Through an agreement with Access Copyright, the Nova Scotia Health Ethics Network (NSHEN) has created groups of readings of relevant and timely articles as educational resources. Each package contains 6-8 articles that are meant to provide a general overview and introduction to a selected topic.

To request the readings from one of the topics below please email the NSHEN Administrator at indicating:

- which topic of readings you would like
- your name and mailing address

We will then mail the readings to you, free of charge.

To view the articles that are included within each package, please select a title of the topics listed below.

1: Complementary & Alternative Health Care

2: Health Policy

3: Health Resource Allocation

4: Hope

5: Moral Distress

6: Organizational Ethics

7: Pandemic Planning

8: Rural Health Care

9: Social Media & Telemedicine

10: All Hazards Planning (articles to follow)

11: Professional Boundries (articles to follow)


Health Ethics Readings by Topic

1. Complementary & Alternative Health Care

Adams, K. E., Cohen, M. H., Eisenberg, D., & Jonsen, A. R. (2002). Ethical considerations of complementary and alternative medical therapies in conventional medical settings. Annals of Internal Medicine, 137(8), 660-664.

Alternative and/or complementary therapy: Standards for registered nurses. College and Association of Registered Nurses of Alberta Provincial Council.

Brown, J., Cooper, E., Frankton, L., Steeves-Wall, M., Gillis-Ring, J., Barter, W., et al. (2007). Complementary and alternative therapies: Survey of knowledge and attitudes of health professionals at a tertiary pediatric/women's care facility. Complementary Therapies in Clinical Practice, 13(3), 194-200.

Canadian association of naturopathic medicine - guide to ethical conduct of naturopathic doctors. (2008).

Canadian association of naturopathic medicine - standards of practice.(2008).

Cohen, M. H., Sandler, L., Hrbek, A., Davis, R. B., & Eisenberg, D. M. (2005). Policies pertaining to complementary and alternative medical therapies in a random sample of 39 academic health centers.Alternative Therapies in Health and Medicine, 11(1), 36-40.

Fries, C.J. (2008). Classification of complementary and alternative medical practices: Family physicians' ratings of effectiveness. Canadian Family Physician, 54 (11), 1570-1571.

Hsu, C., Phillips, W.R., Sherman, K.J., Hawkes, R., & Cherkin, D.C. (2008). Healing in Primary Care: A Vision Shared by Patients, Physicians, Nurses and Clinical Staff. The Annals of Family Medicine, 6 (4), 307-314.

Kelly, M., Hardwick, K., Moritz, S., Kelner, M., Rickhi, B., & Quan, H. (2005). Towards integration: Opinions of health policy makers on complementary and alternative medicine. Evidence-Based Integrative Medicine, 2(2), 78-86.

Public Health Agency of Canada. (2003). Perspectives on Complementary and Alternative Health Care.

Walker, P. C. (2000). Evolution of a policy disallowing the use of alternative therapies in a health system. American Journal of Health-System Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists, 57(21), 1984-1990.

2. Health Policy

Aronson, J. (1993). Giving consumers a say in policy development: Influencing policy or just being heard? Canadian Public Policy, 14(4), 367-378.

Baird, P. A. (1996). Funding medical and health-related research in the public interest. CMAJ : Canadian Medical Association Journal, 155(3), 299-301.

Ezekiel, J.E. (2012). Where are the health care cost savings? Journal of the American Medical Association, 307 (1), 39-40.

Foglia, MB., Fox, E., Chanko, B., & Bottrell, M.M. (2012). Preventive Ethics: Addressing ethics quality gaps on a system level. Joint Commission Journal on Quality and Patient Safety, 38 (3), 103-111.

Guindo, L.A., Wagner, M., Baltussen, R., Rindress, D., et al. (2012). From efficacy to equity: Literature review of decision criteria for resource allocation and healthcare decision making. Cost Effectives and Resource Allocation, 10 (9).

Kirby J., Simpson C. (2007). An Innovative, Inclusive Process for Meso-level Health Policy Development. Healthcare Ethics Forum. 19(2), 161-76.

Kirk, S., Sim, S., Hemmens, E. (2012). Lessons Learned from the Implementation of a Provincial Breastfeeding Policy in Nova Scotia, Canada and the Implications for Childhood Obesity Prevention. International Journal of Environmental Research and Public Health, 9 (4), 1308-1318.

Kuluski, K., Williams, A.P., Berta, W., & Laporte, A. (2012). Home care or long-term care? Setting the balance of care in urban and rural Northwestern Ontario, Canada.  Health & Social Care in the Community, 20 (4),438-448.

MacIntyre, S. (2012). Evidence in the development of health policy. Public Health, 126 (3), 217-219.

Malone, R. E. (1999). Policy as product. morality and metaphor in health policy discourse. The Hastings Center Report, 29(3), 16-22.

McDonald, Fiona; Simpson, Christy; and Fran O'Brien. 2008. Including organizational ethics in policy review processes in healthcare institutions: A view from Canada. HEC Forum 20(2): 137-153.

Sherwin, S., & Baylis, F. (2003). The feminist health care ethics consultant as architect and advocate. Public Affairs Quarterly, 17(2), 141-158.

Stabile, B. (2012). Review of Health Policy Ethics: A critical examination of values from a global perspective. World Medical and Health Policy

Walker, M. U. (1993). Keeping moral space open. new images of ethics consulting. The Hastings Center Report, 23(2), 33-40.

3. Health Resource Allocation

Beauchamp T. Distributive Justice and Morally Relevant Differences. In the Belmont Report Appendix Volume 1, 1978.

Buchanan A, Brock DW, Daniels N, Wikler D. From Chance to Choice: Genetics and Justice (Cambridge: Cambridge University Press, 2000).

Canadian Nurses Association. Working with Limited Resources: Nurses’ Moral Constraints. Ethics in Practice 2000 (Sept).

Daniels N, Sabin JE. Setting Limits Fairly: Can We Learn to Share Medical Resources? New England Journal of Medicine 2002; 347:953-54.

Daniels N. Rationing fairly: Programmatic Considerations. Bioethics 1993; 7(2/3): 224-233.

Daniels N. Justice and Health Care.  In Van de Veer D, Regan T, eds., Health Care Ethics: An Introduction (Philadelphia: Temple University Press, 1987).

Fleck LM. Last Chance Therapies: Can a Just and Caring Society Do Health Care Rationing When Life Itself is at Stake? Yale Journal of Health Policy, Law, and Ethics 2002; 2(2): 255-298.

Fleck LM. Rationing: Don’t Give Up. Hastings Center Report 2002; 32(2): 35-36.

Gibson JL, Martin DK, Singer P. Evidence, Economics and Ethics: Resource Allocation in Health Services Organizations. Healthcare Quarterly 2005; 8(2): 50-58.

McNeally MF, Dickens BM, et al. Bioethics for Clinicians: 13. Resource Allocation. CMAJ 1997; 157: 163-167.

Kenny N, Chafe R. Pushing Right against the Evidence: Turbulent Times for Canadian Health Care. The Hastings Center Report 2007.
Malone RE. Policy as Product. Hastings Center Report 1999; 29(3):16-22.

Rawls J. A Theory of Justice (Cambridge: Harvard University Press, 1971).

4. Hope

Back, A.L.; Arnold, R.M.; & Quill T.E. (2003) Hope for the best, and prepare for the worst. Annals of Internal Medicine, 138, 439-443.

Coulehan, J. (2011). Deep hope: A song without words. Theoretical Medicine and Bioethics, 32, 143-160.

Davison, S. N. & Simpson, C. (2006). Hope and advance care planning in patients with end stage renal disease: Qualitative interview study. BMJ, 333(7574), 868 - 872.

Olver, I.N. (2005) Bioethical implications of hope. In J Eliott (Ed.), Interdisciplinary perspectives on hope (pp. 241-256). New York: Nova Science Publishers, Inc.

Martin, A.M. (2008) Hope and exploitation. Hastings Center Report, 38(5), 49-55.

Pergert, P., & Lutzen, K. (2011). Balancing truth-telling in the preservation of hope: A relational ethics approach. Nursing Ethics, 19 (1), 21-29.

Simpson, C. (2004). When hope makes us vulnerable: A discussion of patient-healthcare provider interactions in the context of hope. Bioethics, 18(5), 428-447.

* For more references and readings on hope, especially for different health conditions see also: The Hope Foundation of Alberta, Hope Literature database (

5. Moral Distress

Anyfantakis, D., & Symvoulakis, E. (2011). Medical decision and patient's preference: 'Much ethics' and more trust always needed. International Journal of Medical Sciences, 8 (4), 351-352.

Austin, W. (2012). Moral distress and the contemorary plight of health professionals. Humanties, Social Sciences and Law, 24 (1), 27-38.

Austin, W., Lemermeyer, G., Goldberg, L., Bergum, V., & Johnson, M. S. (2005). Moral distress in healthcare practice: The situation of nurses. HEC Forum : An Interdisciplinary Journal on Hospitals' Ethical and Legal Issues, 17(1), 33-48.

Canadian Nurses Association. (2003). Ethical distress in health care environments. Ethics in Practice for Registered Nurses, 1-8.

Epstein, E.G., & Hamric, A.B. (2009). Moral distress, moral residue, and the crescendo effect. The Journal of Clinical Ethics, 20 (4), 330-342.

Forde, R., & Aasland, O. G. (2008). Moral distress among norwegian doctors. Journal of Medical Ethics, 34(7), 521-525.

 Hamric, A. B., & Blackhall, L. J. (2007). Nurse-physician perspectives on the care of dying patients in intensive care units: Collaboration, moral distress, and ethical climate. Critical Care Medicine, 35(2), 422-429.

Hamric, A.B., Borchers, C.T., & Epstein, E.G. (2012). Development and testing of an instrument to measure moral distress in healthcare professionals. AJOB Primary Research, 3 (2), 1-9.

Hamric, A. B., Davis, W. S., & Childress, M. D. (2006). Moral distress in health care professionals. The Pharos of Alpha Omega Alpha-Honor Medical Society.Alpha Omega Alpha, 69(1), 16-23.

Nathaniel, A. Moral distress among nurses. American Nurses Association Ethics and Human Rights Issues Update, Spring 2002.

Pauly, B., Varcoe, C., & Storch, J. (2012). Framing the issues: Moral distress in health care. Humanities, Social Sciences and Law, 24 (1), 1-11.

Wilkinson, J. M. (1988). Moral distress in nursing practice: Experience and effect. Nursing Forum, 23(1), 16-29.

6. Organizational Ethics

Carney, M. (2011). Influence of organizational culture on quality healthcare delivery. International Journal of Health Care Quality Assurance, 24 (7), 523-539.

Ells, Carolyn and Chris MacDonald. 2002. Implications of organizational ethics to healthcare. Healthcare Management Forum 15(3): 32-38.

Goodstein, Jerry D. and Bridget Carney. 1999. Actively engaging organizational ethics in healthcare: Four essential elements. Journal of Clinical Ethics 10(3): 224-229.

*Please see above issue for additional readings on organizational ethics

Goold, Susan Dorr. 2001. Trust and the ethics of health care institutions. Hastings Center Report 31(6): 26-33.

Kirby, Jeffrey; Simpson, Christy; McNally, Mary; and Fiona McDonald. 2005. Instantiating organizational ethics in large health care institutions. Organizational Ethics: Healthcare, Business, and Policy 2(2): 117-123.

McDonald, Fiona; Simpson, Christy; and Fran O'Brien. 2008. Including organizational ethics in policy review processes in healthcare institutions: A view from Canada. HEC Forum 20(2): 137-153.

Reiser, Stanley Joel. 1994. The ethical life of health care organizations. Hastings Center Report 24(6): 28-35.

Simpson, Christy and Jeff Kirby. 2004. Organizational ethics and social justice in practice: Choices and challenges in a rural-urban health region. HEC Forum 16(4): 274-283.

Suhonen, R., Stolt, M., Virtanen, H., & Leino-Kilpi, H. (2011). Organizational ethics: A literature review. Nursing Ethics, 18 (3), 285-303.

7. Pandemic Planning

Carbell, G., & Christian, M. (2011). Critical care providers' perceptions of pandemic preparedness folowing the H1N1 pandemic. CHEST Journal, 140 (4), 280a-280a.

Government of Nova Scotia. (2008). Pandemic influenza: Nova Scotia health system pandemic influenza plan. ver.2. Halifax, NS:Department of Health.

Kayman, H., & Ablorh-Odjidja, A. (2006). Revisiting public health preparedness: Incorporating social justice principles into pandemic preparedness planning for influenza.Journal of Public Health Management and Practice, 12(4), 373-380.

Kotalik, J. (February 2006). Ethics of planning for and responding to pandemic influenza: Literature review.Centre for Health Care Ethics Lakehead University.

Kotalik, J. (2005). Preparing for an influenza pandemic: Ethical issues. Bioethics, 19(4), 422-431.

Lo, B., & Katz, M. H. (2005). Clinical decision making during public health emergencies: Ethical considerations. Annals of Internal Medicine, 143(7), 493-498.

Nicoll, A., Brown, C., Karcher, F., Penttinen, P., et al. (2012). Developing pandemic preparedness in Europe in the 21st century: Experience, evolution and next steps. Bulleton of the World Health Organization, 90, 311-317.

Silva, D.S., Gibson, J.L., Robertson, A., et al. (2012). Priority setting of ICU resources in an influenza pandemic: A qualitative study of the Canadian public's perspectives. BioMed Central Public Health, 12, 1471-2458.

Torda, A. (2006). Ethical issues in pandemic planning. The Medical Journal of Australia, 185, S73-6.

World Health Organization. Ethical considerations in developing a public health response to pandemic influenza. WHO Press.

8. Rural Health Care

Artnak, K.E., McGraw, R.M., & Stanley, V.F. (2011). Health care accessibility for chronic illness management and end-of-life care: A view from rural America. The Journal of Law, Medicine and Ethics, 39 (2), 140-155.

Cook, A. F., & Hoas, H. (2008). Ethics and rural healthcare: What really happens? What might help? The American Journal of Bioethics: AJOB, 8(4), 52-56.

*Please see above issue for additional commentaries on rural health care

Malone, J., & Dyck, K. (2011). Professional ethics in rural and northern Canadian psychology. American Psychological Association, 52 (3), 206-214.

National rural bioethics web site. (2008).

*See this website for more resources

Nelson, W., Lushkov, G., Pomerantz, A., & Weeks, W. B. (2006). Rural health care ethics: Is there a literature? The American Journal of Bioethics: AJOB, 6(2), 44-50.

Nelson, W., & Morrow, C. (2011). Rural primary care-working outside the comfort zone. Virtual Mentor, 13 (5), 278-281.

Nelson, W.A., & Schifferdecker, K.E. Rural health care ethics: A manual for trainers.

Roberts, L. W., Battaglia, J., Smithpeter, M., & Epstein, R. S. (1999). An office on main street. Health care dilemmas in small communities. The Hastings Center Report, 29(4), 28-37.

Shih, T.L., & Goldman, J.J. (2011). Recognizing and resolving ethical dilemmas in rural medicine. Virtual Mentor, 13 (5), 291-294.

Simpson, C. (2004). Challenges for health regions--meeting both rural and urban ethics needs: A Canadian perspective. HEC Forum: An Interdisciplinary Journal on Hospitals' Ethical and Legal Issues, 16(4), 219-221.

*Please see above issue for additional readings on rural health care

Townsend, T. (2011). Patient privacy and mental health care in the rural setting. Virtual Mentor, 13 (5), 282-286.


9. Social Media & Telemedicine

Barrett, M., Larson, A., Carville, K., & Ellis, I. (2009). Challenges faced in implementation of a teleheatlh enabled chronic wound care system. Rural and Remote Health, 9, 1-9.

Bulik, R.J. (2008). Human factors in primary care telemedicine encounters. Journal of Telemedicine and Telecare, 14, 169-172.

Demiris, G. (2006). The diffusion of virtual communities in health care: Concepts and challenges. Patient Education and Counseling, 62, 178-188.

Demiris, G., Doorenbos, A., & Towle, C. (2009). Ethical considerations regarding the use of technology for older adults. The case of telehealth. Research in Gerontological Nursing, 2 (2), 128-136. 

Demiris, G., Parker Oliver, D., & Courtney, K.L. (2006). Ethical considerations for the utilization of telehealth technologies in home and hospice care by the nursing profession. Nursing Administration Quarterly, 1 (8), 56-66.

Derse, A.R., & Miller, T.E. (2008). Net effect: Professional and ethical challenges of medicine online. Cambridge Quarterly of Healthcare Ethics, 17, 453-464.

Fleming, D., Edison, K., & Pak, H. (2009). Telehealth ethics. Telemedicine and e-Health, 15 (8), 797-803.

Hsiung, R.C. (2001). Committee Report: Suggested principles of professional ethics for the online provision of mental health services. Telemedicine Journal and E-Health, 7 (1), 39-45.

Kaplan, B., & Litewka, S. (2008). Ethical challenges of telemedicine and telehealth. Cambridge Quarterly of Healthcare Ethics, 17, 401-416.

Norman, S. (2006). The use of telemedicine in psychiatry. Journal of Psychiatric and Mental Health Nursing, 13, 771-777.

van Wynsberghe, A., & Gastmans, C. (2010). Telesurgery: an ethicial appraisal. Journal of Medical Ethics, 34 (22), 1-5.