chapter 6 Flashcards
4 commonly accepted principles of health care ethics, excerpted from Beauchamp and Childress include the principles of?
these principles have been around for a lot longer than 2008 and while critiqued in many ways, still provide the foundational reasoning for how health care decisions are made. for example, ethical decision making in hospital simplicity refer to these principles through ethic boards that puzzle out decisions about health care
respect for autonomy
non-maleficence
beneficence
justice
__________________ suggests the fair distribution of society’s benefits, responsibilities, and their consequences. it focuses on the relative position of one social group in relationship to others in society as well as the root causes of disparities and what can be done to eliminate them
social justice
the notion of well being emerges in ________________ discourse as the intersections of health, personal security, ability to reason, human attachment and self determination
social justice
public health adopts a _____________ approach to ethical decision making. it is important to understand this approach to social control as one that attempts to be the least restrictive. perhaps the best example of the dilemma of social control and respecting individual choice is the advocacy for seat belts or bike helmets and the ongoing debate about vaccines
utilitarian
Utilitarianism is an ethical theory that determines right from wrong by focusing on outcomes. It is a form of consequentialism. Utilitarianism holds that the most ethical choice is the one that will produce the greatest good for the greatest number.
t or f
if you look to building capacity, you may find yourself advocating at the sociopolitical level of intervention and not necessarily providing individual care
true
bias and stereotypes lead to prejudice, discrimination and oppression. sometimes advocating for a different understanding is an intervention that has the potential to interrupt the continuance of __________ information and ______________ but not intervening on a community but on the people who work within the community
bias
oppression
with regards to the community assessment and intervention well, what are the elements that make it up?
community core physical environment education safety/transportation politics/government health/social services communication economics recreation
CNA “values and ethical responsibilities”: (7)
safe, competent ethical care
health and wellbeing
informed decision making
dignity
privacy/confidentiality
justice
accountability
CHN ethics refer to _________, ____________, ___________ principles, ______________ and ______________ that guide conduct
values norms moral virtues traditions
CNA code recognizes ethical endeavours that address aspects of _____________
social justice
state the 10 social justice attributes
equity human rights democracy/civil rights capacity building just institutions enabling environments poverty reduction ethical practice advocacy partnerships
________________ assumes that all societies experience systematic oppression (racism, sexism, heterosexism, classism) which affect some people more than others
social justice
everyone contributes to _____________ and ______________ and are responsible for the achievement of social, political and economic parity
oppression
inequity
what are the central ethical issues in CHN?
ethical issues of:
health promotion
professional relationships
prevention and health protection
access and equity
health maintenance, restoration, and palliation
there is an ethical issue of health promotion:
- because health is a value laden concept, CHNs can influence individuals to conform to _________________ through health promotion and unwittingly becoming agents of social control and _______________
- a possible mortal harm of health promotion is its potential to create adversarial relationships between those who?
- CHNs must be mindful of the social and professional _______________ they possess as respected and trusted health professionals
social norms
medicalization
actively strive to improve their health and those who do not
power
there is an ethical issue of professional relationships:
professional ___________________- crossing a _____________ means the care provider is misusing the power in the relationship to meet their own personal needs
boundaries
boundary
there is an ethical issue of prevention and health protection:
-4 utilitarian principles for making ethical decisions about intervention include?
harm principle- prevent harm… this is more tricky with a public health or community nurse bc their responsibility is also the larger community. e.g. if a patient with active TB wants to go out in public, we might keep them in isolation regardless of their wishes. These type of measures are only acceptable when preventing harm to others (the greater good)
least restrictive or coercive means- e.g. education and promotion would come before enforcing interventions. e.g. a teen smoking cessation program before punishments enforced
reciprocity- e.g. if someone has to serve a duty for others, then are we doing what we can to support them, if not are they compensated? e.g. an isolated patient being compensated for lost wages
transparency- all stakeholders involved in decisions, able to weigh in, does someone hold more power in the decision making?
with regards to the 4 utilitarian principles for making ethical decisions about intervention, which does each of these statements refer to?
“considering whether anyone other than individual is harmed”
“less coercive options are best used prior to governmental intervention”
“social entities are ethically obligated to assist individual in meeting their own ethical responsibilities”
“decision making must be accountable and equitable”
harm principle
least restrictive or coercive means
reciprocity
transparency
there is an ethical issue of access and equity:
-CHNs must take into consideration that social factors such as ___________, ______________ orientation and __________________ status restrict equitable access and distribution of health services and determinants of health
age
sexual
socioeconomic
CHNs are required to disclose health information on a _____________________ and abide by relevant privacy legislation
some exceptions apply such as?
need to know
court orders
subpoenas
emergency situations
other legal issues may arise from negligence resulting from a breach in the standard of ____________
care
CHNs work collaboratively when building individual and community capacity by using strategies involving ______________ and ______________
empowerment
advocacy
_________________ is the process of enabling communities to increase control over their lives and by which they increase their assist and attributes and build capacities to gain access, partners, networks and or a voice, in order to gain control
empowerment
_________________: community health nursing takes a stand for their practice, aims, and reforms that are in line with the moral goals of public health
advocacy
CHN advocacy often has a strong ___________________ orientation for populations sensitive to health inequities and or otherwise marginalized
social justice
explain how capacity building is related to advocacy?
it takes a stand for the practices, aims and reforms that are in line with the moral goals of public health, which have a strong social justice orientation
ethical problems in the community can also take on a _____________ nature
political
t or f
power in itself is ethically neutral
true
efforts to prevent disease and injury restrict the liberty of individuals, thereby limiting their _____________ and _______________ (give example)
choice
autonomy
seat belt laws
healthy choices in vending machines
no smoking laws (this is also the harm principle… can restrict for the greater good of the population)
analyze the political nature of ethical problems in the community:
first, _________________ approaches tend to be concerned with the ethical use of power in health care. broad political and structural dimensions of problems in healthcare and also the day to day use of power by health professionals are examined. power in itself is ethically neutral. how power is used is of ethical significance. it is important to recognize that efforts to prevent disease and injury restrict liberty, thereby limiting their choice and __________________. for example, seat belt laws and speed limits restrict the liberty of individuals but they are needed to protect _____________
social justice
autonomy
health
CHNs encounter ______________ issues in all facets of their everyday work. Ethical nursing practice requires CHNs to be able to reflect critically upon their practice, make sound ethical decisions, and take appropriate action.
ethical
CNA code of ethics also recognizes ethical endeavors that address aspects of ____________________ related to broad societal issues in which nurses are asked to work toward eliminating social inequities
social justice
_____________ refers to those values, norms, moral principles, virtues, and traditions that guide human conduct. Often, ideas that reflect what is good or right and what we ought and ought not to do are associated with ethics. it is also a specialized area of philosophy.
ethics
_____________, also known as healthcare ethics, refers to the study of ethical issues that are related to health and healthcare.
bioethics
_________________ ethics examines ethical issues in healthcare “from the perspective of nursing theory and practice”
nursing
Bioethics and nursing ethics have made use of a range of ethical theories and approaches, including ____________________, _________________, casuistry, principlism, virtue ethics, and _____________ ethics.
deontology
utilitarianism
feminist
state the 7 Canadian nurses association nursing values and ethical responsibilities
providing safe, compassionate, competent and ethical care
promoting health and well being
promoting and respecting informed decision making
preserving dignity
maintaining privacy and confidentially
promoting justice
being accountable
____________________ has been defined by the CNA as “the fair distribution of society’s benefits, responsibilities, and their consequences. It focuses on the relative position of one social group in relationship to others in society, as well as on the root causes of disparities and what can be done to eliminate them”. It assumes that all societies experience broad, systematic oppression and inequities, such as racism, classism, sexism, and hetero- sexism, which affect some people more than others.
social justice
“social” in social justice places emphasis on the application of justice to social groups, such as the need to address _________________ health and unjust social institutions and relationships. From this perspective, the experiences of ________________ are embedded within larger political, economic, cultural, and social contexts
population
individuals
Fundamental to community health nursing is an understanding of the socio-environmental context of health, recognizing that basic resources and prerequisite conditions are necessary to achieve ____________
health
________________ is the foundational moral justification for public health as a social institution. A commitment is needed to address systematic disadvantage that severely limits the well-being of oppressed groups. Well-being involves multiple dimensions, including health, personal security, ability to reason, human attachment, and self-determination. ____________________ strives to achieve sufficiently high levels in all these dimensions for everyone
social justice
social justice
what are the 10 defining attributes of social justice?
equity
human rights
democracy and civil rights
capacity building
just institutions
enabling environments
poverty reduction
_______________ is based on the just treatment of all individuals, which includes equitable access and opportunity to meet health needs
equity
______________ _____________ (including the right to health)- these rights are defined by the UNs universal declaration of human rights and the Canadian charter of rights and freedoms
human rights
Democracy and __________________ rights- these are outlined in the Canadian bill of rights. Democracy and civil rights exist when all have equal rights and power resides in the people and is not based on hereditary or arbitrary differences in privilege or rank
civil
Enabling ___________________- these support positive change, community empowerment, and policy development
environments
__________________-_____________________ that foster social justice are based on the equitable sharing of roles and responsibilities among institutions and individuals across sectors
partnerships
partnerships
It is also important to note 3 features of social justice approaches that are useful to consider when using social justice as a framework for everyday community nursing practice. These features tend to distinguish this type of approach from principle-focused ones typically used in bioethics.
- First, social justice approaches tend to be concerned with the ethical use of ____________ in healthcare. Broad political and structural dimensions of problems in healthcare and also the day-to-day use of power by health professionals are examined. Power, in itself, is ethically ____________. How power is used, however, is of ______________ significance. professional power is “the influence stemming from the professional position we hold. It is the ability to have an impact on the state of being of a person—physically, mentally, emotionally, psychologically, spiritually—in the context of the professional role”. Nurses and other health professionals can use their professional influence to improve the health and well-being of individuals, but they can also use this professional power to deny individuals the right to make _____________ regarding their health. This power can be exercised not only at the level of specific individuals but also can be used to address population-based inequities.
power neutral ethical choices interdependent dilemmas
_______________ expands the agenda of bioethics by examining broad healthcare issues that impact on everyday practice, such as the need to examine social inequities in Canada that prevent individuals from acquiring the determinants of health. It also recognizes that some perspectives, such as those of clients and nurses, have not been adequately brought into the dialogue and debate on ethical issues, nor have they been drawn upon fully in the development of bioethical theory.
social justice
much of the health promotion work that nurses have engaged in has not always focused on the material and sociopolitical conditions necessary for health. Instead there has been an overemphasis on _____________ behavior patterns. This may be the result of nurses working within a biomedical system that primarily values repairing diseased or injured bodies and not the social fabric in which bodies live.
individual
there are potential moral harms in health-promoting activities that need to be discussed. First, because health is a value-laden concept, CHNs can influence individuals to conform to _____________ norms through health promotion strategies. In other words, CHNs can unwittingly become agents of social control and ___________________.
social
control
Second, a possible moral harm of health promotion is its potential to create adversarial relationships between those who actively strive to improve their ____________ and those who do not. A danger exists that those who do not always try to enhance their health through diet, exercise, meditation, and so on may be viewed as morally weak and ________________. Taken to an extreme, if this type of adversarial relationship existed between CHNs and their clients it could compromise nurses’ respect for the dignity of those they serve.
health
inferior
Ultimately, health _______________ activities are powerful tools that must be used with careful reflection as to their consequences for the health and well-being of individuals and communities. CHNs must be mindful of the social and professional power they possess as respected and trusted health professionals. There exists an ethical responsibility to reflect upon whose good and whose conception of health is being promoted and why.
promotion
While _______________ and health protective measures can greatly improve the well-being of populations, they also are not without their potential moral harms. Some of these harms are similar to those associated with health promotion in that they can further medicalization. Prevention and health protection information can weaken people’s confidence and security in their health. Constant surveillance of one’s body can provoke anxiety and can possibly lead to excessive diagnostic testing as well. These iatrogenic risks are an ethical concern because they can erode a person’s sense of well-being
preventive
CHNs must strive to find the right balance of providing information to protect their clients without unduly undermining their ______________, alarming them, or restricting their autonomous choices.
self esteem
Without a conscious awareness of the sociopolitical and economic factors that underlie health and illness, it is possible that CHNs could too easily _____________ clients who do not heed health information and acquire a disease. Alternatively, CHNs could view these clients as powerless victims of their circumstances, thereby absolving them from any responsibility for their health and absolving CHNs from any responsibility to provide information or other support to assist them in making health choices. Either extreme would not respect the dignity of these clients and would not promote social justice. A more helpful perspective would put together these explanatory frameworks in a way that does not eliminate the possibility of ____________, but situates it. The concept of relational autonomy is helpful here. individuals are inherently social and relational beings who are significantly shaped by interpersonal and political relationships. Individuals exercise autonomy and choice within this web of interconnected and sometimes conflicting relationships. Options available to individuals are constrained by circumstances and the availability of resources. Pressure from significant others and social forces can also greatly influence decision making
blame
choice
in some instances, interventions are targeted to one group of people to protect another group’s _____________, such as mandatory reporting of some ____________________ diseases. These interventions can be ethically justified if they fairly distribute benefits and burdens and limit burdens to the greatest extent possible.
health
communicable
harm priniciple?
The CAN has adopted 4 utilitarian principles for ethical decision making about public health interventions that are a form of social control. These are?
- The __________________ establishes the initial justification for restricting the liberty of people in a democratic society. “the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will is to prevent harm to others. His own good, either physical or moral is not a sufficient warrant”. A CHN would only be justified in quarantining individuals if they had a harmful communicable disease such as SARS
- ____________________________, stipulates that the full force of governmental authority and power should not be used unless less-coercive methods are unavailable or have failed. Education, negotiation, and discussion should come before regulation and incarceration. The CHN, therefore, would not incarcerate co-operative individuals exposed to SARS, but instead would provide instructions to them regarding quarantining themselves safely at home.
harm principle
least restrictive/coercive means
Understanding the meaning and impact of various places or settings is central to community health nursing because CHNs deliver nursing services where clients live, work, learn, worship, and play , not in _________________. Different places or settings accomplish different kinds of work; have different values, operational codes, and philosophies; and are influenced and structured by different kinds of knowledge and power. These factors combine to influence a person’s moral agency within a particular place or environment
hospitals
the experience of receiving and providing health- care services cannot be overtly detached from the ____________ in which it is received or provided
place
________________, including nursing ethics, has generally assumed that the hospital, not the community, is the setting of healthcare delivery, resulting in the neglect of many issues facing CHNs that are strongly shaped by the uniqueness of the settings or places in which they arise.
bioethics
Special ethical considerations arise when care is provided in the ___________ because _____________ are highly significant and idealized places that are imbued with multiple meanings, including personal identity and autonomy, intimacy, normalcy, and security
home
homes
The transfer of caregiving responsibilities to family care- givers raises a number of __________ concerns.
CHNs have a responsibility to promote and preserve the health and well- being of their clients, but because persons are relational, nurses also have a similar responsibility to a client’s ____________. At times, it may be difficult to determine who is or should be the focus of care. the health and well-being of clients may be threatened when caregivers are stressed and inadequately educated for their role. when delegating responsibilities to family caregivers who do not have adequate support or resources, CHNs may be compromising safe, competent, and ethical care.
_____________ is also limited because clients may have no other option than to provide and receive care at home.
the source of these ethical problems lies outside of the nurse- client relationship. It is important to recognize that the situations of both CHNs and their clients are the result of broader _____________ forces and agendas that have limited the availability of resources in order to reduce costs
ethical
family
choice
political
________________, including nursing ethics, has generally assumed that the hospital, not the community, is the setting of healthcare delivery, resulting in the neglect of many issues facing CHNs that are strongly shaped by the uniqueness of the settings or places in which they arise.
bioethics
One of the ways that clients can communicate their wishes for care is by means of an ___________________ (living will). this contains a person’s wishes regarding future healthcare decisions. they are not only for people who are terminally ill. Anyone may stipulate what medical treatments he or she will accept or reject in certain situations, and it is used only if the person becomes incapable of making choices.
they, however, cannot substitute for communication between patients, their families, and their caregivers.
they contains two sections. The instructional directive sets out wishes for____________. The second section, the ____________ directive, is a power of attorney for personal care, by which a person designates one or more substitute decision makers for healthcare. This could be a family member or a friend. Each section of an ________________ may exist separately; wishes concerning treatment may be set down with- out naming a proxy, or a proxy may be named without making any stipulations about treatment
advance directive
treatment
proxy
advance directive
CHNs work collaboratively when building individual and community ______________. CHNs begin where individuals and communities are, helping them to identify relevant health issues and to assess their strengths and resources
capacity
it is argued that _______________ is the most common ethical orientation in public health nursing practice that embraces the character of WHO’s perspective on empowerment. It takes a stand for the practices, aims, and reforms that are in line with the moral goals of public health, which have a strong social justice orientation: “The moral aim is to promote the health of the population as a social good that allows people to pursue other valued ends”
advocacy
Public health ethics tends to be distinct from traditional bioethics in its focus on the health of ____________________ as opposed to individuals, and in its concern for the _______________ as opposed to individual agency and responsibility. There is an emphasis placed on advocacy activities that involve collective interventions to promote and protect the health of populations and that are sensitive to health inequities and to marginalized and vulnerable populations
populations
SDOH
Actions based on _______________ and ______________ foster the everyday ethical practice of CHNs
empowerment
advocacy
cycle of oppression
__________________________: When biased information based on stereotypes is used to inform decision making, nurses and others can become highly prejudiced and discriminate against people. This discrimination can ultimately lead to barriers in accessing needed healthcare services, which is ultimately a form of oppression and social injustice that can lead to poor health. (1. Biased information 2. Stereotype 3. Prejudice 4. Discrimination 5. Oppression
The _______________ of ____________ has been legally defined as bringing a reasonable degree of skill and knowledge and exercising a degree of care that could reasonably be expected of a normal prudent practitioner of the same experience and standing. The standard of care determination is often based on professional standards
standard of care
CHNs providing palliative care to clients in their homes must possess an excellent knowledge of the ethical and legal considerations regarding end- of-life care, such as ___________________, _______________ control, and DNR
advance directives
pain
identify and define the 7 central ethical values of Canadian nurses
providing safe, compassionate, competent and ethical care- nurses provide safe, compassionate, competent and ethical care
promoting health and well being- nurses work with people to enable them to attain their highest possible level of health and wellbeing
promoting and respecting informed decision making- nurses recognize, respect and promote an persons right to be informed and make decisions
preserving dignity- nurses recognize and respect the intrinsic worth of each person
maintaining privacy and confidentiality- nurses recognize the importance of privacy and confidentiality and safeguard personal, family, and community information obtained in the context of a professional relationship
promoting justice- nurses uphold principles of justice by safeguarding human rights, equity and fairness and by promoting the public good
being accountable- nurses are accountable for their actions and answerable to their practice
what are the 10 defining attributes of social justice?
equity
human rights
democracy and civil rights
just institutions
capacity building
enabling environments
poverty reduction
ethical practice
advocacy
partnerships
list and define the 4 principles for a public health intervention
harm principle
least restrictive or coercive means
reciprocity
transparency
how can biased information about clients lead to oppression?
cycle of oppression
-biased information on stereotypes is used to inform decision making, nurses and others can become highly prejudiced and discriminate people. the discrimination can ultimately lead to barriers in accessing needed healthcare services which is ultimately a form of oppression and social injustice that lead to poor health
what are the 4 key elements that must be proven to make a finding of negligence?
- that there was a relationship between the person brining the claim and the person being sued
- that the defendant breached the standard of care
- that the plaintiff suffered a harm
- that the harm suffered was caused by the defendants breach of the standard of care
_____________ and ___________________ exist when all have equal rights and power resides in the people and is not based on hereditary or arbitrary differences in privilege or rank
democracy
civil rights
______________ is based on the just treatment of all individuals, which includes equitable access and opportunity to meet health needs
equity
Feminist ethics
implications for care are embedded in the personal and social values and experiences associated with culture, gender, power, and politics.
feminist ethics challenges the philosophic foundations of the justice theory (masculine) and argues that the notion of care is best understood from a perspective that focuses on the associations between people and on the contextual experiences within these relationships [7]. A feminist approach questions power relations and issues of domination within the institution, the academy and within nursing practice
