Classmate Response (1): Topic 6 DQ 1 -summarize a historical ethical dilemma in public health

QUESTION-After reading various topic resources and textbook chapters, summarize a historical ethical dilemma in public health. How may this relate to a current ethical dilemma? Were there any lessons learned from the historical event that can help public health nurses address the current ethical dilemma?

Chayah-Classmate’s Response- Topic 6 DQ 1

Ethics in health care has a foundation in our society rooted in our values and ideals. Western society, which socially has roots in Judeo Christian thought takes saving a life very seriously as taken from the Bible. Despite these values Western society has a long history of doing terrible things to others in a variety of times and settings throughout even relatively modern history (Tulchinsky, 2018).

Eugenics was a part of the “Social Hygiene” movement in the early 1900’s. It became a popular concept to reduce births by people deemed mentally ill or handicapped (Tulchinsky, 2018). There was legislation in multiple states that was upheld by the Supreme Court. In 1942 the American Journal of Psychiatry published articles calling for euthanasia of “feebleminded” people, granted they also published a rebuttal, but the fact that the first article was published in a professional journal shows the thought of some of the time. An editorial even referenced Hitlers practices of killing mentally ill people (Tulchinsky, 2018). Following these ideas were mass sterilizations in the 1930’s and 40’s which was also occurring in Canada and Sweden. Pairing with a movement of mandatory terminations of pregnancies under the idea of racial improvement the ideas were being put into action (Tulchinsky, 2018). Many medical and psychiatric professionals supported these laws and practices (Tulchinsky, 2018). Hindsight screams of the Hippocratic Oath and how these ideas violated that but perhaps many saw these sterilizations and murders as a way to relieve suffering or helping society as a whole.

While the height of forced sterilizations waned, it continued through the 1960s under different definitions of mental fitness. These practices have shown to target minorities with Black women having the highest numbers of sterilizations (Stern, 2020). There were promotions of various ideas such as helping to curb poverty, that it was unkind to expect parenting from those “unfit,” and other ideas of overall helping the individual and the community at large. There was a major lawsuit in Los Angeles in the 1970’s involved coercing hundreds of Mexican women to receive tubal ligations (Stern, 2020). There have been allegations of forced sterilizations in American prisons and most recently women in ICE custody (Stern, 2020). Last year a whistleblower, who was also a nurse, reported that an ICE detention center had performed sterilizations on women without their full informed consent (Manian, 2020). Hysterectomies and other gynecological procedures were also performed without adequate translation services used (Manian, 2020). Clearly forced sterilizations are still a part of our current society whether one is aware of it or not.

Personally, a dilemma is one that has more uncertainty of whether something is right or wrong. There is almost a turmoil that something is right but may harm something or someone in the process making the original action possibly wrong. I would not consider forced sterilizations as a dilemma at first thought. However, since this has occurred throughout the century and now reported in 2020 it must be a dilemma at least to some. At minimum there are a handful of medical professionals who have participated in these procedures and in all likelihood, there have been others who have known about it and have stayed silent. There are many lessons from atrocities and this shows that without safeguards in place society as a whole continues to repeat injustices. Acts such as these promote that there should always be checks and balances, that perhaps there needs to be more history and ethics in medical programs of all kinds, and that facilities need to remain transparent. ICE detention centers gained some publicity with the ruling that children were separated from their parents however the publicity still did not give transparency to what was actually happening within these centers (Manian, 2020). I think it also shows the need for emphasis on nurses being patient advocates as well as the need for our voice within politics.

References

Manian, M. (2020). ACLU News & Commentary. American Civil Liberties Union. https://www.aclu.org/news/immigrants-rights/immigration-detention-and-coerced-sterilization-history-tragically-repeats-itself/.

Stern, A. (2020). Forced sterilization policies in the US targeted minorities and those with disabilities – and lasted into the 21st century. University Of Michigan Institute for Healthcare Policy & Innovation. https://ihpi.umich.edu/news/forced-sterilization-policies-us-targeted-minorities-and-those-disabilities-and-lasted-21st.

Tulchinsky T. H. (2018). Ethical Issues in Public Health. Case Studies in Public Health, 277–316. https://doi.org/10.1016/B978-0-12-804571-8.00027-5

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Solution

Classmate Response (1)

I agree with you that nurses should play a more prominent role in preventing the normalization of unethical practices in healthcare settings. In the early 1900s, when the eugenics movement and social hygiene, which involved reducing births of handicapped and mentally ill people, became popular, it is evident that nurses became more compromising of the Hippocratic Oath (Woodley of Menie, 2016). Nurses and other healthcare providers supported efforts to terminate pregnancies and mass sterilization exercises on people who were considered disabled. The rise of the eugenics movement is evidence of how unethical practices can become justified and widely practiced in healthcare settings without consistent lobbying and advocacy efforts by nurses and other healthcare practitioners. Nurses should therefore be at the forefront in defending the Hippocratic Oath, which requires health caregivers to only perform procedures that benefit their patients and never be involved in any procedures and interventions that may directly or indirectly harm their patients (Woodley of Menie, 2016). By being the main defenders of ethical practice, nurses can therefore help to avoid unethical incidences that have been witnessed in the past. Through unethical historical periods such as the eugenics movement of the 1900s, nurses can understand their role as defenders of human life in contemporary times. For instance, in the ICE detention centers in the US, numerous reports of hysterectomies and mass sterilization of immigrant women without informed consent continue to be reported. Through their professional organization, nurses can therefore ensure that all human beings, including immigrants, are protected from unethical practices.

References

Woodley of Menie M.A. (2016).Eugenics Movement. In: Zeigler-Hill V., Shackelford T. (eds)

Encyclopedia of Personality and Individual Differences. Springer, Cham. https://doi.org/10.1007/978-3-319-28099-8_750-1.