Corrigendum to position statement:

Available online at www.sciencedirect.com

Nur s Ou t l o o k 6 5 ( 2 0 1 7 ) 3 4 6e 3 5 0 www.nursingoutlook.org

Corrigendum to position statement: Political interference in sexual and reproductive health research and health professional education [Nursing Outlook 65/2 (2017)

242e245] Diana Taylor, PhD, RNP, FAAN*, Ellen F. Olshansky, PhD, RN, WHNP-BC, FAAN*,

Nancy Fugate Woods, PhD, RN, FAAN*, Versie Johnson-Mallard, PhD, ARNP, BC, FAANP, FAAN*,

Barbara J. Safriet, LLM, JD, FAAN*, Teresa Hagan, PhD, RN* *Women’s Health Expert Panel

The authors regret that the printed version of the above article contained a number of errors. The correct and final version follows. The authors would like to apolo- gise for any inconvenience caused.

Political interference in sexual and reproductive health research and health professional education threatens the health of women and men. The Amer- ican Academy of Nursing strongly supports actions to prevent political interference by supporting academic freedom principles and policies in institutions of higher education generally, and in those offering in- struction in nursing particularly.

Background

TheAmericanAcademy ofNursing (Academy) has raised the voice of nursing in support of policies that ensure people’s access to sexual and reproductive health (SRH) services. Specific policies focus on the expansion of SRH clinical knowledge and evidence-based women’s pre- ventive health services (Berg, Taylor, Woods, 2013) related to preventing unintended pregnancies (Berg, Olshansky et al, 2012) in order to assure that all women’s health care, including abortion care, is groun- ded in scientific knowledge and evidence-based policies and standards of care (Berg, Shaver et al, 2013).

Unfortunately, politicians across the country are pushing for laws and regulations that restrict ethical standards of care and impose politics and ideology on evidence-based clinical care as outlined by the recent

0029-6554/$ – see front matter � 2017 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.outlook.2017.05.003

policy report (National Partnership for Women & Families, 2015) lead by a coalition of 24 nursing, med- ical, health and advocacy organizations (Coalition to Protect). The Academy has responded to these threats of political interference with the patient-provider relationship, ethical and evidence-based standards of care, and women’s access to safe, quality sexual and reproductive health care, by:

� Participating in an Amicus Brief to the US Supreme Court opposing a deceptive Texas law requiring medically unnecessary restrictions on clinical prac- tice: Read the Amicus Brief of the American Nurses Association (ANA)/Academy and the Academy’s press release from June 2016 applauding the SCOTUS decision to reject Texas HB2 (National Physicians Alliance, American Academy of Nursing et al, 2016; American Academy of Nursing, 2016).

� Speaking out about howpolitical interferencewith SRH care harms women: See article from the Academy’s President Berkowitz, “Examining What’s at Stake: The Supreme Court, Nurses and Abortion Care Provision” pub- lished in Huffington Post Health (Berkowitz, 2016) and quotes from health professionals on political interfer- ence in clinical practice.

� Opposing political interference in the Title X Family Planning Program and fully supported (with testi- mony) proposed DHHS rules strengthening regula- tions that align Title X requirements with established Medicaid/Medicare criteria for qualified providers based on professional and facility scope of practice and licensing (Federal Register, 2016).

i A Committee on Academic Freedom and Academic Tenure of the American Association of University Professors (AAUP) formu- lated a statement of principles on academic freedom and academic tenure known as the 1915 Declaration of Principles, was officially endorsed by the Association at its Second Annual Meeting held in Washington, D.C., December 31, 1915, and January 1, 1916. In 1925, the American Council on Education called a conference of repre- sentatives of a number of its constituent members, among them the American Association of University Professors, for formulating a shorter statement of principles on academic freedom and tenure. The Association of American Colleges (now the Association of American Colleges and Universities) endorsed the statement formulated at this conference, known as the 1925 Conference Statement on Academic Freedom and Tenure, in 1925 and by the American Association of University Professors in 1926. Further in- terpretations, adopted as footnotes to this statement by the Council of the American Association of University Professors in April 1970, asserted, “Academic freedom is essential to these purposes and applies to both teaching and research”. Freedom in research is fundamental to the advancement of truth. Academic freedom in its teaching aspect is fundamental for the protection of the rights of the teacher in teaching and of the student to freedom in learning.

Nur s Ou t l o o k 6 5 ( 2 0 1 7 ) 3 4 6e 3 5 0 347

Now the Academy is focused on another threatdpolitical interference with academic freedom, particularly SRH research and health professional education

A case in Missouri highlights the most egregious political interference in academic freedom that threatens science, clinical training, and research. In September 2015, under pressure from Missouri politicians, the University of Mis- souri (Wilson, 2015) canceled ten contracts with Planned Parenthood eliminating clinical training for nursing and medical students in comprehensive SRH services inclu- ding long-acting contraception methods and early abor- tion care. The University of Missouri thereafter ended admitting privileges for an OB-Gyn faculty member and a Planned Parenthood physician and attempted to stop a University of Missouri graduate student from continuing her dissertation research on the impact of a 72-hour waiting period on women considering abortions (Wilson, 2015; Kingkade, 2015). In response to this abuse of power and threat to academic freedom, individuals from the Academy’s Women’s Health Expert Panel published a response in the Huffington Post on November 13, 2015.Since this posting, growing national attention has brought issues regarding political interference in aca- demic freedom to the forefront of the national conversa- tion on SRH health care research, practice and the education of the next generation of health care providers.

In response to these threats, the Academy Board of Directors approved the development and affirmation of a position statement on Political Interference in SRH Research andHealth Professional Education that follows.

Position Statement: Political Interference in Sexual and Reproductive Health (SRH) Research and Health Professional Education

Prevention of Political Interference Specific to SRH Research and Education The American Academy of Nursing opposes attempts by politicians and/or academic administrators to regulate instruction and research related to sexual and reproductive health based on ideology rather than principles of academic freedom and practice or edu- cation standards related to sexual and reproductive health. Specifically, the American Academy of Nursing:

� Opposes political interference in evidence-based sexual and reproductive health care, education and research;

� Opposes the harassment and censorship of students and their faculty advisors who seek to understand and study the impact of legislation and policies on individual and community health outcomes related to restriction of reproductive choice or SRH services;

� Supports university faculty and students’ freedom to 1) discuss issues of sexual and reproductive health and abortion in the classroom, and 2) provide in- struction in clinical sites that provide a full range of sexual and reproductive health services;

� Supports faculty and students’ freedom to engage in scholarship and research activities related to sexual and reproductive health, including abortion; and

� Supports faculty and students’ freedom from re- striction in pursuit of education and clinical training related to all evidence-based unintended pregnancy prevention and sexual and reproductive healthcare.

The American Academy of Nursing supports the principles and practices of academic freedom in gen- eral, and specifically, as they apply to sexual and reproductive health research and health professional education including:

� Supporting the definition of academic freedom as a university’s fundamental commitment that allmembers of an academic community have the broadest possible latitude to speak, write, listen, challenge and learn.

� Affirming that the intent of academic freedom to afford members of the academic community the broadest possible scope of unencumbered expres- sion, investigation, analysis and discourse. Most ac- ademic institutions and faculty organizations have put into practice the individual and institutional re- sponsibilities and rights to academic freedom to ensure that faculty and students will not experience political interference in research and education.

� Recognizing that academic freedom applies to the individuals and institutions through professional and legal principles, policies, opinions and laws developed by the American Association of University Professors (AAUP) and the American Association of Colleges and Universitiesi and endorsed by over 200 scholarly and professional organizations. In addition to the professional standard of academic freedom, there is a substantial body of law that shapes faculty and institutional claims to academic freedom.

� Supporting principles and policies arising from the 1940 AAUP Statement and case law focused on faculty freedom from external (political) intrusion and institu- tional intrusion. The following fundamental academic freedom principles and policies are incorporated into hundreds of college and university faculty handbooks

Nur s Out l o o k 6 5 ( 2 0 1 7 ) 3 4 6e 3 5 0348

(exemplars from public universitiesdUniversity of Washingtonii, University of Californiaiii, University of Michiganiv; and a private universityvdUniversity of

ii University of Washington Faculty Code, Section 24-33, “A State- ment of Principle: Academic Freedom and Responsibility” Approved by: Senate Executive Committee October 7, 2013; Faculty Senate October 24, 2013; Senate Executive Committee November 18, 2013; Faculty Senate December 5, 2013; Certified by Jack Lee, Chair, Faculty Senate 1/9/2014; President Michael Young January 8, 2014. The University of Washington Faculty Code (UW Code) is an exemplar for enacting academic freedom principles. The UW Code empha- sizes that the academic community e students, faculty members, administrators, and trusteesdis obligated “to respect the dignity of others, to acknowledge their right to express differing opinions, and to foster and defend intellectual honesty, freedom of inquiry and instruction, and free expression on and off the campus.” Expression of dissent and attempts to produce change may not be enacted in ways that “injure individuals and damage institutional facilities or disrupt the classes of one’s instructors or colleagues”. Further, campus speakers must be protected from violence and given an opportunity to speak. Those seeking to call attention to grievances may not significantly impede the university’s functions. The UW Code stipulates that faculty’s exercise of constitutionally protected freedom of association, assembly, and expression, including participation in political activities, does not constitute a violation of duties to the University, to their profession, or to students and may not result in disciplinary action or adverse merit evaluation. In addition to defining the right to academic freedom, the University of Washington stipulates faculty responsibilities, including re- sponsibility to “present the subject matter of their courses as approved by the faculty in their collective responsibility for the curriculum. Within the approved curriculum, faculty members are free to express ideas and teach as they see fit based on their mastery of their subjects and their own scholarship. In addition, the UW Code stipulates institutional responsibilities to academic freedom; that both faculty and students be entitled to “an atmosphere conducive to learning and to evenhanded treatment in all aspects of the instructor-student relationship.” Faculty members have obliga- tions to respect the freedoms of students, meaning that faculty may not refuse to enroll or teach students because of the student’s beliefs or the possible applications that students may make of knowledge gained in a course. In addition, the code asserts that students will not be forced by the authority of the faculty to make particular po- litical choices or their roles in society. Further, evaluation of stu- dents and the award of credit must be based on their academic performance judged professionally and not on matters such as” personality, sexual orientation, or sexual, romantic, familial, or other personal relationships.” iii University of California, Academic Personnel Manual 010.

General University Policy Regarding Academic Appointees: Aca- demic Freedom. APM e 010. Accessed 08/21/16. iv University of Michigan Faculty Handbook 1.C. Senate Assem-

bly Statement on Academic Freedom (www.provost.umich.edu/ faculty/handbook 1/1.C.html accessed 8.21.2016.

v Although most universities today accept the principles of aca- demic freedom, tensions exist between individual and institutional academic freedom under the First Amendment that challenge the professions, the AAUP, colleges and universities and courts. Clearly, the scope of institutional academic freedom between private (especially religiously affiliated) and public sector institutions has tested individual faculty and student freedoms and the four essential freedoms of a universityeto determine for itself on aca- demic grounds whomay teach, what may be taught, how it shall be taught, and who may be admitted to study. [see University of Chicago reference to Freedom of Expression policy, 2015].

Chicagovi) and form the basis for preventing political interference in SRH research and education. B Debate and deliberation may not be suppressed because the ideas put forth are thought by some, or even most, members of the academic community to be offensive, unwise, immoral, or wrong- headed.

B Individual members of the university community, not the university as an institution, will make judgments and act on those judgments not by seeking to suppress speech, but by openly and vigorously contesting the ideas that they oppose.

B Fostering the ability of members of the university community to engage in debate and deliberation in an effective and responsiblemanner is an essential part of a university’s educational mission.

B Freedom to debate and discuss the merits of competing ideas does not mean that individuals may saywhatever theywish,wherever theywish.A university may restrict expression that violates the law, falsely defames a specific individual, consti- tutes a genuine threat or harassment, unjustifiably invades substantial privacy or confidentiality in- terests or is otherwise directly incompatible with the functioning of the university.

B The University may reasonably regulate the time, place, andmanner of expression to ensure that it does not disrupt the ordinary activities of the university. These legitimate, but narrow, exceptions to the well- established general principle of freedom of expres- sion must never be used as a pretense for eroding or obstructing free and open discussion of ideas.

The American Academy of Nursing calls for:

1) Professional organizations in nursing and other health care professions as well as organizations of academic communitiesvii to join in affirming the Statement on Political Interference in Sexual and Reproductive Health (SRH) Research and Health Professional Education,

2) The extension of the Academy’s position statement to bring attention to political interference in evidence-based SRH research and health profes- sional education,

3) The publication of academic freedom principles and practice guidelines specific to SRH research and education using exemplary academic freedom codes from public and private colleges and universities.

vi University of Chicago Freedom of Expression Committee, 2015. Accessed 091516 at http://provost.uchicago.edu/sites/ default/files/documents/reports/FOECommitteeReport.pdf. vii Partial list of the relevant organizations for the Academy to work with on endorsing this statement: National League for Nursing, American Association of Colleges of Nursing, American Association of University Professors, American Association of University Women, Association of Reproductive Health Pro- fessionals, National Partnership for Women and Families, Na- tional Women’s Law Center.

Nur s Ou t l o o k 6 5 ( 2 0 1 7 ) 3 4 6e 3 5 0 349

Acknowledgement

The authors acknowledge the assistance provided by members of the Women’s Health Expert Panel (espe- cially Marcia Killien and Judith Berg), Kim Czubaruk, Esq., Policy Manager and Academy Staff Liaison to the Women’s Health Expert Panel and Sarah Lipton-Lubet, JD of the National Partnership for Women & Families.

r e f e r e n c e s

1940 Statement of Principles on Academic Freedom and Tenure, American Association of University Professors and of the Association of American Colleges.

American Academy of Nursing. (2015). Press release: American Academy of Nursing applauds U.S. Supreme Court decision on Texas abortion access law. 6/27/2016. Retrieved from https:// higherlogicdownload.s3.amazonaws.com/AANNET/c8a8da9e- 918c-4dae-b0c6-6d630c46007f/UploadedImages/docs/Press% 20Releases/2016/2016-06-27_Supreme%20Court%20Decision% 20TX%20Abortion%20Access%20Law.pdf

American Association of University Professors, Academic Freedom Principles and Regulations. Retrieved from https:// www.aaup.org/report/recommended-institutional- regulations-academic-freedom-and-tenure

Barry, D., Friedman, A. D., & Lipton-Lubet, S. (2015). Changing the conversation on abortion restrictions: A proactive response to political interference in healthcare. Washington DC: National Partnership for Women and Families. Retrieved from http:// www.nationalpartnership.org/research-library/changing-the- conversation-a-proactive-response-to-political-interference- in-health-care.pdf

Berg, J. A., Olshansky, E., Shaver, J., Taylor, D., & Woods, N. F. (2012). Women’s health in jeopardy: Failure to curb unintended pregnancies: A statement of the women’s health expert panel. Nursing Outlook, 60, 163e164.

Berg, J. A., Taylor, D., & Woods, N. F. (2013). Where we are today: Prioritizing women’s health services and health policy. A report by the Women’s Health Expert Panel of the American Academy of Nursing. Nursing Outlook, 61(1), 5e15.

Berg, J. A., Shaver, J., Olshansky, E., Woods, N. F., & Taylor, D. (2013). A call to action: Expanded research agenda for women’s health. Nursing Outlook, 61(4), 252.

Berkowitz, B. (2016). Examining what’s at stake: The supreme court, nurses and abortion care provision. The Huffington Post. Retrieved from http://www.huffingtonpost.com/bobbie- berkowitz/examining-whats-at-stake_b_9293684.html

Coalition to Protect the Provider-Patient Relationship. Retrieved from http://www.coalitiontoprotect.org/?referrer¼http:// www.coalitiontoprotect.org/

Federal Register (2016). Compliance with Title X requirements by project recipients in selecting subrecipients, DHHS Rules, 1/19/ 2016. Retrieved from https://www.federalregister.gov/ documents/2016/12/19/2016-30276/compliance-with-title-x- requirements-by-project-recipients-in-selecting-subrecipients

National Physicians Alliance, American Academy of Nursing, Center for American Progress DBA Doctors for America, American Nurses Association, Society for Adolescent Health & Medicine (2016). Brief of Amici Curiae in support of petitioners (Whole Women’s Healthcare) in the U.S. Supreme Court case No. 15e274. Retrieved from https://www.reproductiverights. org/sites/crr.civicactions.net/files/documents/National% 20Physicians%20Alliance%20Skadden.pdf

Euben DR (2002). Academic freedom of professors and American Association of University Professors. Retrieved from https:// www.aaup.org/issues/academic-freedom/professors-and- institutions

Johns Hopkins University, Academic freedom at Johns Hopkins. Web.jhu.edu-academic freedom at Johns Hopkins Statement of Principles on Academic Freedom.

Kingkade, T. (2015). Missouri lawmaker seeks to block students from studying restrictive abortion law. Huffington Post. Retrieved from http://www.huffingtonpost.com/entry/abortion-study- university-of-missouri_us_563fab2be4b0411d307168a3

National Partnership for Women and Families. (2015). Politics in the exam room: a growing threat. Washington DC: Author. Retrieved from http://www.nationalpartnership.org/research- library/repro/politics-in-the-exam-room-a-growing-threat.pdf

Taylor, D, McLemore MR, Burton, CW, Olshansky, E, Berg, J, Levi, AJ, Woods, NF & Shattell, M. Missouri shreds academic freedom. Huffington Post. Retrieved from http://www. huffingtonpost.com/mona-shattell/missouri-shreds- academic-_b_8555628.html

University of California. General University Policy Regarding Academic Appointees: The Faculty Code of Conduct. Part I e Professional Rights of Faculty. APM e 015. Accessed 08/21/ 16. The University of California (UC) statement on Academic Freedomvii emphasizes the role of academic freedom in protecting freedom of inquiry and research, freedom of teaching, and freedom of expression and publication as a basis for the university’s ability to advance knowledge and transmit it effectively to students and to the public. In the UC System, academic freedom is defined as fostering a mature independence of mind in students.

University of Chicago Freedom of Expression Committee, 2015. Retrieved from http://provost.uchicago.edu/sites/default/files/ documents/reports/FOECommitteeReport.pdf. Recognizing ‘nationwide events that have tested institutional commitments to free and open discourse,’ the University of Chicago formed The Committee on Freedom of Expression to draft principles that articulate “the University’s overarching commitment to free, robust, and uninhibited debate and deliberation among all members of the University’s community.”vii In 2015, the University of Chicago clarified its commitment to promote and protect free expression: members of the university community must act in conformity with the principle of free expression; members of the university community may contest views expressed on campus (or by invited campus guests); members of the university may not obstruct or otherwise interfere with the freedom of others to express views they reject or loathe.

University of Michigan Faculty Handbook, 1.C. Senate Assembly Statement on Academic Freedom. Retrieved from https:// www.provost.umich.edu/facultyhandbook/1/1.C.html. The University of Michigan Faculty Handbook emphasizes the influence of the normative structure of disciplines and professions as a basis for faculty practicing their scholarly profession. Michigan further asserts that academic freedom exists “independent of any external protection. as a basic prerequisite for universities to fulfill their mission,” a professional prerequisite of faculty members as a group. Michigan views academic freedom as including freedom of research and publication; freedom of teaching; freedom of internal criticism; and freedom of participation in public debate.

University of Washington Faculty Code, Section 24e33, “A Statement of Principle: Academic Freedom and Responsibility” Approved by: Senate Executive Committee October 7, 2013; Faculty Senate October 24, 2013; Senate Executive Committee November 18, 2013;

Nur s Out l o o k 6 5 ( 2 0 1 7 ) 3 4 6e 3 5 0350

Faculty Senate December 5, 2013; Certified by Jack Lee, Chair, Faculty Senate 1/9/2014; President Michael Young January 8, 2014. The University of Washington Faculty Code is extensive and specific in stipulating the responsibilities and rights of students, faculty members, administrators, and trustees related to academic freedom and the right to speak orwritewithout institutional discipline or restraint on matters of public concern and matters related to shared governance and the general welfare of the University.

Wilson, T. (2015). University of Missouri cancels Planned Parenthood contract after legislative hearings. Rewire, Sep 21, 2015. Retrieved from https://rewire.news/article/2015/09/21/university- missouri-cancels-planned-parenthood-contract-legislative- hearings/

Wilson, T. (2015). Under pressure from anti-choice lawmakers, University of Missouri ends admitting privilege. Rewire, 9/28/15. Retrieved from https://rewire.news/article/2015/09/28/ pressure-anti-choice-lawmakers-university-missouri-ends- admitting-privileges/