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Life and death decisions and COVID-19: how an ethical code supports your practice

An internationally recognised code helps nurses advocate for fairer, ethical treatment for all

An internationally recognised code helps nurses advocate for fairer, ethical treatment for all

The pandemic has revealed serious shortcomings in countries healthcare systems, with many in danger of being overrun with patients who have COVID-19.

If this happens, those patients will not be able to access the treatment they need and nor will anyone else who needs hospital treatment.

COVID-19 has tested international healthcare systems

Nurses and other healthcare workers would be forced into a situation where they have to make decisions about who should receive treatment.

Such decisions are made about individuals every day, of course, based on their clinical situations. They are also taken more strategically when it comes to deciding which treatments

An internationally recognised code helps nurses advocate for fairer, ethical treatment for all

Picture: iStock

The pandemic has revealed serious shortcomings in countries’ healthcare systems, with many in danger of being overrun with patients who have COVID-19.

If this happens, those patients will not be able to access the treatment they need and nor will anyone else who needs hospital treatment.

COVID-19 has tested international healthcare systems

Nurses and other healthcare workers would be forced into a situation where they have to make decisions about who should receive treatment.

Such decisions are made about individuals every day, of course, based on their clinical situations. They are also taken more strategically when it comes to deciding which treatments are available for populations, because no health system can afford every available treatment for all of its people all of the time.

In the UK, the National Institute for Health and Care Excellence makes decisions about which drugs and treatments are available from the NHS, based on an assessment of clinical evidence and value for money.

This is a fair and equitable way to determine what is affordable, based on the benefits patients receive and the length of time – in terms of years of good quality life – that they can expect to gain from a given treatment.

But healthcare staff should never be forced to choose between life and death for patients simply because of a government’s failure to properly protect its population.

Lessons to be learned from COVID-19 decision-making

Some governments made good decisions early on in the pandemic and saw positive results in terms of the number of cases, hospital admissions and deaths, but that was not always the case.

Lockdown delays in some countries led to higher case numbers and, sadly, higher death tolls from the virus.

When the time is right, there will be a reckoning about the best decisions and the worst mistakes that have been made.

That’s how it should be, because we need to learn the lessons of COVID-19 and be better prepared for the next global health emergency, whenever it arises.

Nurses’ ethical code is universal

Whatever the situation they work in, nurses and other healthcare workers are guided by ethical principles that can be traced back to the ancient Greek physician Hippocrates, regarded as the ‘father of medicine’.

The Hippocratic Oath to uphold certain ethical standards has encouraged the development of many similar codes to ensure the protection of patients from quacks, charlatans and mystics parading as qualified, registered and regulated health workers.

‘Healthcare staff should never be forced to choose between life and death for patients simply because of a government’s failure to properly protect its population’

In 1953 the International Council of Nurses (ICN) published its own code of ethics for nurses, which is currently being revised and consulted on by our 130-plus national nursing association members.

Coordinating so many responses is time-consuming but will result in a robust code that will help nurses everywhere, whether they are working in remote rural areas in low-income countries, or in high-tech environments in the world’s richest nations. That is because the fundamentals of nursing are the same the world over.

International nurses’ code is based on four fundamental responsibilities

The current code, last updated in 2012, is used by nursing associations and regulators around the world, as well as by nurses seeking to clarify their actions amid the dilemmas they face in their everyday work.

At its heart are four fundamental nursing responsibilities that have guided the profession in modern times, namely to:

  • Promote health
  • Prevent illness
  • Restore health
  • Alleviate suffering

The code provides ethical guidance in relation to nurses’ roles, responsibilities, behaviours, decision-making and relationships with people who are receiving nursing care.

It is designed to be used alongside individual countries’ laws, regulations and professional standards that govern nurses’ practice.

COVID-19 presented challenges we didn’t see coming and has forced nurses to look closely at their roles and obligations, often in far-from-ideal and sometimes dangerous situations.

Nurses are better supported when equipped with a recognised ethical code

Nurses see injustice and inequality in their practice and they have always had a role in advocating for fair access to appropriate treatment for all.

Ethel Gordon Fenwick, who founded the ICN in 1899, affirmed that nursing is the work of humanity and it requires an ethical code. That has never been truer than today.

Nurses should never be put in a position where they are making life or death decisions without proper support. The updated ICN code of ethics, which will be released in November, will help them to negotiate their way through such difficult situations.


Find out more

2012 ICN Code of Ethics for Nurses


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