1. 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

2. 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)

3. 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!

4. 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

5. Principlism/Four principles approach
by Tom L. Beauchamp and James R. Childress (1994)
• Respect for autonomy:
allowing people to make decisions about themselves for themselves
respecting 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.

6. 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.

7. 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.

8. 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

9. 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.

10. 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?

11. 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.