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• W2140160552 abstract "In recent years, most of the world's people – and nurses are no exception – have celebrated their diversity: different races and languages, religions and cultures, and, most assuredly, different social mores. Indeed, these differences distinguish one group from another, and lead to a vast range of social norms. These differences are what make life infinitely interesting. Nonetheless – all differences aside – what people value most in life is remarkably similar. People – all the world's people – love their children, seek good friends, need enough food and shelter to live in at least frugal comfort, rejoice in work well done, and expect health enough to live fully until they die. When their values are threatened, people become vulnerable – all the more so if they are unable to reduce the threat. Disease, or its threat, wounds what is rarely articulated as a human value – perhaps because it is the substratum upon which all else is built – the human dasein– quite literally one's relationship to self, others and the world. When one is ill, one cannot command one's body to do what one wants it to do. Nor can one determine what is wrong or what to do about it. If the disease is untreated or the trauma unrelieved, how – or whether – one lives and works and has being may be inalterably changed. Thus one is forced to go to another person, to place oneself before this person and to ask for help. Those who are perceived as having the ability to help are invested with enormous, even magical powers. So it was, and so it still is. Codes of ethics came into being – as did almost all early laws – to protect the vulnerable from the powerful; the unwary from the unscrupulous. In ancient Summaria, Hammarabi incorporated a canon on medical ethics into his Coda, in China the emperor addressed appropriate medical conduct in the Nei Ching, and in Greece the Pythagoreans are credited with writing the Hippocratic Corpus. The Greek, Galen, and the Jew, Maimonides, expected – nay, demanded – high moral character of healers, but only India's Charaka Samhita (1st Century AD) attributed moral as well as scientific authority to the healer. The very word ‘profession’ (L. profitere– to proclaim publicly) was derived from the medical acolytes' public promise of altruism and master craftsmanship – both of which were designed to protect a vulnerable public from the unscrupulous and the incompetent. Then as now, the total situation for patients (L. patientia– one who suffers) includes not only the diagnosis and treatment, but also whether or not someone will stand by them through the course of their illness or death. However, then more than now, practitioners could do little to alter this course; thus the early codes stressed fidelity of the practitioner to the promises of the profession. As knowledge grew and skills proliferated, particularly in the latter half of the 20th century, the practitioner's ability to alter the course of disease shifted the ethical emphasis from fidelity to a more modest sharing of information and decision-making: does the patient want his life altered? If so, to what extent, and who decides? The ancient moral dictum was to choose life. The modern moral dilemma is under all circumstances? The emerging compromise is to cede moral authority – and with it, responsibility – to patients and families (what ought to be done), while scientific authority (what can be done) remains with the professional. This shift of authority leads to a complexity that often is simplistically addressed. The ancient authoritarian ethos gave all power to determine and decide to the professional: the patient's only (rather thin) protection being the professed altruism of the professional. The moral hegemony ceded to patients today leads to an ethos of moral detachment in which the professional is seen as an instrument of the patient/family's – or of society's – will. No longer a moral agent, the professional– and the power of the profession – becomes a value-neutral tool used to the ends of others. No longer an altruistic itinerant, the professional is educated, supported, protected and paid by the community. No longer morally autonomous, the professional's choices are limited and even determined by those whose values he may not share, and whose motives he may not know. No longer a compassionate caregiver, the knowledge he possesses makes him a powerful instrument of social control. Today's professional codes of ethics seek to balance moral authority and responsibility as both the lay and professional publics come to grips with the separation of what ought to be done from what can be done. Thus it was, that the International Council of Nurses (ICN) at its quadrennial meeting in Los Angeles, USA over two decades ago, addressed the responsibilities of nurses when treating the victims of police torture. Thus it was that ICN addressed the responsibilities of nurses faced with religious sects who demanded that they mutilate female children in a procedure popularly known as female circumcision … and governments that demanded nurses use their skills to force people to undergo sterilization and abortion to achieve political goals. The world's nurses, for a variety of reasons, have chosen to devote themselves to helping the world's people attain and maintain health – a universal value. ICN first promulgated a Code for Nurses in 1953 – and revised it in 2000 to reflect the universal values nurses share as they address new realities, and assume new responsibilities. Beyond question, this Code will be revised again, as nurses learn more about health and disease, apply more effective remedies, work for the development of health-giving communities, and continue to negotiate the terms of their relationship with the people they serve, and the communities within which they serve. Leah Curtin, RN, MS, MA, ScD (h), FAAN publishes CurtinCalls, an interactive, fact-filled scan of nursing and health care in the USA (http://www.curtincalls.com). She is a faculty member, and author of many articles, editorials and books. Her latest book, Sunflowers in the Sand, describes the experiences of children in war, most notably in Croatia and Bosnia Herzegovina. She lives in Cincinnati, Ohio USA." @default.
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• W2140160552 title "Guest editorial: The ICN code of Ethics for Nurses: shared values in a troubled world" @default.
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