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Ethical Theories and
Foundational Principles for Health Care
Descriptive and Normative Ethics
Descriptive
• What a society maintains concerning morality
• Describes/explains moral norms or principles accepted by a
society
Normative
• Seeks to establish moral norms & principles that …
a) are justifiable, true, applicable to all
b) ought to be accepted by society
• Focus of class
Classic Philosophical Theories
•
Teleology
Deontology
(Virtue Ethics) – “Foundations of Morality chapter …
•
Ethic of Care
•
•
Teleological Ethical Systems
•
“Goal-based” ethical system
•
“What should I do?” = “What is my goal?”
•
Utilitarianism …
Utilitarianism
Based on Principle of Utility (“usefulness”)
•
Actions “right” (moral, good) as they promote happiness or pleasure
•
Actions “wrong”
•
Moral value rests in intended outcome or consequences of decision/action
(immoral, bad) as
they produce unhappiness or pain
Utilitarianism - Process
Utilitarians maximize pleasure (minimize pain) by …
• Examining all available options
• Comparatively judging which brings greatest good
Four step decision-making process - Enroll in MSJ nursing program
1. Identify good or goal you seek to achieve
2. Determine all available options
3. Estimate benefits & costs of each option to those affected
4. Choose option that brings greatest net benefit to greatest number
Deontological Ethical Systems
•
Law-based (duty, obligation) based ethical system
•
“What should I do?” => “What is the (moral) law?” … “my duty?” … “my
obligation?”
- Determine law/duty/obligation on basis of act itself, not consequences
Moral Imperatives - Immanuel Kant
Moral Imperative
• Unconditioned law binding through reason, something we must do
• Hypothetical or Categorical
1. Hypothetical Imperative: “Law” that is binding in terms of a desired end
• “If you want to achieve X, you must do Y”
2. Categorical Imperative: “Law” that is unconditional and universally binding
on all people at all times, no exceptions
• Moral law => Always and everywhere binding on all people
• Acting morally required no matter who we are, our situation, or what we
seek to accomplish
Kant’s Categorical Imperatives
1. “Act only according to that maxim by which you can at the same time
will that it should become a universal law.”
•
Act only in such a way that you would will your action to be accepted and
acted upon by all people
•
Application to HCE …
a. Due care => “Ordinary” or “reasonable” care
b. HCPs => Moral duty to provide due care (standard of care) to all
patients
c. ANA & NATA Code of Ethics (optional notes)
Kant’s Categorical Imperatives
2. “Act so that you treat humanity, whether in your own person or in
that of another, always as an end and never as a means only.”
•
Always treat other humans as ends in themselves, not simply as a
means to your own (or another’s) end
•
Applications to HCE …
a. Enrolling patients in medical studies (IRB)
b. Returning patient to competition/work to meet needs of employer
Review Questions:
“Critical Assessment of Competing Ethical Theories”
1. What two criteria should be used to evaluate any ethical theory?
2. What is the difference between a consequentialist and a deontological ethical theory?
3. What is act utilitarianism? How does it differ from ethical egoism?
4. How does one “do” utilitarian analysis?
5. On what grounds is act utilitarianism criticized?
6. What is rule utilitarianism? How does rule utilitarianism differ from act utilitarianism?
7. What are the two formulations of Kant’s Categorical Imperative? What does each mean
in practice?
8. What is the difference between perfect duties and imperfect duties? Which has “no
legitimate exceptions?”
9. The reading identifies three examples of perfect duties, what are they? The reading
states that imperfect duties promote two goals, what are they?
10. What is the difference between beneficence and nonmaleficence? What is the “duty of
beneficence” and is this duty perfect or imperfect?
Difficulty …
Traditional ethical theories “incomplete,” especially for health care
•
Focus on abstract principles
• Neglect affective (emotion/feeling) aspects of morality
Ethic of Care
Rationale
• Humans  interrelated beings  web of social relationships  community
• Special responsibility for well-being of those ...
a. in close relationship
b. entrusted to our care (parent  child, HCP  patient)
Focuses on …
• Empathy
• Concern for needs of others
• Relationships => seeks to protect interests of all
Important Considerations of Ethic of Care
1. Respond in personalized manner to patient’s needs …
• Physical, psychological, emotional, spiritual, etc.
2. Attain & maintain quality relationships among all parties involved
in patient’s care
a. “Parties” …
• Patient & patient’s proxy
• Family
• Employer & health care insurer
• HCPs (primary and allied) & health care institution
• Clergy (etc.)
b. Determine how treatment options impact relationships among
involved parties (DNR)
Principles for Effective Patient Advocacy
“Foundational Principles and the Beginning of Human Life”
from Course Readings 045-058, Q. 1-6
1. Act in the client’s
•
(patient, group, community)
best interests
Beneficence, Non-malfeasance
2. Act in accord with the client’s wishes and instructions (within reason)
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Self-determination, Integrity & Totality
3. Keep client properly informed
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Informed consent (proxy consent – 2 forms), Truth-telling
4. Carry out physician instructions with diligence and competence
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Due care/Ethic of care
5. Act impartially; offer frank, independent advice
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Truth-telling, Informed consent
6. Maintain client confidentiality
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Confidentiality