See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/6538924

The Evolution of Ethics for Community Practice

Article  in  Journal of Community Health Nursing · February 2007

DOI: 10.1080/07370010709336586 · Source: PubMed

CITATIONS READS

20 1,660

1 author:

Frances E Racher
Brandon University
29 PUBLICATIONS   239 CITATIONS   

SEE PROFILE

All content following this page was uploaded by Frances E Racher on 22 May 2016.

The user has requested enhancement of the downloaded file.

JOURNAL OF COMMUNITY HEALTH NURSING, 2007, 24(1), 65–76
Copyright © 2007, Lawrence Erlbaum Associates, Inc.

The Evolution of Ethics for Community Practice

Frances E. Racher
Brandon University

Defining the community as client or partner requires a different ethical approach, an ap-
proach focused on the aggregate, community, or societal level. A discussion of rule eth-
ics, virtue ethics, and feminist ethics transports the community practitioner beyond tradi-
tional ethical principles to consider a more contemporary ethical foundation for public
health and community practice. Inclusion, diversity, participation, empowerment, social
justice, advocacy, and interdependence create an evolving ethical foundation to support
community practice. Collaboration among health care professionals and members of the
organizations, communities, and societies in which they practice will facilitate the further
development of moral thought and ethical theory to underpin community practice.

Traditionally, health care and human services ethics have focused on the individual cli-
ent. Defining the community as client or partner, however, requires a different ethical
approach, an approach focused on the aggregate, community, or societal level. In this
article, a discussion of rule ethics, virtue ethics, and feminist ethics will move the com-
munity practitioner beyond the traditional ethical principles to ethical foundations for
public health and community practice. Discourse related to the challenges in ethical
practice and consideration of ethical foundations prepares the practitioner to apply eth-
ical theory to community practice. Practitioners are encouraged to consider relation-
ships, environments, and dialogues with and among health professionals and the com-
munities in which they work. Together answers can be sought to ethical dilemmas.
Through discussion and action based on respect for all people and their inclusion, di-
versity, participation, and empowerment, solutions can be achieved. Advocacy is re-
quired to reach the goals of social justice and healthy interdependence among peoples
and their communities.

Correspondence should be addressed to Fran Racher, Brandon University, Brandon, Manitoba, Canada
R7A 6A9. E-mail: racher@brandonu.ca
66 Racher

KEY CONCEPTS IN ETHICAL PRACTICE

Ethics is the philosophical study of morality, the systematic examination and critical re-
flection on living morally, designed to illuminate behaviour that should be taken in con-
sideration of ordinary actions, judgments, and justifications (Beauchamp & Childress,
2001). The terms ethics, from ancient Greek roots, and morality, from Latin origin are
used interchangeably. Values are ideals that have importance or significance to individu-
als, groups, communities, or societies. For example, the Canadian Charter of Rights and
Freedoms documents the societal values of individual freedom, health, fairness, honesty,
and integrity (Department of Justice, 1982). Ethical principles are general standards of
conduct derived from moral theory, to guide moral behaviour, and support the uptake of
consistent moral perspectives and positions (Keatings & Smith, 2000). Ethical principles
such as beneficence and nonmaleficence are stated in many professional codes of ethics.
Virtues are defining traits, strengths of character, and standards for noble conduct, such as
compassion and trustworthiness, that predispose the possessor to consistent excellence
of intent and human performance (Johnstone, 2004).
Ethical pluralism or moral diversity maintains the position that culturally diverse soci-
eties display multiple moral standards which may lead to conflicting moral realities.
However, divergence in values and differences in moral standards across cultural bound-
aries are valued and considered to be resources that have historically led to the evolution
of moral thinking (Volbrecht, 2002). Ethical pluralism rejects the perspective of ethical
relativism, the position that moral judgments can be viewed as right or wrong relative to
the norms or standard patterns of behaviour of a particular culture or society. Different
societies have different cultural norms and thus different moral codes (Card, 2004). Ethi-
cal relativism does not provide direction in situations when cultures conflict, neither is
guidance afforded when individuals belong to multiple cultures with differing perspec-
tives. An individual may belong to various groups which may include ethnic, religious,
professional, and organizational cultures.
Ethical pluralism emphasizes understanding difference rather than striving for unifor-
mity to ensure that moral systems are truly responsive to the lived realities and experi-
ences of all human beings, not just those who hold positions of power (Johnstone, 2004).
Moral diversity ensures that no one point of view dominates. Diversity of values and be-
liefs is crucial to morality’s survival, as it prompts critical reflection, inviting revision and
creative refinement.

ETHICAL THEORIES

Health care professionals and community members regularly make ethical decisions.
These ethical decisions and the moral actions of individuals, organizations, and commu-
nities are influenced by ethical theory. Three ethical theories including rule ethics, virtue
ethics, and feminist ethics are of primary concern in community health.
 Evolution of Ethics 67

Rule Ethics or Ethical Principlism

Two systems, teleology and deontology form the foundation of rule ethics. Teleology
(Greek for “logic of ends”) or consequentialism is concerned about ends, goals, pur-
poses, and outcomes. Rightness is viewed in terms of good produced as consequences of
action. Deontology (Greek for “what is due” or “duty”) is the theory of rights and duties
based on unconditional respect for persons. Deontology requires doing right, regardless
of consequences (Tschudin, 2003). The goal of rule ethics is to delineate moral duties and
obligations within a manageable set of rules or principles.
The search for these principles consumed bioethicists in the later portion of the 20th
century resulting in the seminal work Principles of Biomedical Ethics by Beauchamp and
Childress (1979) who documented four key ethical principles—autonomy, beneficence,
nonmaleficence, and justice, considered to be prima facie or to have equal weight or pri-
ority in a particular situation. The strength of these four principles is in their compatibil-
ity with both teleological and deontological theories. In recent literature, fidelity, verac-
ity, and respect for persons have been included as separate principles (Aiken, 2004;
Purtilo, 2005; Scoville Baker, 2004).
These seven ethical principles form the basis of rule ethics currently applied in com-
munity practice. In health care, autonomy involves respect for clients’ rights to make de-
cisions about and for themselves and their care. Health care providers act to support the
autonomy of clients and provide information to them upon which to base their decisions.
Limitations can be placed on autonomy in situations where individual choices interfere
with the rights or well-being of others. Personal choice or autonomy may be restricted by
concern for the well-being of the community. Although clients generally have the auton-
omous right to refuse treatment, if a contagious disease such as tuberculosis is diagnosed,
clients can be required to take prescribed medication and may be isolated or quarantined
to prevent the spread of the infectious disease to others.
Beneficence and nonmaleficence are age old requirements of the Hippocratic Oath for
health professionals to “do good” and “do no harm.” Beneficence requires potential ben-
efits to individuals and society be maximized and potential harms minimized, while pro-
motion of the common good and protection of individuals are considered (Vollman,
2004). Community-wide initiatives may not be viewed as beneficial to all sectors of the
community or by all sectors of the community. The practice of community health re-
quires advocacy for the benefit, well being, and protection from harm for all people in
general and for populations and groups who are vulnerable in particular.
The principle of justice is based on obligations of fairness, regarding treatment of indi-
viduals and groups within society; the distribution of potential benefits and potential bur-
dens (distributive justice), and the ways that those who have been unfairly burdened or
harmed are compensated (compensatory justice). Procedural rules focus on the process
of distribution noted in maxims such as “first come, first served” and “due process.”
Rules of justice are based on perceptions of fairness, with maxims such as “to each ac-
cording to need.” Distributive justice or the distribution of benefits (education) and bur-
68 Racher

dens (taxes) may be viewed from the perspectives of communitarianism, egalitarianism,

libertarianism, or utilitarianism.
Community practice is traditionally based on utilitarianism, adheres to the axiom “the
greatest good for the greatest number,” and supports the position that maximizing bene-
fits to socially disadvantaged groups ultimately benefits society as a whole. Community
practitioners advocate for distribution of health promotion and chronic disease preven-
tion resources in ways that are fair and equitable to benefit the most people, while also
considering the needs of vulnerable populations.
Respect for persons is the foundation of all other principles and for some is subsumed,
along with fidelity and veracity, under the principle of autonomy (Johnstone, 2004). Re-
spect for persons ensures their right to privacy and confidentiality. Sometimes in public
health the individual right to privacy is usurped by the public benefit of disclosure. For
example, in the United States regulations were changed to allow the use of large health
databases for epidemiological research to benefit society, without the informed consent
of those people whose information was held in the database (Bayer & Fairchild, 2004).
In community health promotion and community development, the respect for persons
is extended to respect for their experience as knowledge, and their abilities and capacities
as community members to contribute to decision making and planning at the community
level. Respect for persons applies to all persons and supports the inclusion and participa-
tion of all community members in community endeavors.
The principle of fidelity is about faithfulness and focuses on maintaining loyalty,
keeping promises, and being faithful in relationships. Whether working with individuals
or communities, health professionals must be careful in making promises and steadfast in
keeping them. Commitments may be as simple as attending meetings or as extensive as
delivering survey findings back to community leaders. The principle of veracity, the duty
to tell the truth and be honest, is essential in building and maintaining trust in relation-
ships with individuals, groups, and communities. Health care providers and researchers
working in and with communities must be truthful and transparent in the work they un-
dertake and the relationships they establish.

Critique of Rule Ethics

The application of ethical principles and the theoretical limitations of the principles have
raised concerns about the effectiveness of rule ethics. Ethical principles are not easily pri-
oritized or applied to concrete moral situations (Johnstone, 2004), whether in the inter-
pretation of the required actions in a given situation or in deciding the relative weights of
given principles (Rodney, Burgess, McPherson, & Brown, 2004). Reliance on ethical
principles may lead to the exclusion of other variables known to influence ethical prac-
tice. Critics argue that rule ethics neglect important aspects of the moral experience of
health care professionals, including moral judgments, the significance of emotions and
 Evolution of Ethics 69

experience, and the relational nature of professional practice (Volbrecht, 2002). The ca-
pacity to make contextual moral judgments and discern morally appropriate responses
exceeds the will to take the right action and the analytic skills to apply rules to situations.
Rule ethics is criticized for reflecting typically masculine characteristics of autonomy,
rationality, and independence of the moral subject, in contrast to an ethic of care that re-
flects more typically feminine characteristics of responsiveness to relational responsibil-
ities, emotional connectedness, and contextuality (Volbrecht, 2002). The principle-based
approach is also criticized for being culturally specific and inattentive to a multicultural
society; weak in insisting on action related to issues such as access to health care or the
creation of choices for vulnerable groups; and missing the subtle pervasive power dy-
namics that infuse individual, family, and community relationships within current hierar-
chies (Rodney et al., 2004).
Emerging ethical theory emphasizes the importance of community as the context, where
values and virtues are collectively shaped and practical moral reasoning is exercised. Com-
munity and relationships are central themes in virtue ethics and feminist ethics.

Virtue Ethics or Moral Virtues

While rule ethics is action based, virtue ethics is agent based. Instead of duties and obli-
gations, virtue ethics focuses on characteristics of the moral agent. With the dissatisfac-
tion of rule ethics, virtue ethics has influenced the development of many codes of ethics.
The main criteria of virtue ethics involve the type of person one should strive to be and the
sort of life one ought to live. Virtue ethics involves the integration of seeing, feeling, and
acting. Virtue connotes the moral excellence of intent and behavior. Goodness is prior to
rightness and various virtues, such as loyalty, courage, and honesty, are necessary for
good actions (Tschudin, 2003). Because individuals live in communities that signifi-
cantly affect their character development and persons can be nurtured or marred accord-
ingly, virtue ethics asserts that people are not only responsible for developing good char-
acter as individuals, but also have responsibilities for the kind of communities they
collectively develop (Volbrecht, 2002).
Professional codes of ethics often identify values and virtues that are considered es-
sential for ethical practice. Values and virtues overlap when the ideals of importance are
defining traits or standards for noble conduct. For example, some values articulated in the
Code of Ethics for Registered Nurses (Canadian Nurses Association, 2002) such as dig-
nity, confidentiality, fairness, and accountability could also be defined as virtues of im-
portance to the profession of nursing and applicable to all health care professions.
Caring is often considered to be a virtue. Tschudin (2003) discussed eight major ingre-
dients for caring in general and five Cs of caring particular to nursing and health care pro-
fessionals. In both cases the characteristics of caring could be defined as virtues for pub-
lic health or community practice.
70 Racher

Critique of Virtue Ethics

The major criticism of virtue ethics is that virtues are not always compatible and no pro-
cess is offered to resolve this type of conflict (Glannon, 2005). For example, disclosure of
negative information may trigger negative consequences, and the virtue of compassion
comes into conflict with the virtue of honesty. Some argue that virtue ethics entails a cir-
cular process whereby the virtuous person does what is good, and what is good is what
the virtuous person does. Thus virtue ethics is unable to explain its force or power as a
moral guide in the absence of obligations, maxims, or principles (Johnstone, 2004). Oth-
ers suggest that virtue ethics places unrealistic and unattainable expectations on people to
be excellent. Proponents respond by questioning the need to justify virtuous actions, re-
jecting the expectation that virtue ethics can be reduced to a set of ethical rules, and
spurning the belief that expecting moral excellence is an unrealistic prospect.

Feminist Ethics

Feminist ethics is viewed as an extension of virtue ethics, as it emphasizes an ethics of

care that involves human connectedness and the importance of interpersonal relation-
ships (Glannon, 2005). Feminist ethics strives to address the imbalance of power be-
tween men and women, and places them on equal footing. Feminist ethics draws atten-
tion to the distinguishing characteristics of relationships and the power within those
relationships at individual, group, community, and societal levels. Based on the core ideal
of achieving social justice, feminist ethics extends the principle of justice and the notion
of distributive justice to consider social structures and contexts. Feminist ethics is com-
mitted to the constructive process of designing alternative ways to restructure relation-
ships, social practices, and institutions, with the ultimate goal of social transformation
that will empower all people to live freer and fuller lives (Volbrecht, 2002).
Feminist ethics in the 1960s coincided with feminist activism, as grassroots activists
were joined by academic feminists and debate ensued on practical issues of contempo-
rary social life. By the late 1970s, feminists were questioning the ability of traditional
ethical theories to address “women’s issues”; others were recognizing the difficulties as-
sociated with using traditional ethical theories to address issues in a complex, multicul-
tural world; and still others were identifying the contributions that feminist ethics could
make to address these concerns and other ethical issues. Carol Gilligan’s (1982) work
revolutionized discussions in moral theory and feminism, as she argued that women
speak with a different voice than men, and espoused a feminine ethic of care that consid-
ered responsibility to care and relationships between people as opposed to a masculine
ethic of justice that considered ethical principles, conflicting duties, and consequences.
Feminist ethics and its application strive to strengthen connectedness and relation-
ships, eliminate oppression, balance power, and achieve social justice. Volbrecht (2002)
 Evolution of Ethics 71

recommended that ethical decision making should involve (a) identifying social practices
that underlie and contribute to the ethical problem or situation, (b) examining and evalu-
ating ways that these social practices may contribute to oppression of the social group in-
volved, (c) considering ways that a relational account of justice reveals the harm done to
the oppressed group, (d) considering unique insights that people who have been
marginalized by social practices can provide, and (e) designing new ways to restructure
or resist oppressive practices.

Critique of Feminist Ethics

The primary criticism of feminist ethics comes from those who believe in the application
of ethical principles in a rational manner, without complication of emotions or concern
for relationships. Proponents of feminist ethics cover a continuum from recognizing this
approach as a complement that extends rule ethics and virtue ethics, to advocating for the
application of feminist ethics in completely new and evolving ways.

AN ETHICAL FOUNDATION FOR PUBLIC HEALTH

AND COMMUNITY PRACTICE

Inclusion, diversity, participation, empowerment, social justice, advocacy, and interdepen-

dence are key considerations of feminist ethics from the individual to the societal level.
These concepts form an ethical foundation for public health and community practice.

Inclusion

Inclusion or the act of being included means being accepted and able to participate fully
within the family, the community, and the society within which one lives (Guildford,
2000). People who are excluded, whether because of poverty, ill-health, gender, race, or
lack of education, do not have the opportunity for full participation in the social and eco-
nomic benefits of the community or the society. Values that underpin this work are social
justice and diversity. Ultimately, the goal is to provide a new way to encourage change
that will transform organizations, communities, and society as a whole.

Diversity

Diversity or differing from one another involves distinct or unlike elements or qualities.
The value of diversity among people is key in ethical pluralism and required for the evo-
72 Racher

lution of moral thought. Valuing diversity requires a recognition and respect for the diver-
sity of culture, race, ethnicity, language, religion, ability, age, and sexual orientation; a
valuing of the contributions of men and women to the social, economic, and cultural vi-
tality of society (Shookner, 2002).

Participation

Public participation involves engaging people in determining the ways a society guides
its actions, makes decisions on public policy, and delivers programs and services. The
desired outcome of participation in decision making is greater social cohesion as evi-
denced by the creation of shared values, the reduction of health and wealth disparities,
and the building of community spirit and capacity for action (Vollman, 2004). Increas-
ingly, community and public health agencies are involving citizens in processes of ser-
vice planning and program evaluation. Public involvement strategies must be designed
and planned in collaboration with stakeholders to facilitate informed and meaningful
public participation.

Empowerment

As a process, empowerment is the development of knowledge and skills that increase one’s
mastery over decisions that affect one’s life (Vollman, 2004). As an outcome, empower-
ment is the achievement of mastery. To be empowered, people must be able to predict, con-
trol, and participate in their environments. Community empowerment is exhibited as resi-
dents actively participate and promote inclusion, communicate with respect and in ways
that accommodate and manage conflict, demonstrate commitment to collectively deter-
mined goals, foster and share leadership and decision making, create supportive environ-
ments, strive for social justice, and nurture intra- and intercommunity relationships. Effec-
tive community practitioners engage with communities and act as resources to them as they
strive to achieve the many aspects of community empowerment.

Social Justice

Social justice is ideologically neutral and open to people of all political and religious af-
filiations, socioeconomic brackets, cultures, ethnic groups, ages, and both genders
(Vollman, 2004). The virtue of social justice allows for people of good will to reach dif-
ferent, even opposing, practical judgments about the material content of the common
good (ends) and ways to get there (means). Social justice is based on the application of
equity, rights, access, and participation. Social justice counters oppression and power-
 Evolution of Ethics 73

lessness. The role of community workers is to support inclusion and empowerment of

people living on the margins of society to freely participate on footings of respect. Em-
powerment is the guarantor of equity and justice, and freedom is the result—freedom to
fully participate in public decisions (Vollman, 2004).

Advocacy

Advocacy is the act of disseminating information to influence opinion, conduct, public

policy, or legislation. It is the pursuit of influencing outcomes, including public policy
and resource allocation decisions within political, economic, and social systems and in-
stitutions, which directly affect people’s lives. Advocacy consists of organized efforts
and actions to highlight critical issues that have been ignored and submerged, to influ-
ence public attitudes, and to enact and implement laws and public policies so that visions
of a just, decent society become reality. The goal of advocacy is to promote social justice
and equity. Human rights—political, economic, and social—are the overarching frame-
work for this vision (Vollman, 2004). Community workers, as advocates, represent the
interests of the people in the community, intervene to investigate problems and resolve
conflicts, assist in capacity building within the community to advocate on its own behalf,
review and comment on public policy, and disseminate information to the community
and across communities.

Interdependence

Public health strives for the health of entire communities and recognizes that the health of
individuals is tied to the life of the community. Interdependence of the people is the es-
sence of community (American Public Health Association [APHA], 2002); reciprocity
among people and between people and their social, economic, and physical environ-
ments, the world in which they live.

ADVANCES IN ETHICS FOR COMMUNITY PRACTICE

Population and public health have come to the foreground as a result of the reminders
posed by Autoimmune Deficiency Syndrome (AIDS) and Severe Acute Respiratory
Syndrome (SARS) that infectious disease has not been conquered. Efforts of public
health management of infectious diseases has raised ethical questions related to the
principle of autonomy and individual choice which is often found in conflict with the
collective good in public or population health. Ethical issues related to the determi-
nants of health and access to employment, education, health services, and healthy envi-
74 Racher

ronments have added to the ethical challenges presented by population health. Public
health issues related to epidemiological research and the use of large population data
bases without expressed consent of members of the population, surveillance related to
AIDS, confinement related to SARS, and restrictions related to tobacco consumption
have generated ethical issues calling for the birth of public health ethics (Bayer &
Fairchild, 2004).
As a result, the APHA (2002) developed the Public Health Code of Ethics. In sharp
contrast to medical ethics, public health is concerned more with populations than with in-
dividuals, more with prevention than with cure (Thomas, Sage, Dillenberg, & Guillory,
2002). Public health is understood as what society undertakes collectively to assure con-
ditions for people to be healthy, and the code states key principles for the ethical practice
of public health (APHA, 2002).
Public health and this code give priority to the common good over the individual, pre-
vention over cure, pubic participation, advocacy, empowerment, social justice, and evi-
dence-based decision making. The code recommends providing information and obtain-
ing community consent for decisions on policies and programs, acting in a timely
manner, applying varied approaches in respect of diversity, and respecting and enhancing
social and physical environments. Public health institutions are expected to strive to pro-
tect confidentiality of information, ensure professional competence of their employees,
and engage in collaborations and affiliations that build public trust and organizational ef-
fectiveness. Although challenges will occur as conflicts arise in the application of the
principles, and the setting of priorities among them dependent on circumstance, they are
an effort at documentation of explicit guidelines for public health practice. Beyond the
principles, the code also includes statements of values and beliefs, and notes related to
the individual principles.

ETHICAL CHALLENGES IN COMMUNITY PRACTICE

A variety of ethical challenges exist within public health and community practice that
continue to keep practitioners, communities, and society as a whole “ethically en-
gaged.”

• The conflict continues between respecting individual autonomy and benefiting or

protecting the collective or the community.
• Protecting individual right to privacy and informed consent may conflict with shar-
ing individual information for the benefit of the health of the public.
• The goals of social justice and empowerment can be very difficult to achieve and
many barriers may need to be identified and addressed in community practice.
• Facilitating and ensuring inclusion and diversity in community participation,
though challenging, is fundamental to effective community practice.
 Evolution of Ethics 75

• Fostering and maintaining effective and caring relationships with the various pro-
fessionals, clients, organizations, and communities with whom one engages re-
quires commitment and constant effort.
• Appropriate boundaries in community work with individuals, groups and communi-
ties, though often difficult to establish and maintain, is vital in community practice.
• Working with multiple partnerships offers challenges in supporting and ensuring
processes through which all groups are respected, involved, contributing as able, in-
cluded in decision making, and benefiting equitably.
• Issues of social justice and conflict arise in striving to support the autonomy and
rights of the community while facilitating the empowerment and rights of groups
within the community who may have been marginalized and are feeling vulnerable.
• Practitioners must be prepared to manage situations where values, roles, and re-
sponsibilities within their professions, organizations of employment, and communi-
ties of practice come into conflict.
• Protection of clients, coworkers, and others, including one’s self, requires consider-
ations of autonomy, informed consent, advocacy for marginalized groups, and risk
management in daily practice.
• Advocacy has the potential to generate conflict and community practitioners are chal-
lenged to build and apply skills in mediation, negotiation, and conflict resolution.
• Community practitioners are expected to prevent or disclose conflicts of interest; be
transparent in their intentions; and act with honesty, truthfulness, loyalty, and integ-
rity at all times.

CONCLUSION

The application of rule ethics, virtue ethics, and feminist ethics offers ways to address
ethical dilemmas and resolve ethical conflict. Feminist ethics have made way for the rev-
olutionary inclusion of responsiveness to relational responsibilities, emotional
connectedness, and contextuality in discussions of ethical practice. Inclusion, diversity,
participation, empowerment, social justice, advocacy, and interdependence and their in-
terrelationships create a foundation to effectively underpin and support ethical commu-
nity practice. The genesis of a public health code of ethics, conversations about ethics in
health promotion, and identification of ethical challenges in community practice extend
the dialogue.
Ethics exists at individual, group, community, and societal levels. Ethics is a process
of reflecting consciously on moral beliefs and consists of an ongoing dialogue about val-
ues and actions that should be taken in light of those values. Ethics, as a communal dia-
logue, is a dynamic, ongoing conversation among members of a community about values
and principles needed to make society and people’s lives as civilized and fruitful as possi-
ble (Volbrecht, 2002). Ethical pluralism promotes ongoing dialogue among community
 76 Racher

members facilitating the development and identification of a community’s shared moral

understandings and expectations of its members and the community as a whole. The in-
terdependence, relationships, and collaboration among health care professionals and
members of the organizations, communities, and societies in which they practice will fa-
cilitate the further development of moral thought and continue the evolution of ethical
theory to ensure ethical community practice.

REFERENCES

Aiken, T. (2004). Legal, ethical and political issues in nursing (2nd ed.). Philadelphia: Davis.
American Public Health Association. (2002). Public health code of ethics. Washington, DC: American Pub-
lic Health Association. Retrieved March 1, 2006, from http://apha.org/codeofethics/ethics.htm
Bayer, R., & Fairchild, A. (2004). The genesis of public health ethics. Bioethics, 18, 473–492.
Beauchamp, T., & Childress, J. (1979). Principles of biomedical ethics. New York: Oxford University Press.
Beauchamp, T., & Childress, J. (2001). Principles of biomedical ethics (5th ed.). New York: Oxford Univer-
sity Press.
Canadian Nurses Association. (2002). Code of ethics for registered nurses. Ottawa, Ontario, Canada: Author.
Card, R. (2004). Critically thinking about medical ethics. Upper Saddle River, NJ: Pearson Prentice Hall.
Department of Justice. (1982). Canadian Charter of Rights and Freedoms. Ottawa: Department of Justice.
Retrieved March 13, 2006, from http://laws.justice.gc.ca/en/charter/index.html
Gilligan, C. (1982). In a different voice. Cambridge, MA: Harvard University Press.
Glannon, W. (2005). Biomedical ethics. New York: Oxford University Press.
Guildford, J. (2000). Making the case for social and economic inclusion. Halifax, Nova Scotia, Canada: At-
lantic Region, Health Canada.
Johnstone, M. (2004). Bioethics: A nursing perspective (4th ed.). Sydney, Australia: Churchill Livingstone.
Keatings, M., & Smith, O. (2000). Ethical and legal issues in Canadian nursing (2nd ed.). Toronto, Ontario,
Canada: Saunders.
Purtilo, R. (2005). Ethical dimensions in the health professions (4th ed.). Philadelphia: Elsevier Saunders.
Rodney, P., Burgess, M., McPherson, G., & Brown, H. (2004). Our theoretical landscape: A brief history of
health care ethics. In J. Storch, P. Rodney, & R. Starzomski (Eds.), Toward a moral horizon: Nursing eth-
ics for leadership and practice (pp. 56–76). Toronto, Ontario, Canada: Pearson Prentice Hall.
Scoville Baker, S. (2004). Ethical quandaries in community health nursing. In E. Anderson & J. McFarlane
(Eds.), Community as partner: Theory and practice in nursing (4th ed., pp. 83–113). Philadelphia:
Lippincott, Williams & Wilkins.
Shookner, M. (2002). An inclusion lens: Workbook for looking at social and economic exclusion and inclu-
sion. Halifax, Nova Scotia, Canada: Population and Public Health Branch, Health Canada.
Thomas, J., Sage, M., Dillenberg, J., & Guillory, V. (2002). A code of ethics for public health. American
Journal of Public Health, 92, 1057–1059.
Tschudin, V. (2003). Ethics in nursing: The caring relationship. Edinburgh, UK: Butterworth Heinemann.
Volbrecht, R. (2002). Nursing ethics: Communities in dialogue. Upper Saddle River, NJ: Prentice Hall.
Vollman, A. (2004). Ethics and advocacy in community practice. In A. Vollman, E. Anderson, & J.
McFarlane (Eds.), Canadian Community as Partner (pp. 106–123). Philadelphia: Lippincott, Williams,
& Wilkins.

View publication stats