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  • If it's ok with you, Vincent, I've emailed this to myself. As I mentioned earlier, I belong to to a philosophy group in Ulverston. This again would be a good topic for debate.
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  • Ethics is a branch of philosophy that address the question “What is right?”. There are various approaches to the ethics in the literature: simply descriptive or analytical, which do not apply moral position; these that do take moral position, and they are called normative ethics. The ethical approach that most relevant to public health nursing is practical normative ethics or applied ethics. Practical normative ethics is the attempt to apply general norms and theories to particular ethical problems.
  • Hedone or “pleasure” is the general term for any philosophy that sais that pleasure is an equivalent to good and pain is equivalent to evil. It judges action according to the balans of good or bad outcomes that the action produce. It is also teleological ethical theory from the Greek word telos “end” or “goal” because of it emphasize on external goal or purpose. Jeremy Bentham: PU actions are right in proportion as they tend to promote happiness and wrong as they tend to produce the reverse of happiness
  • Kantian ethics are founded in the respect for the inherent dignity of each person, due from the person itself and from the others. From the principle of not treating people as means arises the duty to self and others. Perfect duties to others: duty not to kill an innocent person, the duty not lie and the duty to keep promises. Imperfect duty include the moral principle of beneficience.
  • Ethical principles are starting point for moral reasoning
  • VE focused on the person performing the action. It is concerned not so much with how to act but with what kind of person to be and what sort of life to lead.
    For Aristotle the ends or telos of the virtues is that of producing of individual happiness. The person who develops the virtues within herself is more happier than one who not develop these character traits. Aristotle takes it for granted that human action is directed toward the good and that achievment of the good results in happiness. The more exercising virtue the virtuous become a person. Virtues of nurse: fidelity, wisdom, courage, reciprocity, integrity, pride, justice.
  • (e.g., laws requiring the reporting of communicable diseases and the mandating of vaccination programs).
  • Public health must balance the public good with the good of individuals.
  • Presentation1

    1. 1. ETHICAL THEORIES AND THEIR APPLICATION IN PUBLIC HEALTH NURSING Vincent O’Brien, Principal Lecturer, Faculty of Health and Wellbeing, University of Cumbria Tamara Kudaibergenova, Leverhulme Fellow, Kyrgyzstan
    2. 2. Normative Ethical Theories Theories of right and wrong action or Principle based ethical theories: • Consequentialism (Mill’s version) • Deontology (The Kantian version) • Principlism (The four principles approach by Beauchamp TL, Childress JF) Theories of good and bad character or ethical theories without principles: • Virtue ethics (the traditional Aristotelian version)
    3. 3. Consequentialism/Teleology • Group of philosophy claiming that the action is right entirely with the reference to the consequences of the action regardless of any moral features that the action may have, such as truthfulness or fidelity. • Utilitarianism is the paradigm case of consequentialism. Its root is in ancient Greek philosophy of Gedonism (Act-utilitarianism and Rule- utilitarianism) • Classic proponents are Jeremy Bentham 1748-1832), and John Stuart Mill (1806-1873). • The Principle of Utility: act always to promote the greatest happiness for the greatest number!
    4. 4. Deontology/Kantian Theories • the rightness or wrongness of human action depends on the feature of the action which make it obligatory or forbidden, regardless to the consequenses of that action • It comes from the Greek deon - “to owe”, “to ought to”, or “to must”. The duty based theory of Immanuel Kant (1724-1804). (Perfect and imperfect duties) • The Principle of “Categorical Imperative”: Act on the maxim that you wish become overtime would become a universal low! Never treat another person only as a means to an end but always at the same time as an end! • The Principle of Beneficience: to contribute to the welfare of others and the duty to develop one’s own talents
    5. 5. Principlism/Four principles approach by Tom L. Beauchamp and James R. Childress (1994) • Respect for autonomy: allowing people to make decisions about themselves for themselves respecting human dignity, believing in a person's ability to make good decisions. • Nonmaleficence: actions should not harm others; the Hippocratic "first, do no harm”. • Beneficence: principle of doing good; actions maximizing benefits to individuals and society • Justice: refers to distributive justice and is the principle requiring that benefits and harms should be equally distributed among people. Related ideas are fairness, equity, and impartiality.
    6. 6. Virtue ethics It emphasis on commendable and/or condemnable character traits. Virtues are commendably good character traits and vices are condemnably bad character flaws. • The word virtue is derived from the Greek arête and the Latin virtus, which mean “the qualities that make a man a man”. • Plato and Aristotle emphasize the virtuous character • Common Greek virtues/vices were friendship/disloyalty, courage/cowardice, self-restraint/intemperance, wisdom/foolishness, and justice/injustice.
    7. 7. Comparison of ethical theories by Rosalind Hursthouse "Virtue Theory and Abortion” Consequentialism Deontology Virtue Theory Example Mill's utilitarianism Kantian ethics Aristotle's moral theory Abstract description An action is right if it promotes the best consequences. An action is right if it is in accordance with a moral rule or principle. An action is right if it is what a virtuous agent would do in the circumstances. More concrete specification The best consequences are those in which happiness is maximized. A moral rule is one that is required by rationality. A virtuous agent is one who acts virtuously, that is, one who has and exercises the virtues. A virtue is a character trait a human being needs to flourish or live well.
    8. 8. Dominant Ethical Theories in Public Heath Nursing • Teleology/Utilitarianism: achieving the greatest good for the greatest number of people; focus on protecting the population rather than the rights of individuals. • Deontology • Four Ethical Principles
    9. 9. Situation in Public Health The utilitarian approach dominates: • In public health research, individual privacy takes precedence over utility; • in public health practice, utility takes precedence in that beneficence dominates over privacy.
    10. 10. MAJOR ETHICAL TENSIONS IN PUBLIC HEALTH • Individual and Community Rights • Weighing Benefits, Harms, Risks, and Costs • Conflicting Interests: A Special Problem in Occupational Health • Privacy, Confidentiality, and Informed Consent • Impartiality, Advocacy, and Research Integrity • Public Health and the State: Beneficence or Paternalism?
    11. 11. Conclusion All public health research, practice, resource allocation should be based on ethical decision making. To help address these challenges, educating people about the approaches to ethical analysis should be a priority.

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