Week 10: Ethics in Community Health Nursing | Values, Moral Theories, and Decision-Making Models

Structure of Values

• Definition & Characteristics: Internal standards and motivators directing conduct (e.g., honesty). Defined by long-term endurance, cultural transmission, and organization into priority hierarchies.

• Systems & Dynamics: Integrated structures of beliefs guiding individual and collective actions. Prioritizations change with societal, environmental, and personal shifts. Value conflict is inherent to decision-making.

• Core Healthcare Values: Self-determination (agency and autonomy), well-being (optimal physical/mental/social state), and equity (justice and impartiality).

Client Rights

• Fundamental Rights: Right to health, right to healthcare, right to refuse treatment, and right to written advance directives.

• Regulatory Evolution: The American Hospital Association's Patient's Bill of Rights is now established as the Patient Care Partnership.

DECIDE Model for Ethical Decision Making

• D — Define the problem: Identify the core dilemma, clinical facts, and stakeholders.

• E — Ethical review: Identify relevant ethical principles, professional codes, and institutional policies.

• C — Consider the options: Brainstorm feasible alternative courses of action.

• I — Investigate outcomes: Analyze risks, benefits, and potential consequences of each alternative.

• D — Decide on action: Choose the course aligned with ethical standards and client well-being.

• E — Evaluate results: Assess the actual outcomes, efficacy, and unintended consequences.

Public Health Code

• Public Health Ethics: Centers on harm prevention, promoting population-level good, balancing individual versus community rights, and ensuring professional trustworthiness and confidentiality.

• Institutional Ethics Committees: Interdisciplinary panels (nurses, physicians, ethicists, legal experts, community members) providing ethical education, clinical consultation, case reviews, and policy development.

Moral and Ethical Theories

• Consequence-Based (Teleological / Utilitarianism): Evaluates actions solely by their outcomes; seeks the greatest good for the greatest number with the least harm.

• Principle-Based (Deontological): Emphasizes inherent duties and rights independent of consequences; actions are intrinsically right or wrong based on moral rules.

• Relationship-Based (Caring Theory): Evaluates actions through interpersonal responsibility, emotional commitment, and the active preservation of human relationships.

Fundamental Ethical Priniciples

• Respect: Acknowledging individuals as unique, autonomous moral agents (e.g., respecting religious/medical immunization waivers).

• Autonomy: Honoring personal self-determination and requiring informed consent within legal boundaries.

• Beneficence: The affirmative duty to do good and promote positive health outcomes (e.g., screenings, community wellness initiatives).

• Nonmaleficence: The duty to avoid and prevent harm.

  • Hierarchy of Priorities: 1) Do no harm, 2) Prevent harm, 3) Remove harm, 4) Promote good.

• Justice: Ensuring equitable and fair distribution of healthcare resources.

  • Distributive Justice: Allocates resources first to the most disadvantaged or needy.

  • Egalitarian Justice: Distributes equal benefits to everyone regardless of need.

  • Restorative Justice: Directs resources to redress prior historical or institutional wrongs.

• Veracity: Moral obligation to provide accurate, transparent, and timely truth (e.g., immediate disease outbreak disclosure).

• Fidelity: Keeping promises, honoring professional commitments, and fostering community trust.