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.
AND THEIR APPLICATION
IN PUBLIC HEALTH NURSING
Faculty of Health and Wellbeing, University of Cumbria
Leverhulme Fellow, Kyrgyzstan
Normative Ethical Theories
Theories of right and wrong action or Principle based ethical
• 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
• Virtue ethics (the traditional Aristotelian version)
• 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
• Utilitarianism is the paradigm case of consequentialism. Its root is in
ancient Greek philosophy of Gedonism (Act-utilitarianism and Rule-
• 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!
• 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
• The Principle of “Categorical Imperative”:
Act on the maxim that you wish become overtime would become a
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
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
actions should not harm others;
the Hippocratic "first, do no harm”.
principle of doing good;
actions maximizing benefits to individuals and society
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.
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
• Plato and Aristotle emphasize the virtuous character
• Common Greek virtues/vices were friendship/disloyalty,
wisdom/foolishness, and justice/injustice.
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
An action is right if it
promotes the best
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
those in which
A moral rule is one
that is required by
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.
Dominant Ethical Theories
in Public Heath Nursing
achieving the greatest good for the greatest
number of people;
focus on protecting the population rather than
the rights of individuals.
• Four Ethical Principles
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
MAJOR ETHICAL TENSIONS
IN PUBLIC HEALTH
• Individual and Community Rights
• Weighing Benefits, Harms, Risks, and Costs
• Conflicting Interests: A Special Problem in
• Privacy, Confidentiality, and Informed Consent
• Impartiality, Advocacy, and Research Integrity
• Public Health and the State: Beneficence or
All public health research, practice, resource
allocation should be based on ethical decision
To help address these challenges, educating
people about the approaches to ethical
analysis should be a priority.