A Nursing Manifesto for 2030: Human Care Against Extraction and Exploitation (green paper)

August 31, 2026September 12, 2026 / renataem5f99684f1a / Leave a comment

Renata E. Mares MIPH, BScN, BA Kin

Aug 22, 2026

Please use this document in any way that you wish. You can freely use this document (with citation; see our creative commons license in the footer of this and all pages on this site) The format for citing the document is shown at the end of the table of contents. If you wish to have other ideas integrated into this document, or included on this web site, please contact us or the author directly renata@adaptablefolks.com

1.     Introduction
2.     Planetary Health is Nursing Work
3.     Commercial Determinants of Harms and Health: Get Political
4.     Nursing Is Not a Buffer for System Failure
5.     Against the Medical-Industrial Complex
6.     Our Commitment
7.     A Call to Conscience and Action
8.     About the Author
9. Reference list (see image)

Citation: Mares, R. E. (2026). A Nursing Manifesto for 2030: Human Care Against Extraction and Exploitation (green paper). https://nursemanifest.com/2026/08/31/a-nursing-manifesto-for-2030-human-care-against-extraction-and-exploitation-green-paper/

Foreword

I came across this incredible blog post about A Nursing Manifesto 2000 written by three incredible nurses and academics: Richard Cowling, Peggy Chinn, Sue Hagedorn in 2000 and I thought to develop a parallel manifesto which brings together some of the books I have been reading over the past 5 years post-pandemic and some which reaches further back to the 80s 90s, 2000s, till present time.

The world have shifted quite a bit since this manifesto was developed and shared. In and of itself, it reads like something to aspire to. Maybe when I started my nursing career as a new graduate back in 2008, it would have been something to aspire to in my own work, career, research and teaching. But now I find some pretty troubling things not only missing from this manifesto as historical accounts, including the troublesome origins of the nursing and medical profession / culture, but it needs to be updated for the year 2030 and beyond.

But first, take some time to read and get familiar with A Nursing Manifesto 2000: https://nursemanifest.com/a-nursing-manifesto-a-call-to-conscience-and-action/

Below is the introduction to A Nursing Manifesto: A Call to Conscience and Action written in 2000. I am sharing here just the initial Introduction, but please do have a read of the entire manifesto as it discusses the ideals and principles, inspiration, concerns, vision and suggestions for actions. It also describes the authors and their positionality and about the art contained within this blog.

A Nursing Manifesto: A Call to Conscience and Action (2000)

by Richard Cowling, Peggy Chinn, Sue Hagedorn

Introduction (excerpt)

“As nurses, we reach for meaningful expressions of our values, too often finding overwhelming constraint and resistance, sometimes within ourselves and sometimes imposed from without. We are calling for a movement to awaken those precious and powerful ideals that are rooted in nursing’s worldwide historical traditions. We call forth the written and spoken voice of nursing to be claimed and reclaimed. We seek to inspire the fullest expression of the heart of nursing through individual and collective acts. We believe there are profound possibilities in claiming our individual and professional sovereignty” … link to full manifesto here: https://nursemanifest.com/a-nursing-manifesto-a-call-to-conscience-and-action/#intro

My initial thoughts on this this first paragraph would be:

Awakening the so called ‘precious and powerful ideals’ is definitely a good thing, but how does nursing as a profession and value-based career wrestle with the monolith it has created the lack of diversity over the course of centuries
Rooted in nursing’s worldwide historical traditions: would these discuss how Nightingale-like nursing is rooted in supporting war and military efforts? Would these traditions address the issues of explicitly racism, sexism, and harmful medical cultural administrative practice over the course of the centuries? Our current professional associations are build as empires where lack of diverse leadership opportunities persist and patriarchal hierarchies are celebrated as excellence.
Attrition in nursing and healthcare is at crisis levels, yet no one talks explicitly about trauma and cPTSD experienced not from patients, toxic teams, but administrative and regulatory practices. Anyone care to elaborate here?

As I was reading this incredible manifesto and remembering back to the year 2000, I started to draw both parallels and the need to advance these exact thoughts to the years 2030 and beyond. At first I had the idea of taking each section and paragraph and write my thoughts in support and opposition. But then I thought, why not take all that I have read and know and develop something totally new yet complementary. Building upon my elders’ work.

Believe it or not, I have a fear of writing my own voice and ideas down. I don’t want to hurt feelings and I do get intimidated by folks who are much more qualified than myself, and therefore, I have the feeling that maybe I should not share what I have to say. I am now slowly building back my lost confidence and also recognizing that part of nuanced and critical thinking is (sometimes) getting things wrong, and sometimes right but too soon. So, I want to share both what I might be thinking that is wrong and also my worries about the nursing profession that I love so much. After nearly 20 years in this profession across specialties like orthopedic/trauma, medical/surgical units, mental health, public and community health, policy and education, I feel that I did my authentic best in trying to build the new and not getting lost in the challenges of the past. However, burnout happens to all of us, some more resilient than others. I am accepting that I might have pushed too hard for change and lacked the skills of relationship building. My past of being a refugee and immigrant female child who grew up in post-Communist Romania and Hungary could add to some of these reasons. The urgency to alleviate struggles for others was a real cause and drive for me. I never understood how a bunch of smart people could just sit around the table and talk about action, while people were struggling. Access to healthcare is access to people’s tax dollars. Talking was seemingly a waste of time from my perspective, as an early career public health nurse. I was searching to find people who felt the same urgency (or at least understood my motivations) as I did to act and help get folks out of poverty, get access to health and social services, and not just talk about it in meetings.

I may have been naïve and rushed. I was give the privilege of a profession to do good and alleviate harms. However, without trusted relationships, money doesn’t flow and people remain in poverty, in struggles that are the result of structures and systems I wanted to adapt. Some lessons we learn the hard way. I am now re-learning to build the confidence to talk, share ideas, and build relationship among people who are looking to advance the only huma-centered profession still remains. (I might be biased in this view) Is the last human job a nurse? Or so I assume in this manifesto. Or maybe the last human jobs are human-collaborations across sectors. Yes, that sounds more like it. But first we need to pivot (yes, just like that couch on a Friends episode from Feb 1999) and pay those human-collaboration jobs a fair wage.

Therefore, I am using my LinkedIn platform to share my ideas of A Nursing Manifesto for 2030: Human Care Against Extraction and Exploitation – a draft (2026) paralleling what has been written in 2000 and adding in some of my ideas from the list of resources that I will share at the very end of this writing. It might give future nurses in undergraduate and graduate studies something to ponder beyond the status quo of the nursing/ healthcare profession and education. We need to get out of ‘our’ status quo cultural box.

As always, I am open to discussions and opposing views that are shared respectfully.

1. INTRODUCTION

‘We’ are nurses (diverse with complex/ adaptive skills professionals) at a time when care is being remade by machines, markets, and systems that measure human worth in data points, risk scores, productivity targets, and billing codes.

We do not reject technology.

We reject technology without accountability.

Artificial intelligence, automation, surveillance, and predictive systems have entered hospitals, homes, clinics, long-term care, and public health. They promise efficiency while too often deepening abandonment. They sort people by profitability, automate denials, intensify workloads, erase human judgment, and place the burdens of flawed systems on those already made vulnerable by racism, colonialism, poverty, disability, gender oppression, and displacement.

We have seen what happens when an algorithm is treated as neutral while it inherits the inequities of the world that trained it. We have seen staffing systems call exhaustion as ‘optimization’. We have seen virtual care become a substitute for accessible, relational care. We have seen automation used not to relieve nurses of harmful labour, but to eliminate jobs, deskill practice, and demand that fewer workers do more with less.

This is not innovation.

It is extraction.

We are nurses practicing amid converging emergencies: widening inequality, climate breakdown, poisoned water, forced displacement, worsening chronic illness, automated exclusion, and healthcare systems increasingly governed by commercial interests rather than public need.

We affirm that health is inseparable from the conditions in which people are born, grow, work, live, age, and die. Health begins with breathable air, safe homes, nourishing food, clean water, meaningful connection, cultural continuity, freedom from violence, and a stable living planet. No hospital, algorithm, drug, or procedure can compensate for a society that systematically destroys these foundations.

The medical-industrial complex has transformed illness into revenue, crisis into market opportunity, and health into a commodity distributed according to wealth, insurance status, postal code, citizenship, and institutional power. It profits from endless treatment while neglecting clean air, safe housing, food security, living wages, disability justice, mental health, reproductive freedom, and the conditions that allow people to live well before they become patients.

We reject the fiction that health care exists apart from the world. The same systems that commodify illness extract from workers, communities, lands, and waters. The medical-industrial complex profits from treatment while underinvesting in prevention; corporations profit from pollution while public systems absorb the resulting disease; technology firms market “innovation” while shifting social, environmental, and clinical risks onto patients, caregivers, and frontline workers.

This is not an accident. It is a political choice.

We refuse to accept a healthcare system that calls itself advanced while people wait in pain, workers burn out and become patients themselves (Chapman, 2023), communities are poisoned, and the planet warms. (Check out the underlying drivers of planetary harms by Planetary Health Alliance website: culture, values, behaviour, consumption, population size/demographic changes, technology) https://planetaryhealthalliance.org/what-is-planetary-health/

Nursing must be more than the human face placed on an inhumane system. Our role is not to make austerity appear compassionate, to absorb the moral injury created by unsafe conditions, or to quietly compensate for decisions made by executives, insurers, technology firms, regulators and governments far from the bedside.

Our ethical obligation is to care and to confront what makes care impossible.

2. Planetary Health is Nursing Work

Planetary health is not an optional specialty or a future concern. It is present in every heat-related illness, asthma exacerbation, contaminated water supply, food insecurity assessment, infectious-disease outbreak, wildfire evacuation, pregnancy complication, mental-health crisis, and preventable death.

We recognize the health of people as inseparable from the health of lands, waters, ecosystems, and climate. Indigenous peoples have long carried knowledge of these relationships and of stewardship, reciprocity, and collective responsibility. Nursing must listen, learn, and act without appropriating that knowledge or repeating colonial systems of control.

We will advocate for health systems that reduce rather than export harm: low-carbon care, ethical procurement, less waste, resilient infrastructure, safe transportation, sustainable food systems, and emergency planning led with (not imposed upon) affected communities.

Clean water is a health right, not a commercial asset. Water insecurity, contamination, privatization, boil-water advisories, drought, flooding, and inadequate sanitation are nursing concerns because they produce infection, chronic disease, reproductive harm, trauma, displacement, and death. We will name water injustice as a clinical and public-health emergency, especially where it follows colonial dispossession, industrial pollution, and neglect of rural, remote, and Indigenous communities.

3. Commercial Determinants of Harm and Health: Get Political

We confront the commercial determinants of health: the corporate practices that shape exposure to harm, access to care, public policy, and the very definition of health.

Industries profit when people consume products that damage their bodies or environment, including tobacco and nicotine corporations, alcohol producers, ultra-processed food companies, fossil-fuel industries, extractive mining interests, pharmaceutical monopolies, private equity firms, surveillance platforms, and vendors of unaccountable health technology, and digital-addictive designs and digital-afterlife industries. Their influence reaches advertising, research, regulation, education, political lobbying, clinical guidelines, and data infrastructure.

We reject the normalization of harm as “consumer choice” when choices are engineered through marketing, pricing, scarcity, misinformation, racism, design inequity and unequal power.

We also recognize that commercial power can shape health positively only when it is democratically governed, transparent, and subordinated to the public good. Products, technologies, and services must be assessed not simply by revenue or technical novelty, but by their effects on equity, ecological sustainability, worker safety, community control, and long-term health. (my favourite slogan: war brings neither peace nor climate justice, defund military spending).

4. Nursing Is Not a Buffer for System Failure

Nursing is not low-paid emotional labour designed to absorb the failures of health and social systems. It is not a flexible reserve workforce to be stretched during crises, disciplined through precarity, or replaced by automation when budgets demand it.

Nursing knowledge is scientific, relational, ethical, political, and ecological. Nurses assess changing conditions, interpret uncertainty, build trust, notice patterns others miss, coordinate care across fragmented systems, protect rights, respond to suffering, and advocate for structural change. This expertise cannot be reduced to tasks, scripts, dashboards, or a layer of “human oversight” added after an algorithm has already shaped a person’s options.

We reject the use of artificial intelligence and automation to intensify work, monitor workers, remove professional judgment, automate benefit or treatment denials, or redirect accountability away from corporations and institutions. A nurse must never be expected to legitimize a harmful system simply because a person remains nominally “in the loop.”

Technology must serve care, not govern it. Any system used in health care must be transparent, independently audited, accessible, privacy-protective, environmentally accountable, and open to challenge by patients, families, nurses, and communities. It must be assessed for bias, labour impacts, energy and water use, supply-chain harms, and effects on access, not only for accuracy or cost savings.

5. Against the Medical-Industrial Complex

The medical-industrial complex converts suffering into revenue. It treats health as a market, patients as customers, records as assets, and workers as costs to be minimized. It normalizes private equity, monopolies, predatory pricing, medical debt, pharmaceutical profiteering, commercialization of data, and the outsourcing of public responsibilities to corporations.

We refuse a health system that boasts of technological progress while people cannot obtain primary care, medication, safe housing, home care, reproductive services, mental-health support, palliative care, or culturally safe care.

We oppose austerity disguised as efficiency. We oppose privatization disguised as innovation. We oppose surveillance disguised as safety. We oppose extraction disguised as care.

A just health system must be universal, public, adequately funded, community-rooted, culturally safe, accessible, and accountable to the people it serves. It must invest upstream: in income security, public housing, education, food sovereignty, disability justice, harm reduction, clean water, healthy ecosystems, and meaningful public-health capacity.

6. Our Commitment

We therefore commit ourselves to:

Defend human dignity over speed, profit, automation, and institutional convenience.
Defend health as a collective right and reject its treatment as a commodity.
Identify and confront commercial practices that produce illness, environmental destruction, inequity, and barriers to care.
Follow the leadership of communities most affected by environmental injustice, commercial exploitation, and institutional neglect.
Insist that every artificial intelligence system used in health care be transparent, independently audited, explainable, contestable, and governed with meaningful public and worker participation.
Refuse algorithms that reproduce discrimination or replace clinical judgment, informed consent, and relationships of trust. Stand against racism, colonialism, ableism, sexism, homophobia, transphobia, class exploitation, and xenophobia in health systems and society.
Demand that technology reduce harmful work and expand access to care, not intensify surveillance, cut staffing, deskill nursing, or deny services. My post on nursing profession and branding https://www.linkedin.com/feed/update/urn:li:activity:7496682545108025345/
Organize for safe staffing, fair wages (like programmers and coders once were paid), public health infrastructure, union rights, and workplaces where nurses can speak honestly without retaliation (regulatory harms have still not been addressed explicitly and attrition continues to crisis levels). My post on trauma: https://www.linkedin.com/feed/update/urn:li:activity:7496346149822287873/ ; my post on regulatory harms https://www.linkedin.com/feed/update/urn:li:activity:7496353936921071616/
Treat climate disruption as a health emergency created by unequal systems of extraction, and advocate for care that protects communities and the living world.
Stand with patients and communities against medical debt, privatization (yes Canada, you too), predatory pharmaceutical practices, corporate consolidation, and the commodification of suffering (CDoH, 2022). post on global power demand by 2030 https://www.linkedin.com/feed/update/urn:li:share:7255265303691997184/
Advocate for public, universal health systems free from corporate capture and private-profit priorities.
Center the knowledge and leadership of Indigenous peoples, Black communities, disabled people, migrants, low-income communities, and all those harmed first and worst by unequal systems. (Can we please collect wealth tax, and stat? Harrington, 2025)
Protect the right of every person to understand, question, and refuse the technologies affecting their body, records, treatment, and future. (Once people lose mental capacity, at any age, what happens to their digital footprint and logins. Read up on digital-afterlife industry) my post: https://www.linkedin.com/feed/update/urn:li:activity:7496323674120048640/
Practice solidarity across professions, sectors, and borders, because no individual nurse can solve harms produced by structural power.
Protect clean water, sanitation, healthy ecosystems, and climate stability as indispensable conditions of health.
Treat nursing expertise as essential to governance, policy, technology design, climate adaptation, public health, and community-led care, not as inexpensive labour or an afterthought in executive decisions.
Build care systems based on solidarity, reciprocity, prevention, justice, and ecological repair.

7. A Call to Conscience and Action

In 2030, conscience requires more than compassion.

It requires courage. Not only to speak for/with patients, families and communities, but to speak against professional toxic culture, leadership, and stagnant professional envelopment. It requires collective action against the systems that manufacture illness and call the consequences unavoidable.

It requires us to ask not only, “Can this technology be used?” but “Who does it serve? Who exposed to/ bears its risks? Who profits? What forms of care, labour, and life does it displace?” Who is left waiting, excluded, displaced, or silenced?

I have held a role as a nurse informatics, merging duplicate files because IBM refused to adapt their infrastructure. Are informatics professionals seen as human-in-the-loop or human-exploited-in-the-loop?

It requires us to understand that a healthy society cannot be built on exhausted workers, disposable patients, automated exclusion, or a damaged planet. We CAN however, pivot workforce roles and pay people to do human jobs, like witnessing and delivering care where it’s needed. (Pugh, 2026)

Care cannot be ethical if it relies on ecological destruction. Innovation cannot be just if it is built on surveillance, dispossession, or underpaid labour. Health cannot exist where water is unsafe, homes are unaffordable, ecosystems are collapsing, and human needs are subordinated to corporate return.

We will not be reduced to exhausted labour, automated compliance, or human cover for decisions made by machines and markets.

We call on nurses to reclaim our collective (yet, diverse) voice. We call on health workers to organize. We call on institutions to place care above revenue (wealth tax helps here). We call on governments to regulate health technologies in the public interest and to fund universal, accessible, community-rooted health care.

We call on the public to reject a future in which the right to health is determined by an algorithm or a balance sheet.

Care is not a product. Health is not a privilege. People are not (just) data to be extracted and sold.

The planet is not expendable.

We will not be silent witnesses to systems that harm in the name of progress.

We will practice, organize, resist, and build a future in which care remains human, collective, just, and sustainable.

We are nurses. We are advocates, clinicians, educators, organizers, researchers, knowledge holders, and defenders of the conditions required for life.

We will care for people and we will fight for the world in which people can be well.

8. About the Author

The Nursing Manifesto 2030 builds upon and expands The Nursing Manifesto 2000, the pioneering work of Richard Cowling, Sue Hagedorn, and Peggy Chinn. In the age of AI, provenance is one of the most important forms of acknowledgement, demonstrating that ideas and thoughts never simply appear, but are cultivated, grazed, turned over, and digested with time, patience, and communal support. The original authors all came from white, middle-class backgrounds and grew up in diverse regions of the United States (New York, Hawaii, Virginia), with relatively privileged access to education, travel, and cultural experiences. Yet early in their lives, each followed personal and political paths that challenged the status quo, often to the chagrin of family and friends. Though not always overtly “political” on the surface, their journeys reflected a deep yearning for peace, justice, and the caring, nurturing values they perceived to be at the heart of nursing. They came together to prepare the text for A Nursing Manifesto 2000, informed by their shared awareness of the deeply political nature of personal choices.

Renata E. Mares, author of The Nursing Manifesto 2030: Human Care Against Extraction and Exploitation (green paper), brings both continuity and distinct difference to this legacy. Born in 1984 in Oradea, Romania, a region marked by Hungarian legacies and Romanian cultural tensions since the 1920s (Treaty of Trianon), she became a refugee at age four when her family fled the communist regime in 1988. She grew up in post-communist Hungary (schooling) and Romania (summer vacations), experiences that shaped her social justice and ethical compass, and led her to challenge oppressive and racist systems throughout her nursing career. Her father and brother spend fiver years (1990-95) in Rochester, New York in hopes for her mother and herself to follow but at that time families could not easily join. Her family immigrated to Guelph, Ontario, Canada in 1996 and has called this place home even across her decades of travel and nursing. Since nursing school in Canada (2003–2008) and continuing through diverse roles in ortho-trauma, med-surg, rehabilitation, mental health, long-term care, public health, outbreak management, policy consulting, education, and global humanitarian work (2009–2019), she has consistently challenged the status quo, even when it meant alienating friends, colleagues, and family. Today, she firmly believes nursing remains the most human-centered profession, uniquely positioned to challenge profiteering practices, build regulatory and safety guardrails through healthy public policy, and resist automation of human-care work. Grateful to the original manifesto authors for helping her articulate the political nature of her own choices, she writes in hopes that reflection, awareness, and philosophy will offer others the same healing she has found through two decades of honest practice in nursing and across the health system.

9. References

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Alison Pugh. The Last Human Job. 2026. https://press.princeton.edu/books/hardcover/9780691240817/the-last-human-job?srsltid=AfmBOoq_JMH6DnzyIEP2cMrGLQaAsBUtcxJWMy439dXRkiXxKJRId0CX.

Arthur Allen. Vaccine: The Controversial Story Of Medicines Greatest Lifesaver. WW Norton, 2008.

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Bartlett, Cheryl, Murdena Marshall, and Albert Marshall. “Two-Eyed Seeing and Other Lessons Learned within a Co-Learning Journey of Bringing Together Indigenous and Mainstream Knowledges and Ways of Knowing.” Journal of Environmental Studies and Sciences 2, no. 4 (2012): 331–40. https://doi.org/10.1007/s13412-012-0086-8.

Bessel van der Kolk. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Penguin Books Canada Limited, 2015.

Brian Evergreen. Autonomous Transformation: Creating a More Human Future in the Era of Artificial Intelligence. 2023. https://www.amazon.ca/Autonomous-Transformation-Creating-Artificial-Intelligence/dp/1119985293.

Brooke Harrington. Offshore: Stealth Wealth and the New Colonialism. 2025. https://www.penguinrandomhouse.ca/books/773970/offshore-by-brooke-harrington/9781324110323.

Cory Doctorow. The Reverse Centaur’s Guide to Life After AI. 2026. https://www.versobooks.com/en-ca/products/3584-the-reverse-centaur-s-guide-to-life-after-ai.

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Richard Cowling, Peggy Chinn, and Sue Hagedorn. “A Nursing Manifesto: A Call to Conscience and Action.” NurseManifest, 2000. https://nursemanifest.com/a-nursing-manifesto-a-call-to-conscience-and-action/.

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Robin Wall Kimmerer. Braiding Sweetgrass: Indigenous Wisdom, Scientific Knowledge and the Teachings of Plants. 2015. https://www.amazon.ca/Braiding-Sweetgrass-Indigenous-Scientific-Knowledge/dp/1571313567.

Shoshana Zuboff. The Age of Surveillance Capitalism. 2019. https://www.hachettebookgroup.com/titles/shoshana-zuboff/the-age-of-surveillance-capitalism/9781610395694/?lens=publicaffairs.

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Tina D. Purnat, Tim Nguyen, and Sylvie Briand, eds. Managing Infodemics in the 21st Century: Addressing New Public Health Challenges in the Information Ecosystem. Springer, 2023. http://www.ncbi.nlm.nih.gov/books/NBK609023/.

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Vanessa Machado de Oliveira. Outgrowing Modernity. 2025. https://www.penguinrandomhouse.ca/books/783178/outgrowing-modernity-by-vanessa-machado-de-oliveira/9798889842507.

“What Is Planetary Health?” Planetary Health Alliance, September 5, 2017. https://planetaryhealthalliance.org/what-is-planetary-health/.

(Potential) Rescheduling of Cannabis in the US: Policy, Process, and Patients

December 29, 2025 / drcareyclark / 3 Comments

Cannabis has been a DEA Schedule I drug since the initiation of the Controlled Substances Act (CSA) in 1970. Schedule I drugs are those classified as having a high potential for abuse and no known medical benefit. Cannabis has remained a schedule I drug despite the National Academies of Science, Engineering, and Medicines (2017) publication entitled The Health Effects of Cannabis and Cannabinoids, where NASEM concluded that there is substantial evidence for cannabis effectiveness in treating chronic pain, chemotherapy induced nausea and vomiting, and multiple sclerosis spasticity; moderate evidence around cannabis improving sleep with short term outcomes related to sleep apnea, fibromyalgia, chronic pain, and multiple sclerosis; and limited evidence around cannabis’s effectiveness with anxiety, PTSD, Tourette’s, IBS, TBI outcomes, dementia, glaucoma, and other neurodegenerative diseases.

Because cannabis has remained a Schedule I drug, research has been greatly hampered, and the NASEM (2017) report called for the development of a national cannabis research agenda focusing on clinical and observational research, health policy and health economics research, and public health and public safety research.

The NASEM report can be accessed here: https://www.ncbi.nlm.nih.gov/books/NBK423845/

Additionally, in 2003, the federal government issued a patent on cannabinoids related to the drug’s ability to help with healing from brain trauma and age-related brain changes.

There is a lot of excitement in the medical cannabis world around the potential rescheduling of cannabis related to the US president’s December 18, 2025, executive order 14370 to reschedule cannabis. However, in 2024, the U.S. Department of Justice initiated a rulemaking process to begin the rescheduling process, and President Biden issued an executive order in 2022 directing the Department of Health and Human Services and the Department of Justice to review the rescheduling of cannabis. The DHHS in 2023 recommended that cannabis be moved to Schedule III, and in May 2024, the Attorney General signed off on a proposed rule to reschedule cannabis, which was also published in the Federal Register. This can be accessed here: https://www.federalregister.gov/documents/2024/05/21/2024-11137/schedules-of-controlled-substances-rescheduling-of-marijuana

However, an administrative law hearing is needed to formalize the process, and it has been stalled over the past year due to lawsuits alleging bias and procedural misconduct in the rescheduling process. Lawsuits include those from Doctors for Drug Policy Reform that allege they were excluded from the list of 25 designated hearing participants due to supporting rescheduling, Panacea Plant Sciences has sued the federal government because small cannabis businesses have been excluded from the hearings, Attorney Matt Zorn has claimed in a law suit that collusive communications occurred between the DEA and the anti-cannabis group Smart Approaches to Marijuana (focuses on the Freedom of Information Act), and a group of pro-rescheduling entities has been granted an interlocutory appeal based on the DEA being a proponent of the proposed rule. The interlocutory appeal has indefinitely stayed the rescheduling hearing process. Essentially, all of these lawsuits are focused on the concern that the DEA has stacked the witness selection process to ensure that cannabis remains a Schedule I drug in direct opposition to the DHHS recommendation that cannabis be rescheduled to Schedule III. The DEA and the DHHS have historically had differing views of DEA/ CSA scheduling. The current 2025 executive order does not address this issue; it does not provide a defined means to bypass the existing legal process, and the CSA of 1970 does not permit a President to unilaterally reschedule a drug.

The only other approaches toward timely rescheduling of cannabis include an act of congress, which may be required to address the issues of banking concerns, research processes, and address the current conflicts between federal and state laws regarding cannabis. Additionally, Attorney General Bondi could expedite the process by bypassing the notice-and-comment process.

There is a clear need for more medical cannabis research, and moving the drug to a schedule III would bypass researchers’ requirement to have a Schedule I license and the requirement to only access cannabis from a handful of government cannabis sources that may not provide access to quality cannabis products. Rules will need to be changed, and funding for cannabis research as a national public health agenda item will be initiated, with the goal of USFDA treatments being developed. By rescheduling, the reduced stigma associated with the prohibition of the cannabis plant may help to encourage academics, pharmaceutical companies, and cannabis businesses to engage in more cannabis research. Still, again, Congress will likely need to clarify or revise previous laws. For instance, Biden’s 2022 Medical Marijuana and Cannabidiol Research Act has not led to greater cannabis research because of the lack of access to the product, high costs associated with the security of cannabis products, lack of funding sources for research, and issues with federal law prohibiting the transfer of cannabis across state lines.

Additionally, implications around what rescheduling means for cannabis producers, medical cannabis patients, and healthcare providers remain unclear. Cannabis being rescheduled does not change the federal legality of cannabis. It would still be a federally controlled substance, and currently, whether or not patients will be able to have cannabinoid therapeutics covered by insurance remains in question. While dronabinol, a synthetic THC medicine, is a Schedule III drug, it is only approved for CINV when other methods have failed, and loss of appetite and weight loss with anorexia and cachexia. It is not a first-line treatment for any health condition, although prescribing in pediatric settings appears to have increased over the years. Additionally, dronabinol may not be as therapeutically effective as whole-plant cannabis due to its lack of various cannabinoids, terpenes, and flavonoids that are found in whole-plant cannabis and may support optimal functioning of the body’s master regulator, the endocannabinoid system.

While this process of rescheduling cannabis to Schedule III comes with a great deal of uncertainty and legal concerns, it is part of the process of ending the prohibition era of cannabis and entering into an era of cannabis regulation. Ideally, the patients who could benefit from access to cannabis and cannabinoid therapeutics are always at the forefront of benefits in the political process. Patients’ access to safe, tested, effective cannabinoid therapeutics remains a social justice issue, a research priority, and an advocacy concern for nurses. Nurses are ethically obligated to support patients’ autonomous right to access cannabinoids and to ensure that beneficence and nonmaleficence are upheld.

Resources

National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on the Health Effects of Marijuana. (2017). An evidence review and research agenda. The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research.National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK423845/

https://alaskapublic.org/news/economy/2025-12-26/marijuana-rescheduling-would-bring-some-immediate-changes-but-others-will-take-time

https://mjbizdaily.com/news/great-leaps-in-cannabis-research-expected-after-marijuana-rescheduling/613762/

https://www.nbcnews.com/health/health-news/medical-marijuana-research-open-floodgates-cannabis-reclassification-rcna249811

Nurses’ Letter of Declaration Against the Russian War in Ukraine

March 11, 2022March 11, 2022 / Peggy L Chinn / 6 Comments

Contributors: Marsha Fowler,
Deborah Kenny & Elizabeth Peter

Introduction

Soon after Russia invaded Ukraine, it became apparent that immediate action is needed, as innocent lives continue to be lost. We nurses are in a perfect position to do so. Nurses have a large, trusted, and strong voice to advocate for the Ukrainian people and issue a call to action for legislators to put an end to these amoral acts. Sometimes during war, civilian collateral damage is unfortunate and inevitable, but Russia’s targeting of healthcare facilities, churches, schools, and other non-military objectives clearly represents war crimes. To assist all nurses in this advocacy, Dr. Marsha Fowler (US) crafted the attached letter with further input from Dr. Deborah Kenny (US).

Please download and distribute widely the attached letter via your professional social networks and organizational channels. Send to your state Congressional representatives or other leaders representing your individual country. Please tailor for your own country as necessary. Distribute it to nursing students to show them how to advocate through policy action. Together nurses can have a tangible and significant impact on the global health and wellbeing of all individuals. Nurses can be a compelling force for good in the world. Call upon your respective nations governments to take swift and decisive action to end these war crimes against humanity.

US nurses: We encourage each nurse to contact your own Congressional legislators (or legislative body members) and the White House. Congressional members can be found through https://www.congress.gov/members. Additionally, nurses can flood the White House switchboard at (202) 456-1414. It is staffed by live volunteers who tally calls. Call the White House to express your concern and you may use the letter as a template.

Download Letter in PDF format
Download Letter in Word format

Letter

Attn: President Biden, Vice President Harris, Sec. Blinken, Speaker Pelosi, Majority Leader Schumer, Congress, Chairman Milley, Secretary–General Guterres, President von der Leyen, President Roberta Metsola, Director–General Ghebreyesus:

We write to express our profound concern regarding the unjustified, unprovoked, and illegal invasion of Ukraine. Those who sign below represent nurse-leaders, many specializing in bioethics and, as such, we hold dear human life, health, well-being, human solidarity, dignity, freedom, and social justice as core values of our profession. These core values of the nursing profession, affirmed by the fields of bioethics, ethics, and social ethics, are themselves desecrated in Russia’s military invasion of Ukraine. Our concerns and requests are several:

We call upon the United States and the UN and its member nations to hold President Vladimir V. Putin of Russia accountable for multiple and egregious violations of the Hague Regulations of 1907, the Geneva Conventions of 1949 and its associated Additional Protocols, and the Rome Statute of the International Criminal Court.

Under Mr. Putin’s command, the Russian military have committed numerous violations of these regulations, conventions, protocols, and statutes. In particular, we draw your attention to violations of Geneva Conventions that specifically require:

respect for “hospital and safety zones and localities so organized as to protect from the effects of war, wounded, sick and aged persons, children under fifteen, expectant mothers and mothers of children under seven.”
respect for neutralized zones
protection of civilian hospitals
that “Persons regularly and solely engaged in the operation and administration of civilian hospitals, including the personnel engaged in the search for, removal and transporting of and caring for wounded and sick civilians, the infirm and maternity cases, shall be respected and protected.
that “Convoys of vehicles or hospital trains on land or specially provided vessels on sea, conveying wounded and sick civilians, the infirm and maternity cases, shall be respected and protected in the same manner as the hospitals provided for…”

Moreover, we express our outrage at the multiple violations of virtually every regulation under Article 51 of the Additional Protocol of the Geneva Conventions on the Protection of the Civilian Population. These have been made visible to the public through multinational war correspondents. The Hague and Geneva Law identify many of these violations as war crimes, e.g., the illegal use of thermobaric blast weapons against civilians and civilian sites.

We call upon the United States and the UN and its member nations to investigate, document, retain evidence, and try Mr. Putin for the commission of war crimes, genocide, crimes of aggression, and crimes against humanity, consistent with the evidence that is obtained, including but not limited to:

Intentionally directing attacks against the civilian population as such or against individual civilians not taking direct part in hostilities;
Intentionally directing attacks against civilian objects, that is, objects which are not military objectives;
Intentionally launching an attack in the knowledge that such attack will cause incidental loss of life or injury to civilians or damage to civilian objects or widespread, long-term and severe damage to the natural environment which would be clearly excessive in relation to the concrete and direct overall military advantage anticipated;
Attacking or bombarding, by whatever means, towns, villages, dwellings or buildings which are undefended and which are not military objectives;
Making improper use of a flag of truce, of the flag or of the military insignia and uniform of the enemy
Intentionally directing attacks against buildings dedicated to religion, education, art, science or charitable purposes, historic monuments, hospitals and places where the sick and wounded are collected, provided they are not military objectives;
Pillaging a town or place, even when taken by assault;
Employing weapons, projectiles and material and methods of warfare which are of a nature to cause superfluous injury or unnecessary suffering or which are inherently indiscriminate in violation of the international law of armed conflict. (From: Article 8 of the Rome Statute of the International Criminal Court)

While sanctions do not stop material aggression, harm, and damage to life, infrastructure, and environment, we call upon the United States and the UN and its member nations to place, consistently tighten, and maintain sanctions against Mr. Putin and his government so that he is economically and forcibly constrained in his action.

Mr. Putin has waged an unprovoked and unjustified war on a sovereign, democratic nation and has indicated his intent to carry through to the end his invasion until he achieves the full surrender, submission, and subjugation of the Ukrainian people. He has thus indicated that he will not negotiate withdrawal, rendering diplomatic solutions null. He has also indicated that sanctions will not affect his plans for Ukraine. Past statements have indicated his general contempt for Ukrainians and that Ukraine has no right to exist as a country. His invasion and wanton killing in Ukraine are genocidal. And, there is no indication that he will stop with Ukraine, following as it does his military actions in Syria, Chechnya, Georgia, Crimea—including the razing of Grozny.

We call upon the United States and the UN and its member nations, to intervene with increased humanitarian aid both, for the Ukrainian nation and its refugees, and to increase aid to refugee-receiving nations and conflict adjacent nations.

In addition to increased governmental aid, we ask that a central website be established for Americans (and in other nations) with links to authenticated governmental or non-governmental organizations, where donations can be specified for and directed toward aid to Ukrainians and/or Ukraine resistance and Ukrainian refugees.

We call upon the United States and the UN and its member nations, to markedly increase aid to the Ukrainian citizenry to increase their capacity for resistance to Russian invasion.

We support increasing the supply of rations/food, protective gear, field first aid and medical supplies, communications equipment, and those supplies necessary to support the resistance of the Ukrainian people. In addition, we also support the provision of arms, weapons, munitions, armored vehicles, armored fighting vehicles, planes, surveillance equipment, drones, classified surveillance information, cybersecurity expertise, and more.

We call upon the United States and the UN and its member nations, to provide for the medical and nursing needs of the Ukrainian populace, and nurses (and physicians) giving care under wartime conditions.

This war follows upon the heels of the Covid pandemic which had already strained medical and nursing resources in Ukraine. We ask our nation and the UN and its member nations to increase its provision of medical and nursing resources including but not limited to clothing, birthing kits, hygiene kits; cleaning, disinfecting, and sterilizing supplies and equipment; medical and surgical supplies and instruments; head lamps; tourniquets, bandages, and wound care kits; nutrition support for infants, children, and adults; blankets, towels, diapers, isolettes, bassinets, medications, antibiotics, and infusions; disposable scrubs; ambulances, and stretchers. In addition, nurses and physicians are living in hospitals in Ukraine and need personal support with food, warm clothing, ground cold-barrier foam for sleeping, blankets, clothing, and personal care items.

We call upon the United States and the UN and its member nations, to provide the necessities and comforts for the particularly vulnerable in Ukrainian society.

Many of the women, children and elderly persons have had to take cover in underground stations, basements, subway tunnels, and bunkers. We ask that our nation coordinate with NGOs and the International Red Cross to increase the donation of such things as clothing, shoes/boots and socks, blankets, ground-insulating foam rolls, food; child education and amusement kits and comfort toys; hygiene kits; feminine hygiene supplies, reading materials, communications tools; candles and flashlights and batteries, head lamps; supportive religious items; warm clothing, and other necessities.

We call upon the United States and the UN and its member nations to create collaborative and coordinated structures that can support the work of volunteer nurses and midwives who enter conflict zones to ameliorate the excess demands that fall upon the nursing and midwifery work of nationals in conflict zones.

The world is never free of war. War places even greater demands upon both military and civilian nurses and midwives. We call for the creation of an international structure and system of coordination and support for nurse and midwife volunteers who are willing to serve in conflict zones. The remarkable Médecins Sans Frontières, is a model that could be extended to an international cooperative and collaborative system of organizations and agencies, that are materially supplied by their nations of origin or international donations.

We are, collectively, horrified both at the invasion and the conduct of this war. As Mr. Putin appears to accept no diplomatic solution other than utter surrender and accession of the Ukrainian nation and its people into Russia, we ask our nation, and the UN and its member states, to do all in their power to force an end to this war, to maintain the sovereignty of the Ukrainian nation and its populace, to aid the Ukrainian resistance, to bring aid to the people of Ukraine and its refugees, to aid refugee–receiving nations, and to harden other nations against Russian expansionism, invasion and cyberattack.

In affirmation of the dignity of human life; the value of health, well-being, respect, and freedom; the hallowed nature of the natural environment, and our commitment to justice and peace as nurses and bioethicists, we humbly submit these requests and urge stringent intervention to halt this unjustified war, to punish war crimes, and to restore Ukraine and the Ukrainian people to sovereign status.

Sincerely,

The Invisible Brown Immigrant

February 11, 2022February 10, 2022 / Peggy L Chinn / 6 Comments

Contributor: Binita Thapa*

This poem has been inspired by my experiences of racism and discrimination in healthcare and nursing education. In the first part of this poem, I portray my experiences of discrimination in healthcare starting from the ambulance’s refusal to take me to the hospital to nurses under recognition of my pain, all due to ongoing appendicitis. I later illustrate an experience of racial discrimination in the form of exclusion as a Masters student in my school. These experiences were pivotal in not only making me realize the racialized world that I was a part of yet I did not acknowledge and recognize for a very long time but was significant in radically changing the trajectory of my thesis from end-of-life care to racism in nursing. These racialized experiences undoubtedly lowered my confidence and belonging, further oppressing me at times but was also a final thread to my unbearable urge to fight for social justice in nursing. I have now healed myself from these racial injuries with the validation, support, and mentorship from many allies and minority nurses. I am also proudly liberated from oppression. However, nursing education and healthcare continue to become a hostile place for racialized nurses and this poetry piece is a starting point of my reflective activism in fighting systemic racial injustices in nursing.

I open my eyes, I see my partner scream at me begging me to wake up
I see myself lying on the kitchen floor
Cannot recall where I was before
His eyes so desperate, his voice shaken, and his soul fragile
Never had I seen him so agile
Ambulance arrives with such an ease
So were the paramedic attendees
He tells me that I cannot be served sounding reserved
My unbearable pain did not matter, not enough to receive attention
I question myself, why am I an exemption?
His disengaged eyes and white skin
Nice racism as it is, nothing less than a brutal sin
Would my pain ever matter?
Will my pain ever be enough?
I could see my shadow and my feet yet I am unnoticeable
I am just a brown immigrant and my superpower is to be invisible

I stand there in front of my nurse in the hospital three feet away
Hoping that he would look at me without delay
He is sharing jokes with his colleagues
As if that is one of his side gigs
I question to myself: why aren’t his jokes funny to me?
Or is it my pain that is more bothersome to me
I bend down to put my hands on my knees
That is all I have to support my unease
I talk to myself inside my head ‘don’t fall’
‘Please can someone give me a medication to relieve this downfall’
I am clearly visible yet unseeable
Proof are these blank stares of disapproval
I could see my shadow and my feet yet I am unnoticeable
I am just a brown immigrant and my superpower is to be invisible

I sit there in a chair in front of my nursing professor
Her evil smirk, I still clearly remember
She proceeds to tell me that I do not belong here in nursing
Her words come out in such ease
As if dehumanizing racialized students was her expertise
All I hear in my soul is how dare that I am ambitious
Making my white professor have this urge to be this malicious
I walk outside her office, trying to make sense of the event that made me so nauseous
I could feel the warmth of my face increasing
As if my body and mind is exploding
The feeling of being unwanted and unwelcomed is suffocating
The proud nurse that I am but this feels humiliating
I could see my shadow and my feet yet I am unnoticeable
I am just a brown immigrant and my superpower is to be invisible

I question to myself ‘why me’?
Why don’t I have the courage to say ‘try me’?
A realization that racism and discrimination will be never-ending
A choice at hand either oppression or liberation
Oppression appears familiar, expected, and feasible
Liberation seems disobedient, challenging, and impossible
I desire love and humanity
I choose liberation and nonconformity
I refuse to be dehumanized by thousand cuts
I refuse to be silenced, asserts my blood and guts
The invisible brown immigrant is now awake
Unwilling to go back to sleep
She fights, persists, and continues to exist
Unaccepting to be dismissed
She now sees her shadow and her feet, and fights to be noticeable
She is now an empowered brown immigrant regardless of white disapproval
And, her superpower is her non-negotiable demand to be visible

About Binita Thapa

My name is Binita Thapa, an immigrant, a daughter of immigrant parents, an internationally educated nurse, and the first university graduate in my family. I completed my Practical Nursing degree from Centennial College followed by BScN from Ryerson University. I am currently a PhD in nursing student at the University of Ottawa. I am deeply passionate about social justice in nursing. As a woman of colour in nursing education and someone who endlessly faces systemic marginalization and racialization in my nursing school, my goal is to continue to have a voice for myself and for other racialized students. My doctoral thesis is focused on developing a post-colonial and anti-racist foundation for graduate nursing curriculum at the University of Ottawa.