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HLST 354 - Healthy Populations > Public Health Ethics > Flashcards

Public Health Ethics Flashcards

1
Q

What is the science and art of preventing diseases, prolonging life, and promoting health, through the organized efforts of society?

A

Public health

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2
Q

Describe Justice, one of the Core Ethical Dimensions of Public Health according to the Public Health Agency of Canada.

A
  • Health inequalities
  • Potential impact of initiatives
  • Stigmatization
  • Distribution of resources
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3
Q

Describe Trust, one of the Core Ethical Dimensions of Public Health according to the Public Health Agency of Canada.

A

Reciprocity
o Right to share responsibility
o Support those disproportionately burdened

Solidarity
o Sharing the burden of promotion and maintaining health
o Consider the well-being of the community as a whole
o Value interconnectedness

Open, honest truthful, transparency in decision making processes

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4
Q

Describe Non-Maleficence and Beneficence, one of the Core Ethical Dimensions of Public Health according to the Public Health Agency of Canada.

A
  • Obligation to avoid causing harm to others
  • Harms/risk should be lesser in proportion to the benefit
  • Duty to promote well-being and support individuals and communities
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5
Q

Describe Respect for Persons and Communities, one of the Core Ethical Dimensions of Public Health according to the Public Health Agency of Canada.

A
  • Recognizing the autonomy of individuals and communities
  • Right to participate in decisions through respectful consultation
  • Right to be informed and have basis of decisions explained
  • Support the ability of individuals and communities to identify and act on public health issues when and where they can.
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6
Q

According to the Public Health Agency of Canada, what are the Core Ethical Dimensions of Public Health

A

Respect for persons and Communities

Non-maleficence and Beneficence

Trust

Justice

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7
Q

What are the 4 main principles of bioethics?

A

o Autonomy – respect for self-determination
o Beneficence – moral requirement to promote good
o Non-malfeasance – do no harm
o Justice – fair and equitable distribution of resources and fair treatment for individuals and society

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8
Q

How did the SARs epidemic impact public health in Canada?

A

Canada unprepared for the ethical challenges the epidemics posed

Traditional bioethics perspective
o Too much emphasis on individual rights
o Not enough emphasis on population rights
o Not enough acknowledgements of how epidemics disproportionately affected marginalized groups

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8
Q

Describe Stage 3 of Public Health Ethics in Canada

A
  • The future
  • Focus on global and environmental justice and public health research ethics
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9
Q

Describe Stage 2 of Public Health Ethics in Canada

A

In 2000’s emergence of frameworks for public health ethics

Growing agreement that public health ethics is a separate field form healthcare ethics

Proposed alternative philosophical and political foundations

Moving away from traditional utilitarian and contractarian theories

2008 – first journal for public health ethics was launched

Development in feminist and nursing ethics evolved to include similar principles such as autonomy, solidarity, and social justice

SARS
o Canada unprepared for the ethical challenges the epidemics posed

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10
Q

Describe Stage 1 of Public Health Ethics in Canada

A

During the 1970’s-80’s, health promotion and HIV/AIDS emerged, contributing foundational ideas to the later articulation of public health ethics

HIV/AIDS raised dilemma of attending to individual human rights while protecting the health of the population

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11
Q

What are the stages of public health ethics in Canada?

A

Stage 1 - 1970’s HIV/AIDS epidemic raised ethical concerns about individual vs population rights

stage 2 - early 2000’s public health ethics field was developed; SARS showed ethical issues of epidemics

Stage 3 - future focusing on global and environmental justice

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12
Q

What are some examples of future ethical concerns for nurses?

A

Mandatory immunizations

MAID

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13
Q

What were some historical examples of the need for public health ethics

A
  • Auschwitz death camp
  • Tuskegee Syphilis study
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14
Q

What is public health ethics?

A

The application of relevant ethical principles and values to public health decision making
o Identify and clarify ethical dilemmas
o Analyze in terms of alternatives
o Resolve the dilemmas

Completement individual practice competencies while focusing on equities and social determinants of health

Tension exists between individual rights and community or public rights

Concerned with how interventions affect the population and how do we mitigate negative effects to the population

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15
Q

What is ethics?

A

Ethics is a branch of philosophy that is concerned with human conduct, more specifically the behaviour of individuals in society. Ethics examines the rational justification for our moral judgments

Studies what is morally right or wrong, just or unjust

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16
Q

What are the core areas of Public Health?

A
  • Protection
  • Prevention
  • Promotion
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17
Q

What guides public health?

A
  • Governance
  • Advocacy
  • Capacity
  • Information
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18
Q

Why do the ethics for clinical health and public health differ?

A

Clinician focuses on the individual, while public health focuses on societal factors

A clinician will be concerned with treating the victim of a stabbing, but PH is concerned with why the stabbing happened in the first place.

Sincerely, Esther, stabby stabby :)

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19
Q

Describe utilitarian thought

A

o Greatest good for the greatest number of people
o Drives thinking when it comes to public health ethics

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20
Q

What are some of the ways in which public heath ethics differs from clinical ethics

A

Focus is on weighing individual rights against community rights

Utilitarian thought
o Greatest good for the greatest number of people
o Drives thinking when it comes to public health ethics

Equitable distribution of goods combined with providing for the most vulnerable is of a concern

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21
Q

What are some hot public health topics today?

A

o Communicable disease surveillance
o Mandatory reporting
o Detention
o Quarantine

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22
Q

Who is Upshur and what is his contribution to ethics?

A

Upshur came up with a decision framework for public health in 2002. The framework was intended “to bring clarity to some of the ethical aspects of public health decision making in practice” and to determine “when public health action is justified.”

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23
Q

What are the main principles of Upshur’s Public Health Ethics Decision Framework?

A

Harm - preventing harm

Least restrictive means - is there a less restrictive intervention that will achieve the same goal?

Reciprocity - compensation for groups that endure hardship due to an intervention

Transparency - interventions are inclusive with a clear, accountable process

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24
Q

Describe Harm, one of the main principles of Upshur’s Public Health Ethics Decision Framework

A

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

Does the intervention protect others from experiencing harm?

Does the action limit the liberty or autonomy of any individuals or groups?

Does the action set out to:
o Prevent harm to individuals or groups other than those who are being restricted?
o Improve the wellbeing of both populations (those constraining, and those constrained)?
o Prevent individuals or groups from doing harm to others by constraining them?
o Improve the wellbeing of individuals or groups by constraining them?

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25
Q

Describe Least Restrictive Means, one of the main principles of Upshur’s Public Health Ethics Decision Framework

A

Education, facilitation, discussion precedes interdiction, regulation, incarceration
o Interdiction means to stop something
o More coercive methods only employed after less coercive methods have failed
o There should be no discrimination in the restriction

Is there another, less coercive or restrictive intervention that can be implemented that would achieve the same goals?

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26
Q

Describe Reciprocity, one of the main principles of Upshur’s Public Health Ethics Decision Framework

A
  • The right to share responsibility
  • If some people or groups endure a burden because of the intervention, does the intervention ensure compensation for that hardship?
  • Society is obligated to facilitate individuals and communities in their efforts to discharge their duties
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27
Q

Describe Transparency, one of the main principles of Upshur’s Public Health Ethics Decision Framework

A
  • Honesty and truthfulness
  • Was the decision to intervene inclusive and made through a clear and accountable process?
  • Did all stakeholders participate in the decision-making process?
  • Was the decision-making process dominated by one group?
  • Was there any political interference?
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28
Q

What are the CNA Nursing Values and Ethical Responsibilities?

A

A. Providing Safe, Compassionate, Competent and Ethical Care
B. Promoting Health and Well-Being
C. Promoting and Respecting Informed Decision-Making
D. Honoring Dignity
E. Maintaining Privacy and Confidentiality
F. Promoting Justice
G. Being Accountable

MEMORY: Just, Ethical Care Improves Health And Dignity
J - justice promotion
E - ethical, safe, compassionate care
C - confidentiality/privacy
I - informed decision making
H - health and wellbeing
A - accountability
D - dignity

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29
Q

What is the IDEA Framework and what are the steps

A

decision making framework for solving ethical issues

Steps

I – Identify the facts

D – Determine the relevant ethical principles

E – Explore the options

A – Act

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30
Q

Describe the ethical principle of solidarity

A

sharing the burden of promoting and maintaining health

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31
Q

Describe the ethical principle of proportionality

A

using the least restrictive means available/legal and legitimate

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32
Q

What are the Conditions or Concepts that should be observed when using the IDEA ethical framework?

A

Empowerment - minimize power differences

Publicity - transparency in decision making process

Relevance - Fair and evidence based decisions

Revisions and appeals - allows modifications on previous decisions based on new evidence

Compliance - voluntary or public regulation of the process

33
Q

Describe the condition of Empowerment in the IDEA ethical framework

A

There should be efforts to
 Minimize power differences in the decision-making context
 Optimize effective opportunities for participation

34
Q

Describe the condition of Publicity in the IDEA ethical framework

A

Framework, decisions, and rationales should be transparent and accessible to the relevant public/stakeholders

35
Q

Describe the condition of Relevance in the IDEA ethical framework

A

Decisions should be made based on reasons that “fair-minded” people can agree are relevant under the circumstances

36
Q

Describe the condition of Revisions and appeals in the IDEA ethical framework

A

Fairmindedness

Evidence-based decision making

There should be
 Opportunities to revisit and revise decisions in light of further evidence or arguments
 Mechanisms for challenge and dispute resolution

37
Q

Describe the condition of compliance in the IDEA ethical framework

A

Also called enforcement

There should be either voluntary or public regulation of the process to ensure that the other 4 conditions are met

38
Q

What is sanctity of human life in the context of the values and ethical principles of public health?

A

Biblical edict of saving lives

39
Q

What is non-malfeasance in the context of the values and ethical principles of public health?

A

Do no harm (Hippocratic oath)

40
Q

What is Universal Declaration of Human Rights in the context of the values and ethical principles of public health?

A

All humans deserve protection

41
Q

What is Individual human rights in the context of the values and ethical principles of public health?

A

Liberty, privacy, protection from harm

42
Q

What is reciprocity in the context of the values and ethical principles of public health?

A

Right to share responsibility

42
Q

What is proportionality in the context of the values and ethical principles of public health?

A

restriction of civil liberties –legal, legitimate

42
Q

What is solidarity in the context of the values and ethical principles of public health?

A

sharing the burden of promotion and maintaining health

43
Q

What is beneficence in the context of the values and ethical principles of public health?

A

Reduce harm

44
Q

What is transparency in the context of the values and ethical principles of public health?

A

Honest and truthfulness

45
Q

What is precautionary in the context of the values and ethical principles of public health?

A

Duty to take preventative action to avoid harm even before scientific certainty is established

46
Q

What is responsibility to act in the context of the values and ethical principles of public health?

A

Duty to act and implement preventable measures

47
Q

What is equity in the context of the values and ethical principles of public health?

A

Reduce inequities(race, gender, economic, geographic etc)

48
Q

What is cost and benefits in the context of the values and ethical principles of public health?

A

Economic analysis/consider priorities

49
Q

What is stewardship in the context of the values and ethical principles of public health?

A

Responsibility of governance to act in a trustworthy and ethical manner

50
Q

What is trust in the context of the values and ethical principles of public health?

A

Cooperation between the public and non-govt stakeholders in health

51
Q

What is blank in the context of the values and ethical principles of public health?

A

address challenges as anticipated

52
Q

What is evidence based in the context of the values and ethical principles of public health?

A

make decisions and revise them based on evidence

53
Q

In the context of the values and ethical principles of public health, what is the concept of do no harm?

A

Non-malfeasance

54
Q

In the context of the values and ethical principles of public health, what is the concept of the biblical edict of saving lives?

A

Sanctity of human life

55
Q

In the context of the values and ethical principles of public health, what is the concept of all humans deserve protection?

A

Universal Declaration of Human Rights

56
Q

In the context of the values and ethical principles of public health, what is the concept of liberty, privacy, and protection from harm?

A

Individual human rights

57
Q

In the context of the values and ethical principles of public health, what is the concept of sharing the burden of promotion and maintaining health?

A

Solidarity

58
Q

In the context of the values and ethical principles of public health, what is the concept of reducing harm?

A

Beneficence

59
Q

In the context of the values and ethical principles of public health, what is the concept of restriction of civil liberties - legal, legitimate?

A

Proportionality

60
Q

In the context of the values and ethical principles of public health, what is the concept of the right to share responsibility?

A

Reciprocity

61
Q

In the context of the values and ethical principles of public health, what is the concept of honest and truthfulness?

A

Transparency

62
Q

In the context of the values and ethical principles of public health, what is the concept of the duty to take preventative action to avoid harm even before scientific certainty is established?

A

Precautionary

63
Q

In the context of the values and ethical principles of public health, what is the concept of the duty to act and implement preventable measures?

A

Responsibility to act

64
Q

In the context of the values and ethical principles of public health, what is the concept of reducing inequities (race, gender, economic, geographic etc.)?

A

Equity

65
Q

In the context of the values and ethical principles of public health, what is the concept of economic analysis and considering priorities?

A

cost and benefits

66
Q

In the context of the values and ethical principles of public health, what is the concept of responsibility of governance to act in a trustworthy and ethical manner?

A

Stewardship

67
Q

In the context of the values and ethical principles of public health, what is the concept of cooperation between the public and non-government stakeholders in health?

A

Trust

68
Q

In the context of the values and ethical principles of public health, what is the concept of making decisions and revising them based on evidence?

A

Evidence based

69
Q

In the context of the values and ethical principles of public health, what is the concept of addressing challenges as anticipated?

A

Responsive to needs

70
Q

What is relational ethics?

A

The development and expression of personhood, or autonomy, is more reliant on connections with others rather than individual rights.

Approaches that inform, support, and enable such connections are crucial.

This perspective reminds us that not everyone is constructed equally, and it forces us to examine systemic discrimination and privilege.

It is a thoroughly social concept that is historically situated, embodied, and interdependent.

Individuals are inseparable from the communities and build on the fact that the interests of both are interrelated

Additionally, our social group memberships impact our status and opportunities, and it’s important to acknowledge and address oppression.

71
Q

When taking a relational view of public health ethics, what are some of the considerations we need to make?

A
  • Public rather than individuals
  • Social nature of public health work
  • More than individual benefit x community benefit
  • It must make clear the complex ways in which individuals are inseparable from communities and build on the fact that the interests of both are interrelated
72
Q

Define relational autonomy

A

o Concept of self-determination
o Being in charge of one’s person and having the right and ability to make meaningful choices about oneself
o Public health matters may violate this right
o Must establish why it is necessary

73
Q

Sometimes public health has to violate the right of autonomy. Using the relational ethics lens, what are some considerations?

A

It is crucial to note that promoting autonomy is not about compromising public safety.

Instead, it challenges us to examine how public health measures affect different social groups.

Social changes may be the best way to promote autonomy in some cases, as policy decisions can limit the range of options available to individuals.

It’s essential to understand that an individual’s choices are related to their social relationships and influences

74
Q

____________ may be the best way to promote autonomy in some cases, as policy decisions can limit the range of options available to individuals.

A

Social changes

75
Q

What is social justice, a concept of justice using the relational ethics lens?

A

Fair access to social goods
o Rights
o Opportunities
o Power
o Self-respect

Correct patterns of systemic injustice that create inequalities in access and opportunity
o Attend to needs of the most disadvantaged
 Includes ensuring public health
o Public health IS social justice

76
Q

What is distributive justice, a concept of justice using the relational ethics lens?

A

Fair distribution of quantifiable goods
o Public funding
o Access to service
o Income
o Social stability

77
Q

What are the subgroups of justice in relational ethics?

A

Social justice - fair access and reduced inequities

Distributive justice - fair distribution of quantifiable goods

78
Q

Given the broader health focus, a tension exists between _______ rights and ________ rights.

A

Individual

public

79
Q

Describe relational solidarity? How do we accomplish this?

A

Our typical understanding of solidarity
o Does not ignore the differences
o Express concern for all of humanity and our mutual vulnerability
o Shared interest in survival, safety, and security

To accomplish this we need to
o Unravel what contributes to the us vs them divide
o Examine privilege and disadvantage
o Common vulnerability and needs

HLST 354 - Healthy Populations (8 decks)

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