To: Ethics Advisory Board

From: Nurse concerned for my patient

Subject: Human trafficking

I am an RN in a small community hospital. Last month, I admitted a young woman who had suffered a head injury resulting from an assault. The patient only spoke Spanish and her male companion insisted on interpreting for her. The young woman had no family present, and her companion offered to consent to her treatment, although he was not related. The companion was overheard telling the patient that she would not have to work again and that he would protect her. This young woman was dehydrated, malnourished, and appeared to be very afraid. I could tell something was wrong with the situation, but I couldn’t put my finger on what it was, and didn’t know what to do.

From: ANA Center for Ethics and Human Rights

It sounds like your patient may be a victim of human sex trafficking. It’s estimated that each year over 15,000 people are brought into the United States against their will and forced to work in pornography and prostitution. Gang rape, or rape by multiple persons, is a common method to force victims into complying with demands. Captors force victims to use drugs and alcohol as a means of control.

Hospitalization may be a victim’s only entry point into safety. Failure to identify human trafficking and intervene can have tragic consequences. Victims may have signs of trauma such as bruising, burns, scars, lacerations, infestations, genital mutilation, vaginal or anal trauma, flat affect or panic, and substance withdrawal. Individuals who are not fluent in English are especially at risk. It’s critical to obtain an appropriate medical translator to assist these victims.

Establishing trust is difficult but essential. Victims may resist help and have intense fear, shame, and helplessness that may compel them to leave the hospital without treatment. If you suspect human trafficking, keep a staff member with the patient at all times. Assess your patient without the companion present and use a certified medical interpreter. Ask nonthreatening questions such as:

• Where are you from? How did you arrive here? Do you know where you are now?
• Do you have enough food to eat?
• Do you feel safe where you sleep?
• Are you able to freely come and go from your home?
• Are you forced to do things you don’t want to?

Nurses are ethically required to report suspected human trafficking. Provision 1 of the American Nurses Association’s (ANA) Code of Ethics for Nurses with Interpretive Statements states that the nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person. Victims of human trafficking are vulnerable people who desperately need compassion, respect, and nursing care. Provision 2 states that the nurse’s primary commitment is to the patient, and Provision 3 states that the nurse promotes, advocates for, and protects the rights, health and safety of the patient. Victims of human trafficking desperately need nurses to advocate for their rights because they are not able to do so themselves. If you suspect human trafficking, call the police.

Additional information about human trafficking is available from the National Human Trafficking Resource Center (1-888-373-7888). Nurses have an ethical obligation to be educated about human trafficking, including how to identify victims, and must advocate for and help rescue them.

Response by Donna Casey, DNP, MA, RN, NE-BC, FABC, chairperson of the ANA Ethics and Human Rights Advisory Board.

Selected reference

Green C. Human trafficking: Preparing for a unique patient population. Am Nurse Today. 2016;11(1):9-12.