1. Copyright © 2008 Delmar. All rights reserved. Chapter 18 Ethics and Human Rights

2. Copyright © 2008 Delmar. All rights reserved. 2 Ethics –Morality –Values Bioethics –Code of Hammurabi –Nuremberg Code Protection of human subjects in research

3. Copyright © 2008 Delmar. All rights reserved. 3 Rights Human rights Moral rights –Positive –Negative Right to health –United Nations Charter 1946 –Ottawa Charter for Health Promotion 1986

4. Copyright © 2008 Delmar. All rights reserved. 4 Modern Bioethics 1960s and 1970s social movement New medical technologies –Dialysis –Heart transplants Informed consent –Willowbrook State Hospital –Syphilis study at Tuskegee, Alabama

5. Copyright © 2008 Delmar. All rights reserved. 5 Modern Bioethics Current bioethic concerns –Environmental –Sexuality and reproduction –Genetic choice and manipulation –Research

6. Copyright © 2008 Delmar. All rights reserved. 6 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

7. Copyright © 2008 Delmar. All rights reserved. 7 Intersection of Health American Public Health Association 2000 –Principles on Public Health and Human Rights –(See box 18-1)

8. Copyright © 2008 Delmar. All rights reserved. 8 Intersection of Health Ethical theories –Utilitarianism Hedonism Consequentialism –Bentham’s principle of utility

9. Copyright © 2008 Delmar. All rights reserved. 9 Deontological Kant –Categorical imperative Inherent dignity of each person –Perfect duties –Imperfect duties

10. Copyright © 2008 Delmar. All rights reserved. 10 Ethical Principles Autonomy –Self-governance –Relational autonomy –ANA Code for nurses Nonmaleficence –Above all, do no harm –Due care

11. Copyright © 2008 Delmar. All rights reserved. 11 Ethical Principles Beneficence –Promote welfare –Social duties –International Code of Nursing Ethics Paternalism

12. Copyright © 2008 Delmar. All rights reserved. 12 Ethical Principles Justice –Treat equally –Aristotle’s principle of formal justice Two major aspects of justice 1.Noncomparative 2.Comparative (distributive)

13. Copyright © 2008 Delmar. All rights reserved. 13 Various Theories Utilitarian Libertarian Communitarian Egalitarian

14. Copyright © 2008 Delmar. All rights reserved. 14 Moral Rules Function to guide decision making and action Several types: –Substantive –Authority –Procedural

15. Copyright © 2008 Delmar. All rights reserved. 15 Ethical Theories Without Principles Feminist ethics Care ethics Virtue ethics Casuistry

16. Copyright © 2008 Delmar. All rights reserved. 16 Cross Cultural Ethical Perspectives Jewish ethics –Oath of Asaph –Preserve life –Rabbi serves as an ethicist Catholic ethics –Based on theology –Natural law

17. Copyright © 2008 Delmar. All rights reserved. 17 Cross Cultural Ethical Perspectives Protestant ethics –Covenant fidelity –Faithfulness –Sanctity of life Islamic –Quranic texts –Focus on moral and ethical behavior

18. Copyright © 2008 Delmar. All rights reserved. 18 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

19. Copyright © 2008 Delmar. All rights reserved. 19 Cross Cultural Ethical Perspectives Asian ethics –Balance between rights and duties –Confucian ethics Duties Obligation Responsibilities

20. Copyright © 2008 Delmar. All rights reserved. 20 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

21. Copyright © 2008 Delmar. All rights reserved. 21 Public Health Leadership Society Principles of the Ethical Practice of Public Health –Developed by public health professionals Health Community Bases for action

22. Copyright © 2008 Delmar. All rights reserved. 22 Public Health Leadership Society Public health as social justice –Social standing predictor of health –Higher the social standing, the lower the risk

23. Copyright © 2008 Delmar. All rights reserved. 23 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

24. Copyright © 2008 Delmar. All rights reserved. 24 Public Health Decision Making Model Balance between advancement of public health and social justice while retaining individual liberties to the fullest

25. Copyright © 2008 Delmar. All rights reserved. 25 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?

26. Copyright © 2008 Delmar. All rights reserved. 26 Selected Issues in Public Health Nursing Global HIV/AIDS Genetics –Genetic screening