Chapter 18
Ethics and Human Rights
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Ethics
• Ethics
– Morality
– Values
• Bioethics
– Code of Hammurabi
– Nuremberg Code
• Protection of human subjects in research
2
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Rights
• Human rights
• Moral rights
– Positive
– Negative
• Right to health
– United Nations Charter 1946
– Ottawa Charter for Health Promotion 1986
3
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Modern Bioethics
• 1960s and 1970s social movement
• New medical technologies
– Dialysis
– Heart transplants
• Informed consent
– Willowbrook State Hospital
– Syphilis study at Tuskegee, Alabama
4
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Modern Bioethics
• Current bioethic concerns
– Environmental
– Sexuality and reproduction
– Genetic choice and manipulation
– Research
5
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Intersection of Health
• Three proposed linkages by J. Mann
1. Impact of health polices, programs, and
practices on human rights
2. Health impacts resulting from violations of
human rights
3. Health and human rights
• Exploring an inextricable linkage
6
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Intersection of Health
• American Public Health Association 2000
– Principles on Public Health and Human
Rights
– (See box 18-1)
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Intersection of Health
• Ethical theories
– Utilitarianism
• Hedonism
• Consequentialism
– Bentham’s principle of utility
8
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Deontological
• Kant
– Categorical imperative
• Inherent dignity of each person
– Perfect duties
– Imperfect duties
9
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Ethical Principles
• Autonomy
– Self-governance
– Relational autonomy
– ANA Code for nurses
• Nonmaleficence
– Above all, do no harm
– Due care
10
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Ethical Principles
• Beneficence
– Promote welfare
– Social duties
– International Code of Nursing Ethics
• Paternalism
11
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Ethical Principles
• Justice
– Treat equally
– Aristotle’s principle of formal justice
• Two major aspects of justice
1. Noncomparative
2. Comparative (distributive)
12
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Various Theories
•
•
•
•
Utilitarian
Libertarian
Communitarian
Egalitarian
13
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Moral Rules
• Function to guide decision making and
action
• Several types:
– Substantive
– Authority
– Procedural
14
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Ethical
Theories Without Principles
•
•
•
•
Feminist ethics
Care ethics
Virtue ethics
Casuistry
15
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Cross Cultural
Ethical Perspectives
• Jewish ethics
– Oath of Asaph
– Preserve life
– Rabbi serves as an ethicist
• Catholic ethics
– Based on theology
– Natural law
16
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Cross Cultural
Ethical Perspectives
• Protestant ethics
– Covenant fidelity
– Faithfulness
– Sanctity of life
• Islamic
– Quranic texts
– Focus on moral and ethical behavior
17
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Cross Cultural
Ethical Perspectives
• African American ethics based on
– Medical experiences of black people
– Legacy of black activism
• Two ethical principles
– Vital force principle
– Communalism principle
18
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Cross Cultural
Ethical Perspectives
• Asian ethics
– Balance between rights and duties
– Confucian ethics
• Duties
• Obligation
• Responsibilities
19
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Nursing and Other
Ethical Codes and Principles
• American Nurses Association Code for
Nurses
• Scope and Standards of Public Health
Nursing Practice
• International Council of Nurses
– Code of Ethics
20
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Public Health
Leadership Society
• Principles of the Ethical Practice of Public
Health
– Developed by public health professionals
• Health
• Community
• Bases for action
21
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Public Health
Leadership Society
• Public health as social justice
– Social standing predictor of health
– Higher the social standing, the lower the risk
22
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Public Health
Leadership Society
• Ethical decision making in public health
– Dilemmas
• Act in question is morally right and morally wrong
• Morally obligated to perform two or more exclusive
actions
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Public Health
Decision Making Model
• Balance between advancement of public
health and social justice while retaining
individual liberties to the fullest
24
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Public Health
Decision Making Model
• Six-step model:
1. What are goals of the proposed program?
2. How effective is the program in achieving its
goals?
3. What are the burdens of the program?
4. Can burdens be minimized? Are there
alternatives?
5. Is the program implemented fairly?
6. How can the benefits and burdens of a program be
fairly balanced?
25
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Selected Issues
in Public Health Nursing
• Global HIV/AIDS
• Genetics
– Genetic screening
26
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