Doctor, I refuse to do this

In 2015, nurses in the Netherlands received a new professional code. This was a breakthrough. No longer were there four separate codes but only a single ethical point of departure on the basis of which care could be administrated. All nurses can recognise themselves in it. This is our profession, and this is the way we perform it. One might ask why it took so long.

Ethical indications
Around 1900, there was also a kind of professional code in force. It was called ethical indications for the nurse, based on the fundamental principles as formulated by Florence Nightingale in her “Notes on Nursing” from 1859. The first Dutch handbooks were written by physicians and always started with ethical rules. Physicians knew perfectly well what should be demanded of nurses. Obedience was first and foremost here. From 1910 on, when the first clinical nurse managers started to write handbooks themselves, they also devoted ample attention to ethics in nursing. In the 1930s, the 10 commandments by nurse educator Melk were popular. Even today, they are well worth reading. Obviously, their wording is old-fashioned, but the essence is the same: good and civilised nursing, through the use of heart, head and hands. After 1930, when nursing was gradually divided through the pillarisation of Dutch society, protestant and catholic leaders each wrote their own professional codes, based on the Christian faith and intended for their own circles.

Disobedient
But what is the advantage of a national professional code for the nurses themselves? I wish we would have had such a professional code in the 1970s. As a nurse fresh from school, I worked at the psychiatric ward of a medium-sized hospital. Without any knowledge of psychiatric nursing, I was scheduled to assist a psychiatrist in the weekly electroshock treatments. Every Tuesday morning, some 10 patients came in to undergo this treatment. After one morning of this duty, it was clear to me that it was an inhuman treatment. Without any form of sedation or compassion, electrodes were placed on the temples of depressed patients, who were then subjected to a degrading epileptic seizure. I was shocked. When I was again scheduled to perform this duty, I refused. The serving psychiatrist was beside himself over such disobedience. He assured me that my refusal to assist him meant my dismissal. I was obviously taken aback by that, but decided to pay no heed to the threat. ‘Doctor, I refuse to do this,’ was my reaction. I was not dismissed and there even was an adjustment of the procedure surrounding the electroshock treatment.

Professional code

What a support it would have been if I had been able to appeal to a universal professional code. If I had been able to say that I refused because it was my duty as a nurse “not to endanger the health and safety of the patient”, as the code states. How great it is that such a universal professional code is now in place and that nurses can appeal to it.

Nannie Wiegman
Directeur
Florence Nightingale Instituut

Nurse Stieltjes’ Doll

The history of nursing is closely linked to women’s rights. At least, in most European countries. In the Netherlands, the connection is tenuous at best. There, the archives yield no names of nurses who were members of both the women’s movement and a nursing organisation. There are just a few exceptions, such as Jeanne van Lanschot Hubrecht. The reason for this is the subject of my research. I was pleasantly surprised when there was yet another link between nursing and women’s rights, from 1898.

A silver medal

It all started with a telephone call from a district nurse of my acquaintance. She asked me to come to a village in the province of Brabant. Having arrived at a small farm, I followed the district nurse inside. In the gloom, an old lady was sitting in an old-fashioned armchair. We introduced ourselves and had a cup of tea. I had no idea what was in store for me. The old lady asked me: “Are you the author of the article on nurse Antje Stieltjes?” Yes, I had indeed written such an article. In 1998, a group of colleagues and I had issued a collection, about the centennial commemoration of the National Exhibition of Women’s Labour. This Exhibition took place in 1898 on the occasion of the accession to the throne of Queen Wilhelmina. This was such an event that the Dutch Women’s movement organised an exhibition in The Hague. It was a huge success. In conclusion of the exhibition, a committee of distinguished ladies organised a contest for products of women in the Netherlands who had made, embroidered, conceived or developed something extraordinary: “send them to us and be awarded with a silver medal bearing the likeness of Queen Wilhelmina”. Countless women went to work and send in their products. Sadly, none of these products has been preserved, until 1998.

Nurse Stieltjes’ Doll

In the archive, I had discovered that nurse Antje Stieltjes, district nurse by profession, had won this silver medal in 1898. She had developed a new bandage for men suffering from severe eczema, the so-called Labourer’s Bandage. Thereupon, she had bought a doll, had bandaged it with her Labourer’s Bandage and had sent it to the contest’s jury in a shoebox. In September 1898, Antje received notice that she had won the much-coveted medal.

The old lady looked me in the eye and said, “I am so glad that you have saved nurse Stieltjes from oblivion through this article, since Antje was my stepmother, who adopted me in 1905. And due to the article, I finally know what is in that shoe box in the attic.” The district nurse stepped out of the room for a moment and returned with a box, which the old lady then handed to me. When I opened the box, I got goose bumps. There was nurse Stieltjes’ doll, from 1898, fitted with the Labourer’s Bandage, delicate, tiny but intact. I sat there for minutes, looking at it breathlessly. The silver medal and photographs of nurse Stieltjes were also in the box. I safely returned the doll to the box and we said our emotional goodbyes.

Two weeks later, I received the obituary notice. The old lady had passed away and had bequeathed the doll, the medal and the photographs to the Florence Nightingale Institute. The Nursing Collection had acquired another important piece and there was indeed a link between nursing and the women’s movement in the Netherlands.

Nannie Wiegman
Directeur
Florence Nightingale Instituut