Biomedical Ethics: Week 1
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Chapter 1
Theory of Health Care Ethics
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Why Study Ethics?
• Because health care is changing, you need tools for making necessary and difficult decisions.
• It will help you better understand patients, fellow professionals, and the system in general.
• It will assist you in building and maintaining your career.
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Types of Ethics
• Normative ethics – Is the study of what is right and wrong.
• Metaethics – Is the study of ethical concepts and theories.
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Types of Normative Ethical Theories
• Authority-based • Egoistic • Natural law • Deontological • Teleological • Virtue
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Ethical Relativism
• Ethical relativism purports that there is no absolute theory for ethics.
• However, this lack of a complete theory does not mean everything is relative.
• People need to make rational decisions about ethics-based issues.
• Therefore, ethics theories are useful.
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Egoism as Ethics Theory
• Egoism is based on the idea that one’s self interest is the basis his or her ethics decisions.
• Theory is not helpful in health care ethics because professionals are taught to set aside self-interest.
• The interests of the patient should come first.
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Authority-based Ethics Theory
• Decisions about ethics (right or wrong) are based on central authority such as in a theology or an ideology.
• For health care ethics, there may difficulty deciding which authority is the correct one.
• However, knowing this view of ethics helps with understanding patients and health policy decisions.
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Virtue Ethics Theory
• Is founded in the writings of Aristotle. • Everything moves from potentiality to
actuality. • Character development allows you to
actualize your highest good. • Eudaimonia should be sought as the highest
good.
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Virtue Ethics Theory
• Eudaimonia means that you seek to build your character and increase virtue.
• Professional education seeks to develop people of high character.
• People who work toward eudaimonia become persons of practical wisdom.
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Virtue Ethics Theory
• Principles of ethics can help to define your character and assist with your actions. See Chapter Two for more information.
• Virtue ethics is criticized as being elitist. • Virtue ethics requires the balancing of
conflicting obligations. • People with practical wisdom can make
appropriate ethical decisions.
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Natural Law Theory
• It is founded in the writings of St. Thomas Aquinas
• It assumes that nature is rational and orderly. • Humans are part of the natural world and are
given the ability to be rational. • Our natural reason allows us to distinguish
right from wrong.
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Natural Law Theory
• Reason is also action in that humans can choose to do good or evil.
• The Principle of Double Effect helps us decided which action is good.
• Good is also defined as that which helps to maximize potential, such as preserving life, gaining wisdom, and knowing God.
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Natural Law Theory
• In natural law, there are some acts that are not ethical because they violate the ability to reach one’s potential.
• People who support social responsibility can use natural law as a foundation for actions.
• Understanding natural law also assists with patient relations.
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Deontology Theory
• Comes from the Greek word “deon” meaning “duty.”
• It is sometimes called duty-based ethics. • One of the main theorists is Immanuel Kant. • The world exists in the form of things we can
experience directly (phenomenal world) and things that exist independently of the intellect (noumenal world).
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Deontology Theory
• Free will makes ethics possible and without it we would not need ethics.
• Areas of character can be used for good or evil.
• Therefore, the only true good is good will. • The ability to choose to do good is what
makes us human.
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Deontology Theory
• Actions are judged by their intention and not just their outcomes.
• Kant attempted to define a rational principle for making moral judgments.
• The principle is the categorical imperative. • People can never be used as a means to an
end; they must be respected.
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Deontology Theory
• The Golden Rule is not a synonym for the categorical imperative.
• Kant believed that we must act based on duty to moral law and not on the consequences of our actions.
• Practicing this is its pure form is difficult in modern society.
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Kant and Virtue Ethics
• Pure Kantian ethics is absolute in its definition of duty but virtue ethics allows for grey areas.
• Kant does not assist with deciding among lesser evils and greater goods
• Virtue ethics allows the use of tools to make these decisions
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Deontology and Policy
• Health care professionals recognize a duty to the patient
• Health care managers also have a duty to the patient, but they have duties to the organization and community as well.
• Conflicting duties must be considered in policy making.
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Non-Kantian Deontology
• Recent proponents of the deontology tradition include John Rawls and Robert Nozick.
• These theorists deal with the idea of justice through our actions.
• Their thinking influences health care reform, public health, and other health areas.
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John Rawls
• John Rawls worked to define the characteristics of a just society.
• He examined justice as fairness and applied it to societies that respect the rule of law.
• His work is based on the idea of a social contract between members of a society.
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Self Interest and Justice
• Rawls used a hypothetical or mind experiment called the original position to explain why rational people would protect everyone’s self interests.
• In this mind experiment, he also included the concept of the veil of ignorance to help us understand why we would care about self interests.
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Self Interest and Justice
• If we were in the original position, we would all be equal.
• Therefore, we could all be treated in the same way in a society.
• Therefore, it would be in our self interest to make sure that everyone is given an equal share of benefits and burdens.
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Basic Principles of Justice
• The first principle of justice for Rawls is liberty. • This principle is also a priority over all other
principles of justice. • People should have equal right to basic
liberties (see the Bill of Rights).
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Basic Principles of Justice
• The second principle for Rawls is justification of inequalities.
• He uses the difference principle to justify when social and economic inequities are appropriate.
• Physicians are a classic example of the difference principle.
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Rawls’ Opponent
• Robert Nozick is also considered to be a deontologist.
• He represents the conservative tradition and has great influence in the debate over health care reform.
• Nozick emphasizes the autonomy and the rights of the individual.
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Nozick and Social Goods
• For Nozick, there is no social good that requires sacrifice.
• We are only “other people”. • We should influence people to take steps to
improve their own situations. • Theories like Rawls supports defeat voluntary
agreements.
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Nozick and Distributive Justice
• For Nozick, there is no principle of distributive justice.
• He finds justice in acquisition and owned resources.
• Historical injustices are not addressed in his theory except to suggest that society could be organized to maximize the position of the least well off.
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Consequentialism Theory
• Through Mill’s work, this theory is also known as utilitarianism.
• For this theory, your intentions are irrelevant; all that counts is the outcome.
• Greatest Good for the Greatest Number is often used as a summary of the theory.
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Consequentialism Theory
• Has two main types • Classical or act utilitarianism.
– Each act considered on its own • Rule utilitarianism.
– Develop rules that net the greatest benefit
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Consequentialism Theory
• Rule utilitarianism is used to make health care policy.
• Exceptions can be made under special circumstances.
• Rule utilitarianism also allows for negative consequentialism or preventing the greatest harm for the greatest number.
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Consequentialism Theory
• Preference utilitarianism argues that good is honoring preferences and bad is frustrating preferences
• Preferences must be known or a substituted judgment can be used
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Consequentialism Theory
• Criticisms of utilitarianism include – The minority is not protected when the
greatest good for the greatest number is the goal.
– Some say this theory means that the ends justifies the means.
• These criticisms are not valid because respect for autonomy and liberty is essential to the theory.
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Use of Ethical Theories
• There is no pure ethical theory; each has strengths and weaknesses.
• However, health care professionals must make complicated ethics decisions
• The ability to understand theory enhances your decision making tool kit.
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In Summary…
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- Slide Number 1
- Chapter 1
- Slide Number 3
- Why Study Ethics?
- Types of Ethics
- Types of Normative Ethical Theories
- Ethical Relativism
- Egoism as Ethics Theory
- Authority-based Ethics Theory
- Virtue Ethics Theory
- Virtue Ethics Theory
- Virtue Ethics Theory
- Natural Law Theory
- Natural Law Theory
- Natural Law Theory
- Deontology Theory
- Deontology Theory
- Deontology Theory
- Deontology Theory
- Kant and Virtue Ethics
- Deontology and Policy
- Non-Kantian Deontology
- John Rawls
- Self Interest and Justice
- Self Interest and Justice
- Basic Principles of Justice
- Basic Principles of Justice
- Rawls’ Opponent
- Nozick and Social Goods
- Nozick and Distributive Justice
- Consequentialism Theory
- Consequentialism Theory
- Consequentialism Theory
- Consequentialism Theory
- Consequentialism Theory
- Use of Ethical Theories
- In Summary…