Portal de Periódicos da CAPES

Reflections on courage

2009; Elsevier BV; Volume: 57; Issue: 5 Linguagem: Inglês

10.1016/j.outlook.2009.07.008

1528-3968

Marion E. Broome,

Ethics in medical practice

The commentary in this issue, “Fork in the road: Accessories to cruelty or courage,” by Wanda Mohr, discusses the role that she believes nurses in the military may have played in the torture and abuse of prisoners at Guantanamo—a topic long overdue for discussion by nursing. When Dr. Mohr approached me about this commentary, I was hesitant to make the decision without input from the Nursing Outlook editorial board. Given that no one in nursing had taken up this “call to action” (unlike our colleagues in medicine and psychology), I wondered what role Nursing Outlook should play in this issue. When I posed the question “Should NO publish this?” to the editorial board, the overwhelming majority said “Yes,” and two of them very cogently asked “If not Nursing Outlook, then who?”The treatment of prisoners during wartime has been the subject of debate since the revolutionary war. And the role of healthcare professionals who are also military officers is also debated, both in and outside of the military. It is no surprise that nurses, physicians, and other health professionals are held to a different ethical standard than other officers, which is explicitly grounded in their professional identity and the oaths they take to protect human beings from harm.We will each view this subject as written about by Dr. Mohr (commentary 1), Lieutenant General Schoomaker (commentary 2) and Dr. Wocial (commentary 3) through our own lens and experiences. It is very likely that most readers who are not familiar with the military culture will see this through a different lens than those who are, irrespective of their “moral compass or moral courage.” The struggle for me related to publishing this commentary (and inviting the others) was not whether to do so, but how to write an opinion as an editor and “own the color of my own lens.” After spending 20+ years in the US Army Nurse Corps, active and reserves, it was clear my lens for interpreting the role of nurses and holding them accountable for moral courage might be a bit more complicated than some others might be.Brave, bright, and resilient nurses who have fought for and protected the oppressed, vulnerable, sick, and injured when others did not or would not abound in our history, and those nurses lived and worked in and out of military theaters. But here, in this situation, I will restrict my discussion to those in or associated with caring for soldiers in times of national conflicts. Where was their courage, their voice? Florence Nightingale2Bostridge M. Florence Nightingale: the making of an icon. Farrar, Straus and Giroux, New York2008Google Scholar used every power she had, especially here with those in power “back home” being chief among them, to address the abhorrent conditions she found with the wounded and dying soldiers in Crimea. The fascinating book We Band of Angels, a well-written account of the very heroic nurses in Battan3Norman E. We band of angels: the untold story of American nurses trapped on Bataan by the Japanese. Simon & Schuster, New York1999Google Scholar who were prisoners themselves during World War II, provides us with example after example of their courage and resilience as they advocated not for themselves, but for those for whom they cared. The more contemporary account of nurses in the Gulf Wars published in Nursing Outlook in 2008 documents the “sacrifices and chronicles of caring” voiced by these nurses.4Rushton P. Scott J. Callister L. It's what we're here for: nurses caring for military personnel during the Persian Gulf Wars.Nurs Outlook. 2008; 56: 179-186Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar What stands out in all of these accounts is how evident, frequent, and difficult the ethical issues can be that arise in wartime for nurses. These nurses worked in situations when fireside chats about what is right or wrong and what could be or should be were luxuries they did not have—and that nurses will not have in any wartime scenario.Whether the “nurses” at Guantanomo were officers (BSN) or enlisted (LPNs), is not the pivotal reason that should mandate action or inaction, voice or silence on this issue. Most of us complain that nursing is too often invisible in matters of great import. Here is an opportunity to be heard. Frankly, nurses in the military often work under very difficult conditions, with both more and less autonomy than their counterparts in the civilian sector. I agree with Wanda Mohr that we must speak not just for them, but for ourselves, and for the future patients, soldiers, noncombatants, and, yes, the enemy who may fall under our care. I can only hope that Dr Mohr's recommendations are viewed and discussed with some deliberation and some action taken. If not the American Academy of Nursing, with all of its intellectual, political, and experiential power, then who? The commentary in this issue, “Fork in the road: Accessories to cruelty or courage,” by Wanda Mohr, discusses the role that she believes nurses in the military may have played in the torture and abuse of prisoners at Guantanamo—a topic long overdue for discussion by nursing. When Dr. Mohr approached me about this commentary, I was hesitant to make the decision without input from the Nursing Outlook editorial board. Given that no one in nursing had taken up this “call to action” (unlike our colleagues in medicine and psychology), I wondered what role Nursing Outlook should play in this issue. When I posed the question “Should NO publish this?” to the editorial board, the overwhelming majority said “Yes,” and two of them very cogently asked “If not Nursing Outlook, then who?” The treatment of prisoners during wartime has been the subject of debate since the revolutionary war. And the role of healthcare professionals who are also military officers is also debated, both in and outside of the military. It is no surprise that nurses, physicians, and other health professionals are held to a different ethical standard than other officers, which is explicitly grounded in their professional identity and the oaths they take to protect human beings from harm. We will each view this subject as written about by Dr. Mohr (commentary 1), Lieutenant General Schoomaker (commentary 2) and Dr. Wocial (commentary 3) through our own lens and experiences. It is very likely that most readers who are not familiar with the military culture will see this through a different lens than those who are, irrespective of their “moral compass or moral courage.” The struggle for me related to publishing this commentary (and inviting the others) was not whether to do so, but how to write an opinion as an editor and “own the color of my own lens.” After spending 20+ years in the US Army Nurse Corps, active and reserves, it was clear my lens for interpreting the role of nurses and holding them accountable for moral courage might be a bit more complicated than some others might be. Brave, bright, and resilient nurses who have fought for and protected the oppressed, vulnerable, sick, and injured when others did not or would not abound in our history, and those nurses lived and worked in and out of military theaters. But here, in this situation, I will restrict my discussion to those in or associated with caring for soldiers in times of national conflicts. Where was their courage, their voice? Florence Nightingale2Bostridge M. Florence Nightingale: the making of an icon. Farrar, Straus and Giroux, New York2008Google Scholar used every power she had, especially here with those in power “back home” being chief among them, to address the abhorrent conditions she found with the wounded and dying soldiers in Crimea. The fascinating book We Band of Angels, a well-written account of the very heroic nurses in Battan3Norman E. We band of angels: the untold story of American nurses trapped on Bataan by the Japanese. Simon & Schuster, New York1999Google Scholar who were prisoners themselves during World War II, provides us with example after example of their courage and resilience as they advocated not for themselves, but for those for whom they cared. The more contemporary account of nurses in the Gulf Wars published in Nursing Outlook in 2008 documents the “sacrifices and chronicles of caring” voiced by these nurses.4Rushton P. Scott J. Callister L. It's what we're here for: nurses caring for military personnel during the Persian Gulf Wars.Nurs Outlook. 2008; 56: 179-186Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar What stands out in all of these accounts is how evident, frequent, and difficult the ethical issues can be that arise in wartime for nurses. These nurses worked in situations when fireside chats about what is right or wrong and what could be or should be were luxuries they did not have—and that nurses will not have in any wartime scenario. Whether the “nurses” at Guantanomo were officers (BSN) or enlisted (LPNs), is not the pivotal reason that should mandate action or inaction, voice or silence on this issue. Most of us complain that nursing is too often invisible in matters of great import. Here is an opportunity to be heard. Frankly, nurses in the military often work under very difficult conditions, with both more and less autonomy than their counterparts in the civilian sector. I agree with Wanda Mohr that we must speak not just for them, but for ourselves, and for the future patients, soldiers, noncombatants, and, yes, the enemy who may fall under our care. I can only hope that Dr Mohr's recommendations are viewed and discussed with some deliberation and some action taken. If not the American Academy of Nursing, with all of its intellectual, political, and experiential power, then who? Marion E. Broome, PhD, RN, FAAN, is a Professor and University Dean, School of Nursing, Indiana University, Indianapolis, IN.