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

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)

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!

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

Principlism/Four principles approach

by Tom L. Beauchamp and James R. Childress (1994)• Respect for autonomy:

allowing people to make decisions about themselves for themselvesrespecting 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.

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.

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.

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

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.

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?

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.