What were your first thoughts when you heard the news of convicted Ohio kidnapper and rapist Ariel Castro’s successful suicide while in protective custody in a state prison reception facility? Based on my Twitter and Facebook timelines, there have been a variety of responses in the public, nursing, and correctional health care communities. Many are glad that society is saved from the cost of caring for such a heinous criminal. Some are critical of the mental health and security oversights that led to this opportunity for self-injury. After all, Castro’s suicide potential score must have been off the chart. Fellow blogger and forensic psychiatrist Annette Hanson (@clinkshrink) provides a thoughtful post with her take on the subject: “Your Patient Died. Who Cares?”
This major news item is a reminder of the personal and professional conflict frequently experienced by those of us who care for criminals, many of whom are pretty unlovely, even monstrous, people. The very definition of professional nursing, however, requires us to consider their well-being and seek their best by preventing illness and injury while alleviating suffering. Are people like Ariel Castro unworthy of our efforts? Many think so. The issue gets to the root of an ethical dilemma in our specialty and can provide insight into the very heart of nursing practice.
The ethical dilemma stems from a need to feel that our patients are worthy of our good intentions in providing nursing care. From that perspective, inmate Castro and many others behind bars do not merit our attention. But is valuing the individual really the basis of our practice? Do we only provide nursing care to individuals who meet our moral standards or expectations? This is where the rubber meets the road in all of nursing, but it is a continual lived experience in correctional nursing.
I would like to suggest that our nursing practice is more about who we are than about who our patients are. In other words, we choose to provide care that goes beyond any consideration of the personal attributes of our patient. That is, in fact, the first and possibly primary provision of the Code of Ethics for Nurses: “The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.”
Unlike members of most other specialties, correctional nurses are regularly called upon to look beyond the personal attributes, social and economic statuses of our patients in order to deliver nursing care to murderers, rapists, and kidnappers.
Yet nurses in every area of practice must be mindful of biases and inappropriate attitudes toward our patients. Who among us has not mentally judged a patient who is now struggling with a condition brought on by poor lifestyle choices, whether it be smoking, overeating, or alcohol intake? Have we not, even, professionalized these judgments by standardizing terms such as ‘noncompliant,’ ‘drug-seeking,’ or ‘frequent flyer’?
The case of the in-custody death of Ariel Castro provides yet another opportunity for consideration of who we are and what we do as nurses. Correctional nurses like those who provided care to Ariel Castro are regularly confronted with the unique ethical nature of nursing care. I hope you took the time, as I did, to check your attitudes about the demise of Ariel Castro last week. Could you have provided nursing care to this wretched fellow? What does our answer to this question say about us as nurses? Is the moral courage to “practice with compassion and respect for the inherent dignity, worth, and uniqueness of every individual” what distinguishes professional nursing practice? I wonder . . .