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…