Filipino Nurses and COVID-19 Vaccine Acquisition

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Answering the question of whether to allow or not the use of nurses as a bargaining chip for the acquisition of COVID-19 vaccines requires an in-depth study of its ethical aspect but before we proceed with it, we must first look past how the situation is framed, take it down to its bare essence and gather all the relevant facts and look at it with objectivity. The phrase “using nurses as a bargaining chip” triggers an emotional response, the feeling of anger is more pronounced compared with other feelings associated with that statement. Some might argue in favor of the independence of language and emotional response but neurophysiologic research has proven that language and emotion processing affect each other (Weis & Herbert, 2017) and it has the capacity to cloud one’s objectivity. Setting aside our initial emotional response and looking with objectivity, let us analyze the statement.

  • Is it really the nurses that they are going to use as a bargaining chip?
  • Why Filipino nurses?
  • What do Filipino Nurses have?
  • Does the statement fully convey its intent?
  • Was it written in a way that sensationalized the issue?
  • Would your initial reaction be different if the statement was written in another way?

After trying my best to set aside my initial emotional response and innate biases, I was able to strip down the statement into a version I believe accurately describes its intent: “Lifting nurse deployment cap as a condition for COVID-19 Vaccine Acquisition Agreement.” Analyzing the statement allowed me to realize that it is not us nurses but it’s what we can do, our expertise, the quality of care we deliver, and our value as individuals and as a professional that will be the condition of the acquisition of the vaccines.

Deciding on whether to allow this or not requires good ethical decision-making utilizing ethical principles and approaches. We all know that there are a lot of Ethical Principles and Approaches and we cannot determine if something is ethical or not based solely on a single ethical principle or approach. This also presents another challenge for the reason that there are big possibilities of having some ethical principles contradict one another. This is where an Ethical Decision-Making Framework comes would be useful.

An Ethical Decision-Making Framework is a decision-making model that utilizes a series of steps that requires individuals to assess the conflicting situation; consider various dispositional factors, such as benevolence, justice, and honor; complete a comprehensive review of the alternatives; make a judgment; and document and justify the final decision (Johnson, et al., 2017)

There are multiple Ethical Decision-Making Frameworks we can use to come up with an Ethical. Decision but for this case, I decided to use the Markkula Center Framework. This is a simple ethical decision-making framework developed by a group of philosophers at the Markkula Center for Ethics at Santa Clara University. It distills various philosophical approaches towards ethics in simple questions and answering these helps approach a difficult situation from various perspectives. While the framework cannot solve certain thorny issues, it is quite successful at elucidating ethical problems (Schwarz, 2005)

1. Recognizing the Issue

The issue that needs to be solved in this case is to determine whether it is ethical or unethical to allow the use of the Lifting of Nurse Deployment Cap as a condition of the agreement for the acquisition of the much-needed COVID-19 Vaccines.

2. Getting the Facts

Establishing the facts will help us scrutinize every detail of the issue and look at it closely under different ethical principles. Here are the facts that I considered for this issue:

  1. Nurses: It has the potential to open more opportunities for nurses to work overseas and enjoy better career upward mobility and improvement of financial capacity. The cap on the deployment of nurses will remain without this agreement.

  2. The Public: There will be another source of vaccine for the public which will increase their health security and positively affect the country’s economy. Without this agreement, the government will have to make use of the negotiation for the vaccine acquisition with manufacturers and wait for the supply from COVAX, the global initiative aimed at equitable access to COVID-19 vaccines which the Philippines is a member. Both options present possible delays due to limited supplies as manufacturers struggle to fulfill preorders. Further delays in vaccine rollout may cause further economic problems and increases the risk of infection.

  3. Destination Country: They will have access to highly qualified and globally competitive nurses which will increase their healthcare delivery capacity.

3. Evaluate Alternative Options

In evaluating the above facts and weighing the effects of different alternative course of action, I utilized the Five Ethical Approaches which includes Utilitarian, Rights, Justice, Common Good, and Virtue Approach. In the Utilitarian approach, I looked for what will create the greatest balance of good over harm as this approach conforms to our belief that our actions will always produce some good and some bad, and that the right decision will be one that produces the most good or the least harm. Using the Rights Approach, I looked at the rights of those involved and see which decision will protect their ethical rights. This approach also allowed me to look at the common argument on the issue which is reducing nurses to a mere commodities and ensure that my decision will emphasize the dignity of nurses and all those involved. Another consideration is the fairness of the options and which options will serve more instead of just a select few. The last consideration I used is to determine which decision will reflect the principles of the kind of person I want to be.

4. Make a Decision & Test It

I have decided to allow the use of the lifting of the nurse deployment cap as a condition of the agreement on COVID-19 Vaccine Acquisition. I believe that this provides better and less harm to people and nurses. More opportunities for nurses to work overseas will be available and a solution to the limited supply of vaccines for the country will be secured. This also allows nurses to share with society the responsibility for initiating and supporting action to meet the health and social needs of the public, in particular those of vulnerable populations (ICN,2012). At the same time, it allows the government to institute measures that will result in humane working conditions, better career prospects, and dignified existence for nurses essentially fulfilling their responsibility toward nurses as stated in the Declaration of Policy of the Philippine Nursing Act of 2002 (RA 9173)

3. Act & Reflect on the Outcome

My decision to allow the use of the Lifting of Nurse Deployment Cap as a condition of COVID-19 Vaccine Acquisition comes with the recommendation that the government also create measures that will let nurses choose to stay and serve them in the Philippines. Though allowing nurses to work overseas provides opportunities for nurses, the government should not rely on it as the only way to fulfill their responsibility of providing humane working conditions and better career prospects for nurses. The government should also make established measures that these are also available for nurses working in the Philippines – this will also pave the way for them to fulfil their responsibility of guaranteed delivery of quality basic health services to the public.

I understand that the nobler a decision we have to make, the more people we need to hear for us to have a wider perspective on the issue and to have the needed sensitivity to the ethical implications of our decisions. Though I stand by my analysis and my decision, I strongly recommend having a healthy discussion on my decision.

references

• Hunt, S. D., & Laverie, D. A. (2004). Experiential Learning and the Hunt-Vitell Theory of Ethics: Teaching Marketing Ethics by Integrating Theory and Practice. Marketing Education Review, 14(3), 1–14. https://doi.org/10.1080/10528008.2004.11488874
• International Council of Nurses. (2012). The ICN Code of Ethics for Nurses.https://www.icn.ch/sites/default/files/inlinefiles/2012_ICN_Codeofethicsfornurses_%20eng.pdf
• Johnson,R. L., Liu, J., & Burgess, Y. (2017). A model for making decisions about ethical dilemmas in student assessment. Journal of Moral Education, 46(2), 212–229. https://doi.org/10.1080/03057240.2017.1313725
• Manuel, V., Dennis, M., Michael J., M., Thomas, S., Margaret R., M., David, D., Claire, A., & Kirk O., H. (2009). Markkula Center Framework. Markkula Center fo Applied Ethics at Santa Clara University. https://www.scu.edu/media/ethics-center/ethical-decision-making/AFramework-for-Ethical-DecisionMaking.pd
• The Philippine Nursing Act of 2002 (RA9173),(2002). https://www.officialgazette.gov.ph/2002/10/21/republic-act-no-9173/
• Schwarz, T. S. J. (2005). Teaching ethics and computer forensics. Proceedings of the 2nd Annual Conference on Information Security Curriculum Development -InfoSecCD’05. https://doi.org/10.1145/1107622.1107637
• Trevino, L. K. (1986). Ethical Decision Making in Organizations: A Person-Situation Interactionist Model. Academy of Management Review, 11(3), p601617. https://doi.org/10.5465/AMR.1986.4306
• Weis, P. P., & Herbert, C. (2017). Bodily Reactions to Emotional Words Referring to Own versus Other People’s Emotions. Frontiers in Psychology, https://doi.org/10.3389/fpsyg.2017.01277

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