethical issues. For instance, ethical principles of beneficence, non-maleficence, and patient autonomy are brought to light. For example, healthcare providers, whether traumatized, should offer quality care to patients for their benefit and avoid subsequent devastating effects of lack of care.
Similarly, patients’ decisions to seek healthcare must be respected and therefore must be treated with dignity regardless of the healthcare provider’s past experiences. This scenario also outlines the importance of observing and sustaining the welfare of healthcare providers as it correlates with their productivity.
Nurse practitioners always encounter ethical dilemmas and issues in their practice. Nurses should therefore approach these situations bearing in mind legal and state laws, ethical considerations, and professional code of conduct to guide their decision-making. It is relatively common for a nurse practitioner to care for perpetrators post-conflict.
It is elemental for nurses to maintain clinical neutrality and peace during such circumstances and deliver high-quality care despite previous experiences. Finally, healthcare systems should support traumatized healthcare providers.
American Nurses Association (ANA). (2019). American nurses association code of ethics for nurses. Rutgers.edu. https://nursing.rutgers.edu/wp-content/uploads/2019/06/ANA-Code-of-Ethics-for-Nurses.pdf
Asare, P., Ansah, E. W., & Sambah, F. (2022). Ethics in healthcare: Knowledge, attitude and practices of nurses in the Cape Coast Metropolis of Ghana. PloS One, 17(2), e0263557. https://doi.org/10.1371/journal.pone.0263557
Reynolds, C. W., & Sánchez Meertens, C. (2022). How should health systems help clinicians manage bias against ex-combatants? AMA Journal of Ethics, 24(6), E483-488. https://doi.org/10.1001/amajethics.2022.483
Toh, H. J., Low, J. A., Lim, Z. Y., Lim, Y., Siddiqui, S., & Tan, L. (2018). Jonsen’s four topics approach as a framework for clinical ethics consultation. Asian Bioethics Review, 10(1), 37–51. https://doi.org/10.1007/s41649-018-0047-y