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Ethics & Decision-Making Dr Dónal O’Mathúna [email protected] 700 7808 What is ethics? What is ethics? • Ethics: from Greek ethikos (moral character), related to ethos (custom). • Morality: In Latin, ethikos was translated as mores (character, proper behaviour in society); plural: mores, customs. • Virtue: from Anglo-French, vertu (moral life and conduct, moral excellence) • Ethics is the systematic study of concepts, principles and theories that address issues of right and wrong. Examines arguments, actions and character qualities. • Morality refers to the broader traditions of right and wrong, good and bad, in society and culture. • Virtue describes personal characteristics that impact ethical behaviour: courage, honesty, fidelity, etc. • Ethics differs from laws and codes, but they are all interrelated. • Ethics builds and evaluates arguments about ethical issues and situations to establish principles of right behaviour. • The terms ‘ethics’ and ‘morality’ are used interchangeably. • Ethics is a branch of philosophy. Ethics as philosophy • Ethics builds & scrutinizes arguments about right and wrong behaviour • Ethics seeks to determine valid principles (e.g. never take innocent human life) & the relationship between principles and actions (e.g. does saving a life in some situations constitute a valid reason for breaking a promise?) • Ethical decision-making ‘is a complicated process of using all of one’s faculties— intellect, emotions, and imagination—to evaluate a particular situation and determine how to act.’ Hawkins 2002 in Stories Matter p76 Dónal O’ Mathúna, “The Place of Dignity in Everyday Ethics,” Journal of Christian Nursing 28.1 (January-March 2011): 12-18 Using cases in ethics • Cases are stories or descriptions of situations in which people disagree about core ethical values. 1. Examine the facts of the case • • • • Do you understand all the terminology? Are all terms being used in the same way? Are there communication problems? What ‘facts’ are missing? Have they been overlooked, ignored or deliberately left out? 2. Identify the ethical issues • Why is there a conflict? • Are there a number of different ethical issues? • Are there other issues that are not ethical? – e.g. any misunderstandings? – any hurt feelings? – any relational issues? 3. Examine all the ethical issues • Are some more significant than others? • Are some more pressing than others? • Do different people differ in which needs to be resolved first? – e.g. which treatment simplifies to whether to treat or not • Decide on how to approach the issues. 4. Examine each ethical issue • What ethical principles and values are central? • Is one ethical principle in conflict with another? – e.g. autonomy versus justice • Are different interpretations of an ethical principle involved? – e.g. beneficence includes or excludes suicide 5. Consider other cases • Try to find other cases that bring light to this one because of their similarities or differences. 6. Consider alternative options • Is there another option that has not been considered? • Have we asked someone else who might have a different perspective? • Is an ethics committee available? 7. Test consistency • If we do this here, what will it mean in another situation where …? • Would I want others to know that this is what I recommended here? • Would I want this to be done in my case? 8. Decide, act … and reflect • Decisions need to be reviewed. To tell or not to tell • What makes this an ethical issue? • What reasons would you give to support your view on what should happen? • What other information is needed? • Make assumptions explicit & examine them. • What alternatives may exist? • Get input from other sources. • The ethical issue can be what to do, but also how to do it. • What are the time factors? • Organise the issues. • What are the general principles? • What if this approach was taken in similar cases? • Look for other related issues: legal, financial, family, social, etc. • Who is responsible for the final decision? What does ethics offer? Embryonic stem cell research religion Scientific freedom harm law suffering patients embryo playing God rights cure s person philosophy death autonomy ethics Embryonic Stem Cell Research Ye s No patients’ rights embryo’s rights human suffering human dignity common ground action action If you are faced with a dilemma on what is the right thing to do, moral philosophy will not find a decision for you. What it can do is remove some confusions and clarify some obscurities, so that the options stand out more plainly. DD Raphael, Moral Philosophy, p.10. Ethics can… • Provide direction towards better answers and away from worse ones. • Help clarify various positions held on controversial issues. • Make explicit values and norms in healthcare (and thereby improve services??). • Engage our mental, emotional and relational dimensions to consider those aspects of practice. • Guide us as we grapple with some of the deeper implications of healthcare.