This document discusses ethics in community health nursing. It addresses how community health nurses often experience ethical conflicts between focusing on individual clients' needs versus maximizing population health with limited resources. The traditional focus on individuals is difficult to maintain with legislative funding influencing care for specific groups. Nurses recognizing this dilemma between individual care and community health settings experience a conflict between professional nursing values. The document also outlines clients' rights, societal obligations, professional responsibilities including codes of ethics, and principles of beneficence, autonomy, and justice that guide ethical decision making in community health.

1. Ethics in Community Health
Nursing

2.  Community health nurses experience many ethical
conflicts in today's health care system.
 The nursing profession has traditionally upheld the
rights and needs of the individual client.
 Yet today this focus is difficult to maintain when
nurses have the additional goal of maximizing the
health of populations at risk.
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Introduction

3.  The traditional focus is also difficult to maintain
when nursing resources are influenced by legislation
and funding for specific population groups.
 Nurses who experience this conflict between the
individualistic focus of community health recognize
the dilemma of professional nursing in community
health settings.
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Introduction cont…

4.  Ethics is the study of good conduct, character, and
motives. It is concerned with determining what is good or
valuable for all people. Acts that are ethical often reflect
a commitment to standards beyond personal
preferences- standards on which individuals,
professions, societies agree.
 Bio-ethics are principles and rules of conduct applied to
living things. Bio-medical ethics is the system applied to
the areas of human endeavor in which health-care is
given.
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Introduction cont…

5.  Ethics is a system of moral principles, and rules of
conduct recognized in respect to a particular class of
human actions or to a particular group of people.
 Ethic is also a branch of philosophy dealing with
values relating to human conduct with respect to the
rightness and wrongness of certain actions and to
the goodness and badness of the motives and ends
of such actions.
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Definition

6.  Professional ethics concerns the moral issues that
arise because of the specialist knowledge that
professionals attain and how the use of this
knowledge should be governed when providing a
service to the public.
 A professional code of ethics provides a framework
for making ethical decisions and sets forth
professional expectations.
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Professional Ethics

7.  One of the earliest recognitions of clients' right
concerning health was made by the national
convention on the French revolution in 1973.
 Undergoing the theme of basic human rights, the
leaders of the revolution declared that there should
only be one patient on a bed in hospital and hospital
beds were to be placed at least 3 feet apart (Annas
1978).
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Clients' rights

8.  This kind of direction by the government or
legislating body in the recognition and assertion of
clients' right has continued to be prominent in
consideration of thought to health and the right to
health-care as extensions of basic human rights.
 Such as right to informed consent, to refuse
treatment or to privacy were apparently aided by
consumer groups and health-care providers.
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Clients’ right cont…

9.  As health is a fundamental right and the state is
obligated to protect it, although it is the responsibility of
all persons to monitor their own health state.
 The laws of public health measures such as sanitation
and water supply regulation to control the spread of
disease demonstrate early protective laws in matter of
human health and hygiene.
 Most of these measure protected a negative right to
health-the right to not to have ones health endangered
by the action of others.
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Right to Health cont…

10.  In 1949 the Universal Declaration of Human Rights of
the United Nations Assembly, acknowledges the right of
all persons to a standard of living adequate to provide for
health and well-being and the right "to food, clothing,
housing, and medical care."
 It suggests that persons are entitled to do certain
services, programs, and some other to maintain or
achieve health as a basic human right.
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Right to Health

11.  “The right to health” is an elliptical term for the
expression of “the right to health-care” (Daniel).
 It is a rights claim against the state or its agencies to
provide specific health care services that one request or
is entitled to receive.
 For example, immunization, kidney dialysis services,
home health services for Medicare and Medicaid
recipients, & generally funded prenatal and family
planning services- all these recognize the positive right
to specific health care services.
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Right to health-care

12.  The basic human rights included the following;
 Considerate and respectful care.
 Obtain complete medical information
 Informed consent
 Refine treatment
 Consideration of privacy
 Confidential treatment
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Other rights

13.  Request services
 Information on other institution & individuals related
to care & treatment
 Refuse participation in research projects
 Expect reasonable continuity of care
 Examination & explanation of financial charges
 Know institutional regulations
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Other rights cont….

14.  Society has an ethical obligation to ensure
equitable access to health care for all.
 The societal obligation is balanced by individual
obligation.
 Equitable access to health care requires that all
citizens should be able to secure an adequate
level of care without excessive burden.
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Societal obligations

15.  When equity occurs through the operation of private
forces, there is no need for government’s
involvements. But the ultimate responsibility of
ensuring that society obligation is met, through a
combination of public and private sector
arrangements rests with the Federal Government.
 The cost of achieving equitable access to health
care ought to be shared by the family.
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Societal obligations cont…

16.  Efforts to certain nursing health care costs are
important but should not focus on limiting the
attainment of equitable access for the least well-
served portion of the public.
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Societal obligations cont…

17.  In response to client’s rights, health care
professional incur particular duties or
responsibilities which are supported by
professional code of ethics and are correlative to
basic liberty rights of client.
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Professional responsibilities

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Code of ethics
Rule of
confidentiality
Code of
duties
Duty of veracity
Accountability
Duty of
advocacy
Professional
Responsibilities

19.  Professional codes of ethics are statements
encompassing rules that apply to person in
professional role.
 Two questions generally arise concerning the
importance of these codes in health-care delivery.
 What is their relation to universal moral principles?
 What is their relation to legal requirements for professional
practice. - (Walter)
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Code of ethics Cont…

20.  In answering the first question, we should consider the
rules included in professional code of ethics for
nurses-to be specific, applications of more universal
moral principles.
 The professional code of ethics for nurses prescribes,
moral behavior, and actions based on moral principles.
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Code of ethics Cont…

21.  In second questions, we should consider many of
the rules in the code of nurses to be morally
obligatory and legally required.
 Some of rules may even have legal ties to licensure
requirements concerning professional acts.
 For example, the rules of respecting clients’
confidentiality and accountability are mentioned as
both morally obligatory and legally required by the
code for nurses.
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Code of ethics cont…

22.  In general veracity means accuracy or conformity to
truth. As a part of the nursing code of ethics,
veracity guides nurses to practice truthfulness.
 Persons have a duty of veracity- a duty to all the
truth and don’t lie or deceive people.
 In community health nursing, we respect person and
uphold a duty of veracity by not deceiving clients as
to the nature of the care they are receiving.
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Duty of veracity

23.  Seconds argument claims that contract between client and
community health nurse create the expectation that the
nurse will, while interacting with the client, speak truthfully.
 Third argument claims that relationships of trust are
necessary for cooperation between client and health care
professional.
 Sometimes, nurses withhold information because they
think that client’s, particularly if very sick or dying, do
not really want to know the truth about their
conditions.
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Duty of veracity cont…

24.  But this belief is not certified by surveys of sick and
dying. In a survey of 100 cancer patients, 89% preferred
knowing their condition; in a survey of non-cancer
patients, 82% said they preferred knowing; in another
survey of 740 patients being diagnosed in cancer
detection center, 98.5% said they wanted to know their
condition.
 Regardless of the reasons for not telling the truth to
clients or withholding information, it is clear that
community health professionals have a duty of veracity.
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Duty of veracity cont…

25.  It is defined as the rights and privileges of clients for
protection of privacy without diminishing access to
quality care.
 First, if health care professionals did not follow a rule
of confidentiality, clients might not sick help when
they needed it.
 In short, it is derived from the sphere of privacy. We
recognize it as a basic human right of all persons.
Confidentiality helps protect the functioning of
professional and client relationships.
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Rule of confidentiality

26.  The nursing profession recognizes a strong duty of
advocacy where the care or safety of clients is
concerned.
 As the code of nurses’ states,” the nurse must be alert to
& take appropriate action regarding any instances of
incompetent, unethical or illegal practices by any
member of the health care team or the health care
system, or any action on the part of others that places
the right or best interests of the client in jeopardy” (ANA
1976).
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Duty of advocacy

27.  Position of advocacy can be difficult to maintain when
they conflict with accepted professional practices.
 The community health nurse is only required, in the role of
an advocate, to protect, speak for & support the interests
of the clients. Nothing should be harmed in the provision
of health care services.
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Duty of advocacy cont…

28.  It is defined as “being answerable to someone
for something one has done”.
 It includes providing an explanation to ones’ self,
to the client, to the employing agency, & to the
nursing profession for what one has done in the
role of nurse.
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Accountability

29.  In nursing and specially community health nursing,
accountability appears to be the quality that defines
the kind of relationship between client, nurse & other
professional & the public at large that form the moral
foundations of the professional ethics.
 Accountability enables the nurse to achieve the
protection of the clients human dignity and right to
self-determination in matter of health.
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Accountability cont…

30.  In addition to its simply being the right thing to do,
always acting ethically brings some particular
advantages with it.
 Program effectiveness
 Standing in the community
 Moral credibility and leadership
 Professional and legal issues
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Importance of ethical behavior in
community interventions

31. Principles of beneficence
 The principle of beneficence state “we ought to do
well and prevent or avoid doing harm”.
 It includes the idea that beneficence is a duty to help
others gain what is to benefit to them but does not
carry the obligation to risk one’s own welfare or
interiors in helping others.
 Beneficence involves benefiting or promoting the
good of clients.
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Ethical principles in community health

32. Application in community health
 The principle of beneficence can be applied for:
 Balancing harms & benefits to client population.
 In the use of cost benefit analyses in decisions
affecting client population.
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Principles of beneficence cont…

33.  In community health, a rule of utility may be
appealed to in deciding whether to conduct
screening programs for communicable disease after
several cases have been found in vulnerable
population & whether to conduct research project
where individual rights to privacy may be concerned.
 In each example the decision is made by balancing
the possible harm & benefits of several alternative
courses of action.
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Principles of beneficence cont…

34. Balancing harm and benefits
 Services that bring about the greatest balance of
good over evil, or benefit over harm, it is accordance
to rule of utility .
 This rule is derived principle of beneficence and a
moral duty to weight and balance benefits against
harms to increase benefits and reduce the
occurrence of harms.
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Principles of beneficence cont…

35. Cost benefit analysis
 It is specific application of the principle of
beneficence.
 To measure the benefits and costs of alternatives
approaches to a problem or to decide how to
distribute health program funds.
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Principles of beneficence cont…

36. Examples of beneficent actions:
 Resuscitating a drowning victim,
 providing vaccinations,
 encouraging a patient to quit smoking and
 talking to the community about STD prevention.
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Principles of beneficence cont…

37.  Decision-making in community health setting on the
basis of a principles of beneficence and the
weighing of harm & benefits raises moral questions
concerning;
 Paternalism in health care decisions &
 Extent of the rule of utility
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Problems and conflicts

38.  Autonomy is form of personal liberty in which
individual chooses his or her own course of action.
 It refers to freedom of action, as chosen by an
individual. Persons who are autonomous and
capable of choosing and acting on plans they
themselves have selected.
 To respect persons as autonomous individual is to
acknowledge their rights to make choices & act
according to individual determinations.
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Principles of autonomy

39. Application in the community
 The principle of autonomy is applied in community health
through considerations with:
 Respect for persons.
 The protection of privacy.
 The provision of informed consent.
 Freedom of choice including treatment refusal.
 The protection of diminished autonomy.
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Principles of autonomy cont…

40. Problems and conflicts
 Respecting the ethical principle of autonomy can be
difficult in community health nursing practice. Those
areas creating the most conflict for nurses have
included;
 Caring out coercive health measure.
 Invasion of privacy for health reasons.
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Principles of autonomy cont…

41.  The term justice refers to fairness often is used during
discussion about resources.
 The principle of justice or equity involves the fair
distribution of benefits or burdens among members of
society.
 Under the principle of justice all things being equal, all
group of people should be treated equally.
 Ethical decisions based on the principle of justice are
grounded in the brief that society’s resources equally
distributed.
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Principle of justice

42.  The normal principle of justice claims that equals
should be treated equally and that those who are
unequal should be treated differently according to
their differences.
 In consideration of community health we appeal to
principle of justice in determining the manner in
which social burdens & benefits, including health
goods, have to be distributed among all individuals
in the community.
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Principle of justice cont…

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