Application of Ethics in the Community

history of nursing ethics

-florence nightingale believes God spoke to her which inspired her career

• she was drawn to reform nursing

• believed nursing was a call to service and the moral character of persons entering nursing was important

• passionate about primary prevention

-many nursing programs were ruled by religious organizations and ethics was embedded into the curricula

-1960s ANA recommended that all nursing education occur in institutions of higher education

-technological advancements consumed more content of nursing programs

-bioethics movement of the era encouraged ethics to be integrated into various nursing disciplines

-in 1950, the Code of Professional Nurse developed

-1953 First International Council of Nurses

• first international code of ethics for nurses

public health code of ethics

a state of complete physical, mental, and societal well-being, not merely the absence of diseases

-consists of 12 principles related to the ethical practice of public health

ethics

branch of philosophy that includes both a body of knowledge about the moral life and a process of reflection for determining what person ought to do or be regarding this life

bioethics

branch of ethics that applies the knowledge and process of ethics to the examination of ethical problems in health care

moral distress

an uncontrollable state of self in which one is unable to act ethically

morality

shared and generational societal norms about what constitutes right or wrong conduct

values

beliefs about the worth or importance of what is right

ethical dilemma

puzzling moral problem in which a person, group, or community can envision morally justified reasons for both taking and not taking a certain course of action

code of ethics

moral standards that delineate a profession’s values, goals, and obligations

utilitarianism

an ethical theory based on the weighing of morally significant outcomes or consequences regarding the overall maximizing of good and minimizing of harm for the greatest number of people

deontology

an ethical theory that bases moral obligation on duty and claims that actions are obligatory irrespective of the good or harmful consequences that they produce

principlism

an approach to problem solving in bioethics that uses the principles of respect for autonomy, beneficence, nonmalificence, and justice as the basis for organization and analysis of ethical issues and dilemmas

advocacy

the act of pleading for or supporting a course of action on behalf of a person, group, or community

nuremburg trial

in 1946 Nazi doctors were accused of conducting murderous and torturous human experiments in concentration camps during WWII

-resulted in the development of the Nuremburg Code

• set the standard to regulate human experiments; voluntary consent of human subjects is essential

tuskegee study

in 1932, 600 black men were given treatment for syphilis and informed consent was not collected, however they did not receive actual treatment for the disease

ethical issues

can occur in any situation where moral questions of “rightness” or “wrongness” underlie professional decision-making and the beneficient care of pts

ethical dilemmas

complicated situations where there are morally justified reasons for taking or not taking a certain course of action

diverse society

ethical issues and dilemmas can result from a _ with differing cultures, values, and beliefs (conflict can result)

callahan’s considerations for diverse communities

-situations that place person at direct risk of harm whether psychological or physical

-situations in which cultural standards conflict with professional standards - health care providers need to recognize that some groups hold different values

-situations in which the greater community’s values are jeopardized by values of a smaller culture within that community

• in the absence of significant harm there is no clear moral mandate to interfere

-situations in which community customs may cause mild offense, but no major problems

• no moral mandate to intervene, unless they cause harm or undue hardship

ethical decision-making process

1) identify the ethical issues and dilemmas

2) place the ethical issues and dilemmas within and meaningful context

3) obtain all relevant facts

4) reformulate ethical issues and dilemmas, if needed

5) consider appropriate approaches to actions or options

6) make a decision and take action

7) evaluate

ways to address moral distress

1) identifying the type of situations that leads to distress

2) communicating that concern to your manager and examining ways to work toward addressing the stressor

3) seeking support from ethics committees, social workers, and pastoral care

4) seeking support from colleagues

5) being proactive and expressing one’s voice on matters that are ethically concerning

ethical principles and theories

guide to decision making:

-health of communities differs from the care of individuals

-public health focuses on maximizing benefits for all

-as a result, some individuals liberties may be lost

ethical principles of principlism

-respect for autonomy

-nonmaleficence

-beneficence

-distributive justice

-some principles will be more emphasized than others in certain situations

respect for autonomy

individuals be permitted to choose those actions and goals that fulfill their life plans unless those choices result in harm

nonmaleficence

health care professionals act according to the standards of due care, always seeking to produce the least amount of harm possible

beneficence

requires to promote good

distributive justice

requires that there be a fair distribution of the benefits and burdens in society based on the needs and contributions of its members

-a society must determine a minimal level of goods and services to be available to its members

-egalitarian, libertarian, liberal democratic

egalitarian

everyone is entitled to equal rights and equal treatment and the right to receive certain social goods necessary to satisfy basic needs

libertarian

advocates for social and economic liberty

• emphasizes the contribution and merit of individuals

liberal democratic

each person has the same claim to a fully adequate scheme of equal basic liberties

-benefit greatly to the least advantaged members of society

public health 9 moral considerations

1) producing benefits

2) avoiding, preventing, and removing harms

3) producing the maximal balance of benefits over harms and other costs (utility)

4) distributing benefits and burdens fairly (distributive justice)

5) respecting autonomies choices and actions, including liberty of actions

6) protecting privacy and confidentiality

7) keeping promises and commitments

8) disclosing info and speaking honestly and truthfully

9) building trust

care ethics

-responsibility to care for others

-caring is a moral imperative

-interrelated with feminist ethics:

• recognize the role of political and social structures in health

• advocate for economic, social, and political equity