Ferry Efendi

Nursing ethics today is often guided by policies, professional codes, and principle-based frameworks. These structures are essential for protecting patients and ensuring professional accountability. However, ethical practice cannot be reduced to following rules alone. Many nurses continue to experience moral distress, emotional strain, and loss of professional meaning, even when they comply with institutional guidelines. This suggests that ethical principles, while necessary, are not sufficient to sustain morally grounded practice in complex healthcare environments. This paper argues that nursing ethics requires a stronger focus on moral agency – the capacity of nurses to act with integrity, reflection, and moral responsibility in challenging clinical situations. Drawing on Islamic ethical frameworks, particularly its emphasis on moral intention, trust ( amanah ), human dignity, and proportional responses to harm, the discussion offers a complementary perspective for strengthening ethical practice. In this sense, Islamic ethics is not presented as a replacement for existing frameworks; it is presented as a moral tradition that can enrich ethical reflection in diverse and plural healthcare settings. Through a structured normative conceptual analysis informed by contemporary scholarship in nursing ethics and Islamic bioethics, this paper proposes a reframing of nursing ethics that supports the development of reflective, ethically grounded practitioners in contemporary healthcare.

Indonesia is recognized as a nurse exporting country, with policies that encourage nursing professionals to emigrate abroad. This includes the country’s adoption of international principles attempting to protect Indonesian nurses that emigrate as well as the country’s own participation in a bilateral trade and investment agreement, known as the Indonesia–Japan Economic Partnership Agreement that facilitates Indonesian nurse migration to Japan. Despite the potential trade and employment benefits from sending nurses abroad under the Indonesia–Japan Economic Partnership Agreement, Indonesia itself is suffering from a crisis in nursing capacity and ensuring adequate healthcare access for its own populations. This represents a distinct challenge for Indonesia in appropriately balancing domestic health workforce needs, employment, and training opportunities for Indonesian nurses, and the need to acknowledge the rights of nurses to freely migrate abroad. Hence, this article reviews the complex operational and ethical issues associated with Indonesian health worker migration under the Indonesia–Japan Economic Partnership Agreement. It also introduces a policy proposal to improve performance of the Indonesia–Japan Economic Partnership Agreement and better align it with international principles focused on equitable health worker migration.