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Application of Upshur’s ethical principles in Public Health Activities during the Pandemic

Globally, nurses are putting themselves in the frontline against the Covid-19 pandemic.

Although ethical issues are common in the health care system, new challenges arose during this

period. Many unexpected restrictions were implemented by the Central and provincial/territorial

governments to reduce the spread of the virus. It deeply affected each individuals' social and

personal life. This paper discusses the application of Upshar's four ethical principles in the

pandemic interventions and the challenges nurses face while dealing with these measures.

The harm principle is a foundational principle for justifying public health actions. It sets

out the justification to take action to restrict the liberty of an individual or a group in order to

prevent harm to others (Stanhope et al., 2021). All the group members observed that social

isolation, quarantine, shutting down schools and businesses are very much linked with the

principle of harm even though these measures put restrictions on a person's independence and

autonomy. The implemented interventions protected the society to a great extent. According to

Upshur’s " least restrictive principle" the full authority and powers should be used only in

exceptional circumstances, and coercive methods should precede when less coercive methods

have failed (Stanhope et al., 2021). The primary preventive measures such as health education

was delivered by the public health authority to educate the people regarding the transmission and

prevention of the virus. However, when the second wave hit the nation, the authorities executed

more intensive measures to protect the public. Sheryl restated that, according to Canadian Nurses

Association (2006), there should be education and discussion before an individual is forced to do

something, he/she does not wish to do. Maria mentioned about Manitoba's dedicated website that

provides all the necessary information to the public. Savitha, noted that the countrywide

lockdown profoundly affected every aspects of people's life.

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The “reciprocity principle” holds that once public health is warranted, society is

obligated to support individuals and communities in their effort to comply with the public health

interventions (Stanhope et al., 2021). Charnelle and Maria shared almost the same views about

the application of the principle. They mentioned that the Government of Canada opened testing

centres, picked up masks and government hotlines. Moreover, the financial assistance programs

like CERB were provided to the people who are directly affected by COVID-19 (Public Health

Agency of Canada, 2020). This support reduced the resulted burden of intensive measure on

individuals and communities. The “principle of transparency” applies to the manner and context

in which decisions are made (Stanhope et al., 2021). Sheryl noted that this ethical principle

stimulates a culture of openness within organizations, which is thought to have a positive effect

on trust. All the members asserted that the people should have access to the decisions being

made, and also all the key stakeholders, especially clients, should be involved in the decision-

making process. Charnelle enunciated that public health officials' daily briefing through various

media such as radio and television is the best example that demonstrated the transparency of the

nation's health actions.

Health care professionals, especially nurses, confront many ethical challenges in caring

for patients and families. According to Anitha, front-line nurses encounter ethical dilemmas

when they put themselves and others at risk due to inadequate supply of personal protective

equipment (PPE) and limited testing. Charnalle agreed with Anitha and she said that she

experienced the same and couldn't provide bedside nursing care to palliative patients due to the

restrictions. Savitha described a situation where the people hesitated to test due to the expected

financial and social isolation if they come positive. She fears that a nurse's responsibility to the

public cannot be fulfilled in such situations. Maria, in response to Savitha, shared her fear of
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being tested. Sheryl noted that many people who died in isolation units without seeing their

loved ones create ethical concerns for nurses (Morley et al., 2020). In Maria’s point of view the

combination of high job demands and low resources such as PPE for health care providers,

affects the health and well-being of nurses. The resulted stress adversely affects their decision-

making ability.

Overall, all the group members actively shared their observations on Upshur's ethical

principles in the Covid-19 public health actions. However, the ethical challenges they

encountered were different. Some group members expressed a sense of satisfaction in the central

and provincial governments' public health activities to flatten the curve.

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References

Canadian Nurses Association. (February, 2006). Ethics in practice for registered nurses: Public

health nursing practice and ethical challenges. https://cna-aiic.ca/~/media/cna/page-

content/pdf-en/ethics_in_practice_jan_06_e.pdf

Morley, G., Grady, C., McCarthy J., & Ulrich, C. M. (2020). Covid-19: Ethical challenges for

nurses. Wiley Public Health Emergency Collection. doi: 10.1002/hast.1110

Public Health Agency of Canada. (2020). COVID-19 pandemic guidance for the health care

sector - Canada.ca. Government of Canada. https://www.canada.ca/en/public-

health/services/diseases/2019-novel-coronavirus-infection/health-professionals/covid-19-

pandemic-guidance-health-care-sector.html

Stanhope, M., Lancaster, J., Jakubec, S. L., & Pike-Macdonald, S. A. (2017). Community Health

Nursing in Canada (3rd Canadian ed.). Toronto: Mosby Elsevier