Ethical Issues in Public Health - PowerPoint PPT Presentation

1 / 22
About This Presentation
Title:

Ethical Issues in Public Health

Description:

Ethical Issues in Public Health Marymount University Eileen Sarsfield, PhD, PHCNS-BC * – PowerPoint PPT presentation

Number of Views:705
Avg rating:3.0/5.0
Slides: 23
Provided by: Eil60
Category:

less

Transcript and Presenter's Notes

Title: Ethical Issues in Public Health


1
Ethical Issues in Public Health
  • Marymount University
  • Eileen Sarsfield, PhD, PHCNS-BC

2
Objectives
  • Describe ethical principles in relation to
    individuals and populations.
  • Discuss nursing traditions and documents which
    support social justice in light of the present
    market justice environment.
  • Use ethical problem-solving strategies to
    address dilemmas related to care of individuals,
     communities, and populations

3
Define Ethics
  • The philosophical study of moral values and
    rules.
  • The science of human duty in terms of what is
    right and wrong, true or false.

4
Ethical Approach to Solving Health Care Dilemmas
  • Bioethics- refers to the study of ethics as it
    relates to health and moral dilemmas.
  • Ethical dilemma-a situation characterized by
    conflicting rights or obligations.
  • (Lundy Janes, 2009)

5
Bioethics-The Big Four Principles
  • These principles are widely used as a starting
    point for practical decision making in clinical
    professions dealing with individual cases
    (biomedical)
  • Autonomy- free choice
  • Beneficence-doing good
  • Nonmaleficence- do no harm
  • Justice- fairness
  • Beauchamp Childress (2008) Principles of
    Biomedical Ethics, 6th Edition

6
Use in Public Health
  • Though the Big Four Principles are primarily
    used in clinical practice addressing individual
    cases, they can be applied on a population level.
  • In public health practice, principles such as
    beneficence often carry more weight than the
    principle of autonomy.
  • For example, fluoridation of the water programs

7
Population-based Ethical Principles In Public
Health
  • Consequentialism- What are the goodness or
    badness of the consequences? The consequences of
    a particular action form the basis for any valid
    moral judgment about that action. A form of this
    is
  • Utilitarianism the greatest
    happiness/good for the greatest number of
    people. The moral worth of an action is
    determined by its outcome. (John Stuart Mill).
    To a utilitarian the results are paramount.
  • Deontology- derives the rightness or wrongness of
    an act from the character of the act itself
    rather than the outcomes of the action. i.e.
    murder is inherently wrong regardless of the
    situation.

8
Community / Public Health Ethical Principles cont
  • Communitarian ethics - What can I do to make
    society better or does what I am doing improve
    society?
  • Beneficence- The obligation to act in ways that
    benefits others
  • Justice- fair, equitable, appropriate treatment
    in the light of what is owed to people.
  • Egalitarian ethics Stresses equal access to
    important social goods based on giving primacy
    to principles of social justice.

9
Principles that Frame the Right to Health Care
Argument
  • Often the right to health care is framed within
    the communitarian principle and the principle of
    distributive justice which states that resources
    should be given first to those who need it the
    most.

10
The Ethical Principle of Justice
  • Social justice the principle that all persons
    are entitled to have their basic needs met
    regardless of economic status, class, gender,
    race, ethnicity, religion, citizenship, age,
    sexual orientation, disability or health. (PHN
    Scope and Standards, 2007)
  • Distributive justice- resources should be given
    first to those who need it the most
  • Egalitarian justice- equal distribution to
    everyone regardless of need (Socialism)
  • Restorative justice payback those previously
    harmed by injustice-i.e. Native Americans

11
Social Justice
  • We lack benchmarks to determine what is fair
    and what is unfair.
  • The construct is difficult to teach, practice or
    model.
  • It is a highly personal idea often
    formed/influenced by life experiences.
  • In health care it is often interpreted to mean
    there is a collective responsibility for health
    care.

12
Nursing and Social Justice
  • Nursings traditional ethos rooted in the theory
    of social justice
  • Respect for patients
  • Caring
  • Compassion
  • Concern for their well-being
  • Concern for the poor and vulnerable

13
Nursing's Policy Statements
  • Three contemporary documents and statements about
    the meaning of social justice.
  • 2001 Code of Ethics for Nurses
  • 2004 Scope and Standards of Nursing Practice
  • 2010 Nursings Social Policy Statement
  • There is an emphasis on individuals rather than
    on populations and the common good.

14
Social Justice and Public Health Nursing
  • Beauchamp (1976) asserted that the ethical
    foundation of public health is social justice.
  • The ANA Scope and Standards of Public Health
    Nursing (2007) uses
  • Utilitarianism the greatest happiness/good
  • for the greatest number of people.
  • Using utilitarianism as a guiding principle for
    public health nursing can focus on quantitative
    evaluation justice is considered through the
    lenses of who ever happens to be the majority.

15
Market Justice vs. Social Justice in Public Health
  • Market justice is increasingly influencing public
    health nursing through the partnering of managed
    care companies and public health agencies.
  • Managed cares focus on the medical model, market
    demands, shareholders concerns and the individual
    rather than on the common good is incompatible
    with social justice principles.

16
Todays Challenges to Social Justice
  • Although public health nurses are champions of
    social justice, their work places embrace
    bureaucracy, standardization, individual care and
    medical models.
  • A market driven health care system challenges us
    to study, analyze and discuss social justice.

17
Major Ethical Tensions in Public Health
  • Individual and Community Rights. Perhaps the
    clearest example of an ethical tension in public
    health is the balancing of individual and
    community rights when a person is discovered to
    have a communicable disease.
  • Weighing Benefits, Harms, Risks, and Costs. All
    public health interventions require a balancing
    of benefits versus harms and costs. Vaccination
    campaigns always have an associated risk of harm
    because of adverse reactions to the vaccine.

18
Public Health Ethical Dilemmas
  • Typhoid Mary
  • AKA Mary Mallon

19
Public Health and the State Beneficence or
Paternalism?
  • The formation and enforcement of public health
    policy is a government function.
  • Many public health interventions, such as water
    fluoridation and mass vaccination programs
    certainly have benefits, but respect for autonomy
    may be undermined.
  • When the state does something to protect people,
    some may hold different values and feel that the
    state is acting paternalistically toward them.

20
Community/Public Health Ethical Decision Making
  • Kass Six Step Framework
  • What are the public health goals of the proposed
    program?
  • How effective is the program in achieving its
    stated goals?
  • What are the known or potential burdens of the
    program?
  • Can burdens be minimized? Are there alternative
    approaches?
  • Is the program implemented fairly?
  • How can the benefits and burdens of a program be
    fairly balanced?
  • (Lundy Janes, 2009)

21
Ethical Decision Making Common Themes or Models
  • Clarification of the ethical dilemma- gather data
  • Determine if an ethical principle/s can guide the
    decision making process
  • Evaluate options- unpack the elements
  • Seek advice if possible
  • Justify the position and act on it
  • (Lundy Janes, 2009)

22
Summary
  • Nurses have opportunities to participate in
    ethical decision making with individuals,
    families and communities.
  • Understanding the principles of ethical theory
    and decision making provides us with a starting
    point and a framework for developing our own set
    of beliefs that will guide us in the practice of
    nursing.
Write a Comment
User Comments (0)
About PowerShow.com