Ethics and Human Rights
Life and death decisions are a part of nursing, and ethics are therefore fundamental to the integrity of the nursing profession. Every day, nurses support each other to fulfill their ethical obligations to patients and the public, but in an ever-changing world – there are increased challenges.
“The Code” is a vital
tool for nurses
now and in the future.
VIEW THE CODE
The ANA Center for Ethics and Human Rights
The Center is committed to addressing the complex ethical and human rights issues confronting nurses and designing activities and programs to increase the ethical competence and human rights sensitivity of nurses. Through the Center, ANA's abiding commitment to the human rights dimensions of health care is demonstrated.
The American Nurses Association (ANA) Center for Ethics and Human Rights was established to help nurses navigate ethical and value conflicts, and life and death decisions, many of which are common to everyday practice. The Center develops policy designed to address issues in ethics and human rights at the state, national, and international levels. Through its highly visible information, activities, and programs, the Center promotes the ethical competence and human rights sensitivity of nurses in all practice settings and demonstrates ANA’s abiding commitment to human rights.
2020 Center for Ethics and Human Rights Annual Report
2019 Center for Ethics and Human Rights Annual Report
2018 Center for Ethics and Human Rights Annual Report
2017 Center for Ethics and Human Rights Annual Report
Contact the Center of Ethics and Human Rights at ethics@ana.org
READ MORE ABOUT THE CENTER FOR ETHICS AND HUMAN RIGHTS
The Code
The Code of Ethics for Nurses with Interpretive Statements, or “The Code”, is a vital tool for nurses now and in the future. While the foundational values of nursing do not change, The Code is regularly updated to reflect changes in health care structure, financing, and delivery. It supports nurses in providing consistently respectful, humane, and dignified care. These values are often second nature to nurses’ caregiving but are frequently challenged by the failings in U.S. health care and by negative social determinants of health.
The Code, consisting of nine provisions and their accompanying interpretive statements:
- Provides a succinct statement of the ethical values, obligations, and duties of every individual who enters the nursing profession;
- Serves as the profession’s nonnegotiable ethical standard; and
- Expresses nurses' own understanding of our commitment to society.
The Code is particularly valuable in today’s healthcare environment because it clearly and eloquently reiterates the fundamental values and commitments of the nurse (Provisions 1–3), identifies the boundaries of duty and loyalty (Provisions 4–6), and describes the duties of the nurse that extend beyond individual patient encounters (Provisions 7–9).
To serve as the most useful aid in challenging situations, The Code's interpretive statements provide specific guidance for practice. The statements respond to the contemporary context of nursing and recognize the larger scope of nursing’s concern for societal health.
The Code of Ethics for Nurses with Interpretive Statements is the social contract that nurses have with the U.S. public. It exemplifies our profession's promise to provide and advocate for safe, quality care for all patients and communities. It binds nurses to support each other so that all nurses can fulfill their ethical and professional obligations. This Code is a reflection of the proud ethical heritage of nursing; one which will continue on, whatever challenges the modern health care system presents.
BUY THE CODE OF ETHICS FOR NURSES WITH INTERPRETIVE STATEMENTS ONLINE
The ANA Center for Ethics and Human Rights helps nurses navigate complex and every day ethical issues, in all practice settings.
ANA position statements on ethics and human rights
In tandem with The Code, ANA’s position statements support nurses by offering an explanation, a justification, or a recommendation for a course of action in particular situations.
Ethics and Human Rights
2024
- Capital Punishment and Nurses' Participation in Capital Punishment (Approved 2/24)
- Nurses' Roles and Responsibilities in Providing Care and Support at the End of Life (Approved 2/24)
- Privacy and Confidentiality (Revised 2/24)
2022
- The Ethical Use of Artificial Intelligence in Nursing Practice (Approved 12/20/22)
- The Nurse's Role and Responsibility in Unveiling and Dismantling Racism in Nursing (2022)
- Risk and Responsibility in Providing Nursing Care (Approved 10/6/2022)
2021
- Therapeutic use of Marijuana and Related Cannabinoids (Approved 5/4/2021)
-
Nurses’ Professional Responsibility to Promote Ethical Practice Environments (Approved 5/4/2021)
2020
- The Ethical Use of Restraints: Balancing Dual Nursing Duties of Patient Safety and Personal Safety (Approved 11/23/2020)
- Nursing Care and Do-not-resuscitate (DNR) Decisions (Approved 2/19/2020)
2019
- Nurse’s Role in Providing Ethically and Developmentally Appropriate Care to People With Intellectual and Developmental Disabilities (Approved 10/10/19)
- Ethical Considerations for Local and Global Volunteerism (Approved 8/2/19) [VIDEO]
- The Nurse’s Role When a Patient Requests Medical Aid in Dying (Approved 6/22/19)
2018
- The Nurse’s Role in Addressing Discrimination: Protecting and Promoting Inclusive Strategies in Practice Settings, Policy, and Advocacy (Approved 10/3/18) [VIDEO]
- The Ethical Responsibility to Manage Pain and the Suffering It Causes (Approved 2/23/2018) [VIDEO]
- Interdisciplinary Guidelines for Care of Women Presenting to the Emergency Department with Pregnancy Loss (Endorsed 2/23/2018)
- Nursing Advocacy for LGBTQ+ Populations (Approved 4/19/18)
2017
- Non-Punitive Treatment of Pregnant and Breastfeeding Women with Substance Use Disorders
(Approved 3/15/17) - Nutrition and Hydration at the End of Life (Revised 6/7/17)
2016
- Frequently Asked Questions: ANA Position on Capital Punishment
- The Nurse’s Role in Ethics and Human Rights: Protecting and Promoting Individual Worth, Dignity, and Human Rights in Practice Settings (February 2016)
Retired ANA Position Statements
- Constituent/State Nurses Associations (C/SNAs) as Ethics Resources, Educators, and Advocates
(Retired ANA Position Statement - Approved 11/11/11) - Stem Cell Research (Retired ANA Position Statement - Approved 1/10/07)
Ethics Topics and Resources
For nurses to fulfill their ethical obligations to patients, it is vital to have access to a wide range of information and to keep up-to-date with advances in ethical practices. These articles and links offer context for nurses on difficult issues and best-practice recommendations.
Social Justice
When nurses vow to protect the health and safety of patients, that promise does not end at the bedside. While social justice is a logical extension of the nursing profession, it can be difficult for nurses to navigate these divisive areas and ensure every individual receives timely and high-quality care.
Sign the Pledge Against Torture
Given the importance of ethics and the protection of human rights in nursing practice, the American Nurses Association is urging RNs to join ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, and ANA Chief Executive Officer Marla J. Weston, PhD, RN, FAAN, in signing on to the Health Professionals' Pledge Against Torture.
Physicians for Human Rights launched a pledge May 18 for health professionals across the United States to stand together in their rejection of torture, voicing the consensus that torture and cruel, inhuman, or degrading treatment are absolutely prohibited in all circumstances. Already the list of signers includes Nobel laureates in medicine, former surgeons general, prison physicians, leaders of health professional organizations, and medical ethicists who pledge never to collude in torture under any circumstances, in keeping with the ethical codes of their professions.
By uniting in large numbers behind the pledge, nurses and other health care professionals send a strong message to policymakers, health professional associations and the American public that future attempts to enlist health professionals in the design, study or use of practices that result in severe physical or mental abuse will not be tolerated. The pledge also serves as a declaration of support for health professionals who resist orders to torture or inflict harm.
For more than a decade, PHR and its network of partners have led efforts advocating against torture, documented the devastating long-term health consequences of torture, and called attention to the complicity of some health professionals in the post-9/11 U.S. torture program.
“At a time when human rights are increasingly under threat, we’ve launched this pledge to marshal the powerful voices of health professionals across the United States and reaffirm their ethical duties to honor human dignity,” said PHR Executive Director Donna McKay.
ANA’s Code of Ethics for Nurses with Interpretive Statements is essential to nursing practice, and the national association has a long history of human rights advocacy. For example, ANA successfully advocated for the ethical right of a Navy nurse to refuse to force-feed detainees at Guantanamo Bay. In January, ANA released its Ethics and Human Rights Statement emphasizing that nursing “is committed to both the welfare of the sick, injured, and vulnerable in society and to social justice.” To read more visit, Health Professionals' Pledge Against Torture.
Moral Courage, Moral Distress, Moral Resilience
Nurses practicing in today’s health care environment face increasingly complex ethical dilemmas. Upholding our commitment to patients and communities requires significant moral courage and resilience. It involves the willingness to speak out, whether alone or collectively, to do what is right for patients and other nurses
Documentary
The Moral Distress Education Project
Core multidisciplinary experts on moral distress from across the country were interviewed in a documentary-style media project. This project is a self-guided web documentary.
A Call To Action Report: Exploring Moral Resilience Toward a Culture of Ethical Practice
Relevant Nursing Journal Articles
- Compassion Fatigue as a Threat to Ethical Practice: Identification, Personal and Workplace Prevention/Management Strategies, MEDSURG Nursing: July-August, 2016
- Moral Resilience: Managing and Preventing Moral Distress and Moral Residue MEDSURG Nursing: March-April, 2016
- Moral Distress References
- Moral Distress in Academia OJIN: The Online Journal of Issues in Nursing
- Moral Courage and the Nurse Leader OJIN: The Online Journal of Issues in Nursing
- Creating Workplace Environments that Support Moral Courage OJIN: The Online Journal of Issues in Nursing
- Strategies Necessary for Moral Courage OJIN: The Online Journal of Issues in Nursing
- Moral Courage in Healthcare: Acting Ethically Even in the Presence of Risk OJIN: The Online Journal of Issues in Nursing
- Understanding and Addressing Moral Distress OJIN: The Online Journal of Issues in Nursing
- Using the AACN Framework to Alleviate Moral Distress OJIN: The Online Journal of Issues in Nursing
- Moral Distress and Moral Courage in Everyday Nursing Practice OJIN: The Online Journal of Issues in Nursing
- Moral Courage in Action: Case Studies MEDSURG Nursing: August, 2007
- Moral Courage: A Virtue in Need of Development? MEDSURG Nursing: April, 2007
End of Life Issues
In an aging population with rapidly increasing technological interventions possible, end of life care is a vital discussion. With multiple perspectives to consider, these resources serve to convey the breadth of opinion that nurses experience, and help nurses respect individual dignity and autonomy.
Advance directives, Education, Professional Organizations, Hospice
In an aging population with rapidly increasing technological interventions possible, end of life care is a vital discussion. With multiple perspectives to consider, these resources serve to convey the breadth of opinion that nurses experience, and help nurses respect individual dignity and autonomy.
Advance directives
End of life care often starts when a person is healthy. Many people, including nurses, have specific ideas about what health care they want, or do not want, at the end of life. Advance directives are a means to allow people to convey their wishes for end of life care. This includes discussions with those who might be a surrogate decision maker, as well as documents used to express preferences.
The National Hospice & Palliative Care Organization (NHPCO)
HHPCO has a directory of advance directives that are acceptable to each statue.
Five Wishes
An easy guide for patients and families to discuss preferences for end of life care, as well as for healthcare professionals who might not be comfortable with such discussions. The guide includes prompts for discussions about how you wish to be remembered.
Education
The End-of-Life Nursing Consortium (ELNEC)
ELNEC is a series of programs developed by the American Association of Colleges of Nursing. Current ELNEC modules include core curriculum, pediatric palliative care, geriatric, and many others. There are also train-the-trainer modules. After taking a train the trainer course, a nurse can then offer an ELNEC course. The courses are comprehensive and provide all teaching materials needed. The courses are typically offered in a block over two days.
Education in Palliative and End of Life Care (EPEC)
EPEC was originally developed as physician education but has expanded. It has both in-seat and online programs. The model includes the training of facilitators. Sessions may be given in day-long formats, or in shorter sessions, such as grand rounds.
Professional Organizations
The Hospice & Palliative Nurses Association (HPNA)
HPNA has the mission of advancing expert care in serious illness. HPNA is the professional organization for palliative care nurses and hospice nurses. HPNA provides education and certification for nurses across levels, including Advance Practice Registered Nurses (APRN), Registered Nurses (RN), RN Pediatrics, and more. HPNA has many Special Interest Groups (SIGs) with online discussion groups. The organization has also developed a series of position statements to guide professional practice. With The American Academy of Hospice & Palliative Medicine (AAHPM), HPNA has an annual assembly for professionals.
The American Academy of Hospice & Palliative Medicine (AAHPM)
AAHPM is the professional organization for hospice physicians, palliative medicine physicians, and other health care professionals (nurses, social workers, chaplains, etc.) in these fields. Their goal is to improve the care of patients living with serious illness. AAHPM provides certification for physicians in palliative medicine, as well as for hospice medical directors. AAHPM provides many options for education, online discussion groups, special interest groups, and certification. With HPNA, AAHPM has an annual assembly for professionals.
The Center to Advance Palliative Care (CAPC)
CAPC is a multidisciplinary organization that supports practice, research, and education. Hospitals can become member organization, and all employees of those organizations have extensive access to continuing education and other resources. Even non-members have access to the myriad resources of CAPC.
The National Hospice & Palliative Care Organization (NHPCO)
NHPCO is one of the oldest advocacy organizations in the fields of hospice and palliative care. Their focus is primarily on the care of patients with terminal illness, and their families. They have developed Standards of Practice and have several position statements.
The Schwartz Center
The Schwartz Center is another organization whose goal is to improve the care of patients who are dying. One of their best known efforts is Schwartz Center Rounds, which are intended as a regularly scheduled forum for caregivers to discuss the challenges of caring for patients and families. Schwartz Center Rounds are currently held in about 550 centers in the U.S., U.K., and Canada.
Hospice
Hospice is a model of care for people who are at the end of life. Specifically, hospice care is eligible for people who are estimated to have a prognosis of six months or less. Hospice is tremendously underutilized, with about 50% of patients having a length of stay of less than 18 days, as opposed to the approximately 180 days of the hospice benefit. Misperceptions about hospice are common. A common misunderstanding is that hospice is a place (“She’s going to hospice”), rather than a model of care. Greater than 90% of hospice care occurs in patients’ homes.
The Centers for Medicare and Medicaid Services
This resource explaining the hospice guidelines is helpful for patients, families, and providers.
Elder Law Answers
This resource from Elder Law Answer is used to make the Medicare Hospice Benefit more comprehensible.
Caregiving Resources
Nurses frequently come into contact with caregivers and can provide vital support to individuals who may not come into regular contact with others due to the often all-consuming nature of providing care. It is important for caregivers to realize that they are not alone and that there’s a wealth of information and resources to improve their situation.
Links to tools and support groups for caregivers:
National Association for Home Care & Hospice (NAHC)
NAHC is the voice of home care and hospice. NAHC represents the nation’s 33,000 home care and hospice providers, along with the more than two million nurses, therapists, and aides they employ.
Caregiver Action Network (CAN)
Education, peer support, and resources for family caregivers. CAN serves a broad spectrum of family caregivers ranging from the parents of children with special needs, to the families and friends of wounded soldiers; from a young couple dealing with a diagnosis of MS, to adult children caring for parents with Alzheimer’s disease.
Help for cancer caregivers
Tools and information to improve the quality of life for caregivers.
The American Cancer Society
A national website with a tab on finding support for caregivers: what to expect; what you need to know when caring for a loved one at home; and tips of caring for oneself.
The American Association of Critical-Care Nurses
You can search for Caregivers and it links you to multiple articles on caring for the chronically critically ill.
Patients’ Action Network
Has a tab on advocate resources.
Women's Institute For A Secure Retirement
Resource tab for caregivers and their families.
Caregiver support - online caregiver support
Caregiver support for people who take care of their elderly loved ones, or have the possibility of being a new caregiver or potential caregiver.
The Conversation Project
Contains a toolkit to help people talk about their wishes for end-of-life care. An essential for all caregivers.
VA Caregiver Support
Can tell you about assistance available from VA, help you access the services, connect you to the Caregiver Support Coordinator at a VA Medical Center near you, and just listen, if that is what you need. Support line 1.855.260.3274.
Alzheimer’s Association Caregiver Stress
Describes caregiver stress and offers tips for managing stress.
American Psychological Association
Common Ethical Issues: Supporting the Caregiver.
Bioethics
While the consequences of Bioethics may not be felt by every single nurse, it is vital they are aware of the enormous implications of these issues, in case of crisis. From Ebola to natural disasters, through keeping aware of the very latest threats, nurses can protect patients and themselves in the face of any obstacles.
Related Resources
American Society of Bioethics and Humanities (ASBH)
Serves as a resource for anyone interested in bioethics and humanities by providing a group of further online resources and links to aid in finding other related information through the Internet.
Ethics, the law, and a nurse’s duty to respond in a disaster
International Council of Nurses
Ethics and Human Rights.
National Center for Ethics in Health Care - Veterans Affairs
A resource for addressing complex ethical issues in health care.
The NCSBN National Nursing Guidelines for Medical Marijuana
Nursing guidelines for the patient using medical marijuana
National Reference Center for Bioethics Literature
Offers extensive searches in Bioethics.
Nursing2015 / Issues in Nursing
“A Nurse’s Obligations to Patients with Ebola.”
United Nations Educational, Scientific and Cultural Organization (UNESCO)