Bad medicine

Martha Paynter is a Registered Nurse, a PhD Candidate in the Dalhousie University School of Nursing, and the Chair of Women’s Wellness Within.

It is outrageous enough that Jacob Blake was shot seven times in the back. In recovery he was handcuffed to his hospital bed, adding to the violence inflicted on him. In the days after yet another unjustifiable, ragingly violent police attack on a Black man, his family say his treatment includes being held in “chains.” Wisconsin Governor Tony Evers is reported to have said, “It seems to be bad medicine.”

Bad medicine indeed. Bad nursing, bad care. Not care. Health care providers who participate in the ill treatment of prisoners, by standing by, complying, continuing on with their clinical routines in the context of carceral force, are abdicating their professional responsibilities. 

This is not a horrific practice unique to Wisconsin, or the United States. This happens in Canadian hospitals too. Four years ago, we protested the shackling of Fliss Cramman while she recovered from major abdominal surgery at the General Hospital in Dartmouth, Nova Scotia. The mother of four was facing deportation over a technicality. At the time, the province’s then Minister of Justice Diana Whalen said, “It sounded like we had gone a little too far.”

Indeed. Cramman’s shackles were removed. Her deportation was stayed. 

For nurses and physicians, our Code of Ethics prohibits us from treating someone without their free and informed consent. Health care providers do not generally seek consent while a patient is heavily medicated, because their cognition is obviously affected, their self-governance is impaired. Upholding patient autonomy, acting with the intention of good and at least with the goal of avoiding harm, and promoting justice — these are the basic foundations of health care provider ethics. 

A patient cannot consent while shackled. There is no protection of autonomy, no avoidance of harm and promotion of benefit, no justice, when a patient is treated in shackles. 

The United Nations Standard Minimum Rules for the Treatment of Prisoners, also known as the Mandela Rules, provide international guidance on how health care professionals must care for prisoners. The Rules appear to be infrequently taught in health professional programs; they were not part of my baccalaureate preparation in nursing. Canada has acknowledged these Rules, but they are not officially enacted nor are they legally binding. However, they are consistent with health professional Codes of Ethics and the BC Health Professional Review Board states they can inform practice in carceral settings. 

Even if a health care provider never works in a prison, prisoners will be brought to our care in health institutions. The Rules stipulate that health care providers are not to follow a different set of principles when caring for prisoners than for patients in the community. We have a “duty of protecting prisoners’ physical and mental health and the prevention and treatment of disease on the basis of clinical grounds only,” and face “an absolute prohibition on engaging, actively or passively, in acts that may constitute torture or other cruel, inhuman or degrading treatment or punishment.” Further, the Rules prohibit the use of restraints “which are inherently degrading or painful.” Mr. Blake, who was paralyzed from the waist down by the police, presented no flight risk. There is no other purpose than degradation and pain for the restraints placed upon him, or any patient recovering from major surgery. 

What Mr. Blake experienced, what Ms. Cramman experienced, are violations of the Mandela Rules and violations of our professional Codes. We should not require these standards be legally binding for us to have moral clarity with respect to our clinical actions. 

Nurses remain “the most trusted profession.” Do we deserve this trust if we allow such cruelty on our watch? To say, “No,” to withhold our labour, to refuse to participate in cruelty, we must navigate the patriarchal hierarchies of both the hospital and the carceral systems. We must reject the white supremacy that dominates the profession of nursing in Canada.

We need to train nurses that manufactured concerns about “security” do not matter more than human rights. “Security” is subjective, generated in this country through a lens of racism and colonialism, prioritizing protection of property over the health of the public. People experiencing criminalization are members of the public, they are our patients, to whom we owe a duty to care. 

We need leadership from our unions and professional organizations to provide guidance and support in our ethical resistance to carceral force against our patients. 

Most importantly, we must join the calls to defund the police and to reallocate public investment into infrastructure and services that uphold and advance human rights and just health care for all.