Henrietta Lacks and the Social Covenant of Nursing

Nurses are always considered helpers and the profession is widely regarded as one for compassionate and helping individuals. The Nursing’s Social Policy Statement is a work that seeks to detail the many ways in which nurses can assist others. How nurses relate with the society is through a relationship. A relationship that is sort of a social contract complete with expectations from both sides. The relationship allows nurses to carry out their professional duties in the provision of care to individual clients and to the society. It also empowers nursing practitioners to engage in policymaking, legislative and political action for the purposes of improving the provision of care, improving nursing practice, improving nursing research, and improving nursing education. It also enables nurses to comprehend the concepts of justice and social ethics and the roles they play in individual and societal health (Fowler, 2015). This work discusses the nursing social contract with regards to Henrietta Lack’s story as detailed in Rebecca Skloot’s The Immortal Life of Henrietta Lacks (Skloot, 2010).
Henrietta Lacks was a poor, undereducated, African American woman living in Baltimore in the 1940s. She was married and had five children with her husband who is named David. For quite some time, she was living with abdominal pain that she could not explain. In 1950, she decided enough was enough and asked her husband to take her to the Johns Hopkins Hospital. It was the only regional health facility where black people could get treatment for complicated conditions back then (Skloot, 2010).
After undergoing tests at the hospital, she was found to have cervical cancer. This was in the second month of 1951. She subsequently received radiation treatment under general anesthesia. Cervical radiation treatment was the gold standard intervention back then for the disease. Continuing research at the hospital by two physicians, George Gey and Richard TeLinde, plays an important role in Henrietta Lacks’ story. Gey was trying to develop and grow immortal cell lines in the lab for research, while TeLinde was a renowned cervical cancer doctor who at the time was investigating how cervical cancer types are related (Skloot, 2010; Stump, 2014). 
Just 21 days into utilizing Lacks’ cells for research, Gey made a breakthrough in his research. Lacks’ cells were special and enabled him to make the first immortal cell line from humans. He called them HeLa cells by combining the first two letters of Lacks’ first and second names (Stump, 2014). From then on, the cells have been used to develop cancer treatments, HPV vaccines, smallpox vaccines, and polio vaccines. They have also been utilized in over 80,000 studies and investigations. In the tenth month of 1951, Mrs. Lacks died. She died never knowing the significant role she played in advancing human medicine.
What does “Social Contract” Mean?
A social contract with regards to the nursing profession specifies how nurses and the society relate. It also specifies how nurses relate with one another. One can think of a social contract as one that specifies the responsibilities of nurses toward one another and toward patients. Nurses who understand the social contract have clarity in their role in professional settings. They know doctors, medicines, and machines treat and manage illnesses, while they play more of a supporting role to the patients ensuring they are safe, have dignity, and get what they need to recover as expected (Reeves et al., 2013). The clarity that the social contract brings can help in building relations between nurses and other medical professionals and in enabling professionals from different backgrounds to work together for the good of the patient.
The social contract concept is essentially a political science concept. It only started being using in care provision circles at the start of this century. It describes how health professionals relate with the society they serve (Cruess & Cruess, 2008).
The social contract between the health profession and the society has for the longest time been implicit. It has functioned well that way since many values between the profession and the society are shared. The responsibilities of medical professionals required to uphold the contract were well known and have been taught and passed on in various ways. The society also knew what to expect from the medical professionals. However, its responsibilities were less clear. They included providing the health professionals respect, status, financial incentives, freedom in practice, and the power to regulate themselves. This arrangement is what forms the basis of the nursing social contract.
For the social contract to be sustained, professionalism is a must. The society is giving money, respect, status, and practice autonomy in return for professionalism on the part of nurses, doctors and other medical professionals. Without the professionalism, there is no contract. This is why it is key for medical professionals to comprehend the origins and responsibilities of professionalism.
Medical professionals usually play two roles at the same time – they are professionals and they are healers (Cruess & Cruess, 2008). The world has always needed and had healers. The growth in prominence of science is what made the healers more competent and professional (Cruess & Cruess, 2008).
And with the rise in science, laws and regulations were passed that have made practicing medicine or nursing a preserve of those who have the requisite training. In other words, it they legislations have restricted practicing nursing and medicine a preserve for trained professionals. This is what established the current social contract. The implicit contract that gives doctors and nurses the obligation the monopoly to treat and care for the sick in return for financial incentives, status, and respect.
Social contract in the context of Henrietta Lacks
In the context of the implicit social contract between the society and the health care professionals, Henrietta Lacks automatically expected several things when she visited Johns Hopkins Hospital in Baltimore. She expected accountability, autonomy, and transparency. However, with regards to her special HeLa cells, she did not get these very things (Skloot, 2010).
Firstly, the health professionals who handled Mrs. Lacks’ case did not sustain the integrity and morality elements of the contract. The professionals are obligated to show autonomy. Those who do not show autonomy often lose trust (Cruess & Cruess, 2008). The autonomy of Mrs. Lacks was violated. This is evident in the fact that she had only one place to go to for care because of lack of money and racism. Moreover, the fact that she was not highly educated also means that she probably did not understand parts of her treatment (Palmd, 2010). Therefore, she possibly did not know or understand that the cells that were being taken from her were to be used for research. She ought to have been asked whether she agrees to the procedure.
Secondly, the medical professionals failed to uphold Mrs. Lacks’ right to transparency. They conducted themselves and provided the treatment without much disclosure (Cruess & Cruess, 2008). Nowadays, this is completely not acceptable. Now there is a need for transparency and for standards to be followed. Her body cells were collected without her express permission while she was undergoing treatment and they helped to advance the field of medicine (Skloot, 2010).
Nevertheless, the researcher never cared to inform Mrs. Lack that her cells were collected for research and that they have helped tremendously. In spite of the concerted efforts by healthcare professionals at the hospital, Henrietta did not beat cancer. She died at a young age and left behind her husband and their five children. Her family was never informed that her cells helped to launch a medical research industry worth billions of dollars and never got any compensation.
Lastly, the medical professionals failed the accountability test. For many years, medical professionals have recognized and embraced the fact that they are accountable to the people they treat or care for, to the society, and to each other (American Nurses Association, 2010). Accountability to individual patients should take the priority. The medical professionals caring for Mrs. Lacks should have focused all their resources on helping her rather than conducting research for posterity. This is a fact even though the end product of the research has subsequently helped many people (Quinlan, 2018).
Conclusion
Nurses and all other care providers have a social contract with the society. Through the contract, much is expected from them. They are expected to provide care, to be transparent, to be accountable, and to contribute to the society. In return, they get status, respect, financial benefits, recognition, and relevance from individuals and the society.
Mrs. Lacks story shows a case in point where medical professionals were not careful sustaining the unwritten rules of the social contract. Maybe it was because of her race. Maybe it was because of her financial status. Or maybe it was because things were lax back then. Nevertheless, the case shows a situation where the patient should have been given more control over their body and the professionals should have been more accountable to her.
References
American Nurses Association. (2010). Nursing's social policy statement: The essence of the profession. Nursesbooks. org.
Cruess, R. L., & Cruess, S. R. (2008). Expectations and obligations: professionalism and medicine's social contract with society. Perspectives in Biology and Medicine, 51(4), 579-598.
Fowler, M. D. M. (2015). Guide to nursing's social policy statement: Understanding the profession from social contract to social covenant. Silver Spring, MD: American Nurses Association.
Palmd, (2010). More on Lacks ethics. Science blogs. Retrieved from https://scienceblogs.com/whitecoatunderground/2010/02/03/more-on-lacks-ethics
Quinlan, C. (2018). Trust in Medical Research: The Legacy of Henrietta Lacks, Part 1. Science 36 Trial Mix. Retrived from https://www.science37.com/blog/medical-research-trust-and-henrietta-lacks/
Reeves, S., van Soeren, M., MacMillan, K., & Zwarenstein, M. (2013). Medicine and nursing: A social contract to improve collaboration and patient-centred care. Journal of interprofessional care, 27(6), 441-442.
Skloot, R. (2010). The immortal life of Henrietta Lacks. Broadway Books.
Stump, J. L. (2014). Henrietta Lacks and The HeLa Cell: Rights of Patients and Responsibilities of Medical Researchers. The History Teacher, 48(1), 127-180.