Download Introduction to Medical Ethics

Biomedical Ethics
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Introduction to Philosophy
“Philos” = Love
“Sophia” = Wisdom
“Philosophy” = Love of Wisdom
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A Formal Definition of Philosophy:
• The rational, critical investigation of the
fundamental questions of life that resist
solutions by empirical science
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Ethics
• The Study of
Right or Correct Behavior
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Divine Command Theories
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Ethics Chart
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Ethics
Objectivism
Absolutism
Contextual
Absolutism
Relativism
Conventionalism Subjectivism
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Objectivism
• There are universally valid moral principles
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Relativism
• There are no universally valid moral
principles
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Absolutism
• There is one universally valid moral principle
• Immanuel Kant
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Contextual Absolutism
• There are several universally valid moral
principles and context decides which one to
follow
• The Ten Commandments
• Aristotle
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Conventionalism
• Society decides moral principles
• Ruth Benedict
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Subjectivism
• The individual decides moral principles
• Jean Paul Sartre
• Friedrich Nietzsche
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Meta-Ethics
• The study of
• Concepts
• Methods of Justification
• and Knowledge
• of Ethics
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Normative Ethics
• The study of rational guidelines for behavior
• How people “ought” to act
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Descriptive Ethics
• The study of how people do act
• Describes how people do act
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Naturalistic Fallacy
• Confusing what “is”
• With what “ought” to be
• Confusing how people do act
• With how they “ought” to act
• “Ought” does not equal “is”
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Normative Ethics
• Biomedical ethics is a branch of normative
ethics
• Business ethics
• Sports ethics
• Etc.
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Biomedical Ethics
• Ethical issues associated with the practice of
medicine
• Advance reasoned analysis to clarify and
resolve ethical issues
• Practice of medicine in most inclusive way
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Criteria for Ethical Theories
• 1. Clear, well-defined concepts
• 2. Consistent statement
– No Contradictions
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• 3. Should tell us how to act in all situations
– Abortion
– Euthanasia
– Death Penalty
– Sex and Love
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• 4. The Simpler the better
– Occam’s Razor
– Less likely to make mistake
– Easier to follow
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• 5. Should be based upon the most complete
evidence available
– Many decisions lead to wrong action because of
incorrect information
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Consequentialist Theories
• Moral theories that judge right / correct
behavior based upon the consequences of
the actions
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Utilitarianism
• John Stuart Mill
• The right action in any situation is that action
which creates the greatest amount of
happiness
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Cost-Benefit Analysis
• A form of Utilitarianism
Actions are evaluated based upon their
corresponding cost and the anticipated
benefits of the action
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John Stuart Mill’s Moral Theory
John Stuart Mill
(1806-1873)
English
Member of Parliament
Wrote on many subjects
Utilitarianism
The Greatest Happiness Principle
Jeremy Bentham
Act to create the
Greatest amount of happiness
For the greatest number of people
As per a disinterested spectator
Greatest Number of People
• Everybody that your action will effect
Disinterested Spectator
• Your happiness cannot be more important
than anyone else’s
Happiness defined
Pleasure
Absence of Pain
Hedonism
• The goal is to experience as much pleasure as
possible
• Usually physical pleasure
Epicureanism
• The goal is to experience as much pleasure as
possible without experiencing any pain
• Only the best wine, food
• No hangovers
Different Kinds of Pleasure
Quality
Quantity
Mental and Physical
Quality of Pleasure
• How many McDonald’s hamburgers equals a
Filet Mignon?
• None because the quality is different!
• Some pleasures are simply better than others
Quantity of Pleasure
• Whatever you enjoy, isn’t more of it better?
Point of Diminishing Returns
• But we reach a point in our pleasure where more is
not better but actually painful
• How many pieces of candy do you like?
• 5,10,15,?
• How about a 1,000?
Paradox of Hedonism
• The more pleasure you derive from
something, the more you need of it next time
to receive the same amount of pleasure
• Drugs and Alcohol
Mental v. Physical
Which is Superior?
Mental
Why?
Based upon empirical evidence
Ask those who have experienced both
They agree that mental is superior
Why is Mental Superior?
1. Greater Permanence
2. Safer
3. Less Expensive
Act Utilitarianism
An action is right if it produces more total
happiness than any other alternative action
available at the time
Me
My Mom
My Dad
My Aunt
My Friends
Total
Visit Aunt
-10
+8
+6
+10
0
+14
Go to Beach
+10
-8
-6
-10
0
-14
Rule Utilitarianism
After many acts,
we develop a principle
that if general followed
would create the greatest amount of happiness
for all people involved
Criticisms
1. Requires too much
2. Focuses too exclusively on the future
3. Can lead to injustice
Deontological Ethics
• Greek: “Deon” = “Duty”
• Moral theories that judge right / correct
behavior based upon the intrinsic value of
human beings
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Kant’s Moral Theory
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Immanuel Kant
1724-1804
German
Wrote on many subjects
Critique of Pure Reason
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Requirements for Morality
Free Will
Rationality
Moral Autonomy
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Happiness?
We are not here to be Happy
But
To be Worthy of Happiness
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If happiness were the goal of human life
Then we would be controlled by our instincts
not reason
The more you know the more pain and
suffering you experience
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Good Will
Only thing in the world that cannot be
perverted
Although we might not always be able to do
the right thing
We must always want to do the right thing
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Categorical Imperative
Absolute Command
of
Moral reason
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Deontological Ethics
Morality based upon duty
It is our duty to follow the
Categorical Imperative
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Moral Worth of an Action
Based Upon Our
Intentions
Not
The Consequences
of the Action
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Why?
1. Because doing what is right has intrinsic
value
2. Since we are not God, we cannot guarantee
that what we intent to happen will actually
happen
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Therefore
We are only responsible for what we have
complete control over
OUR INTENTIONS
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Wallet Example
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1st Formulation
Act only on the maxim that you could will to be
a universal law of nature
(without contradiction)
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What is a Maxim?
An Intention
Or
Reason
for doing something
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What is a Universal Law of Nature?
Something that must happen whether or not
we want it to
Example:
Gravity
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Without Contradiction?
Every time we are going to act
We are to think about why we want to take
that action
Then imagine how we might write out a
statement expressing our reasons for action
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If the action we are thinking about taking is
morally wrong
Then we will see a contradiction in the
sentence stating our intentions
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Example
We want to borrow money from a bank
But we have no intention of paying the money
back to the bank
What would a statement look like expressing
this intention?
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It is morally acceptable
to sign a
promissory note
to pay back the money
when I have
no intention of keeping my promise
to pay the money back
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Contradiction?
I make a promise
with no intention
of keeping the promise
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2nd Formulation
Always treat people as
ends in themselves
never as means to an end
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Don’t use people
Why?
Because human beings have intrinsic value
Rationality
Free Will
Moral Autonomy
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We use objects
not people
Pornography?
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Conscience?
• We might think of the Categorical Imperative
as our conscience
• The sense of what is right or wrong in our
behavior and motives
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Deontological Medical Ethics
• Ultimate worth of the Individual
• Maximum Individual autonomy
• Respect for the individual
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Virtue Theories
• Mainly concerned with
what kind of a person we are
• A virtuous person will act correctly in
situations
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Teleological Ethics
• Greek: “teleos” = end / purpose
• Moral theories that judge right / correct
behavior based upon a particular goal or
purpose or consequences of the action
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Aristotle’s Moral Theory
384-322 BC
Greek Philosopher
Nicomachean Ethics
Student of Plato
Wrote on many subjects
What do you want to be when you
grow up?
HAPPY!!!!
Teleological Ethics of Aristotle
The end or goal of man is to be happy
Isn’t your ultimate desire to
be Happy?
All things aim toward happiness
• Why do you want to be rich?
• Why do you want a nice car?
• Why do you want a nice spouse?
• Intermediate Goals
Isn’t your final goal
TO BE HAPPY?
Why do you want to be Happy?
• Silly Question
• Because Happiness is the Ultimate Goal in
Life
Eudiamonia
Greek for Happiness
Eudiamonia Defined
To live well
Well-being
Human flourishing
Self-sufficient
Family
Friends
Fame
Wealth
But also:
Luck
Fortune
Based upon
TEMPORAL CIRCUMSTANCES
Example
Wonderful family tragically killed in accident
Would you still be happy?
Probably not!
How do we understand happiness?
By answering the question:
What is the function of Man?
The function of a thing will help us determine
what a “good” thing really is
Example
What is the function of a knife?
To cut
Therefore a good knife cuts good and is
therefore sharp
The function of man
is the exercise of
his reason
A Good Man
Is a man who uses his reason
The rational man
What does it mean to be rational?
To live in such a way that will enable you to
satisfy your purpose
Which is to be happy!
How do we achieve this?
By Developing Virtue
Arete
Virtue
Excellence
The virtuous man is the most excellent man
What is Virtue?
The Relative Mean
between two extremes
The middle point between two extremes
The “Golden Mean”
Relative v. Absolute Mean
Absolute Mean
is the exact mid-point
between two extremes
Aristotle is not talking about this!
Relative Mean
• This is what Aristotle is talking about
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Based Upon?
• The Individual’s
• Physical
• Intellectual
• Genetic
• Specific Circumstances
For Example
• How much should you drink?
Considerations
Weight?
Physical Constitution?
• How much food have you consumed?
• What’s your mental and emotional state?
These may change over time
• Your Mean may change
You need to know yourself
• Possessing Virtue means that you also know
yourself
• Your Limits
• Your Strengths
• Your Weaknesses
4 Primary Virtues
Wisdom
Justice
Courage
Moderation
Wisdom
What are the two extremes that wisdom is the
middle point of?
Justice
Courage
Moderation
Social Virtues
Concerning Money
• The Virtue is to be Generous
Virtue Concerning Honor
• Pride
• (Appropriate Self-Respect)
We should have
Good Temper
Virtue is not Natural
• We are not born with virtue
This is Good
• If we had to be born with virtue and were not
• That would be it
• There would be nothing we could do about it
How do we develop Virtue
By Developing Character Qualities
Through Practice
Through Habits
• Thru Experience
• Thru a Good Teacher
Virtue Ethics in Medical Ethics
• Emphasizes Virtuous Character
• Truthfulness
• Compassion
• Sincerity
• Courage
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Emphasizes who we are
as opposed to the performing of actions
In virtue ethics
Agents performing the actions are the focus
In action-based approaches to ethics
The principle thing emphasis is the doing the
right thing
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For Example
• Suppose someone does what is wrong (?) but
has extraordinary compassion
• (Lies to a patient)
• Recovering from a serious car accident and
does not tell of the death of a family member
as passenger
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• Suppose someone does what is right (?) but
is mean and nasty
• (Tells the patient the truth)
• Recovering from a serious car accident and
does not tell of the death of a family member
as passenger
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Prima Facie Duties
• W.D. Ross
• (1877-1971)
• English Philosopher
• The Right and Good
• (1930)
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Prima Facie Duties
• “at first sight”
• A prima facie duty is a conditional duty
• There is no absolute prima facie duty
• Any duty can be overridden depending upon
the circumstances
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Moral Relativism
• Right or correct action is relative to
• 1. The Situation
• 2. Important Factors
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Common sense tells us in some situations that
an action (keeping a promise) is right,
not because of its consequences,
but because of what has happened in the past
(we made the promise).
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Conflicting Duties
• Common sense also tells us in some
situations that we have more than one duty
and that one duty
• (relieving distress)
• may be "more of a duty" than another duty
(fulfilling a promise).
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Elements of Ross’ Moral Theory
• A variety of relations among individuals are
morally significant
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• promiser-promisee,
• creditor-debtor,
• wife-husband,
• child-parent,
• friend-friend,
• etc
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• There are a few general "rules of thumb" to
follow when prima facie duties conflict
• For example:
• Nonmaleficence is generally more important
than beneficence.
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• However, there is no ranking among the
prima facie duties that applies to every
situation.
• Each situation must be judged separately.
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Ross’ List of Prima Facie Duties
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1. Fidelity
• Duty to fulfill (explicit and implicit)
promises/agreements into which one has
entered
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2. Reparation
• Duty to make up for wrongful acts previously
done to others
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3. Gratitude
• Duty to repay others for past favors done for
oneself
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4. Justice
• Duty to promote fairness
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5. Beneficence
• Duty to improve the conditions of others
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6. Self-Improvement
• Duty to improve one's own condition
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7. Nonmaleficence
• Duty not to injure others
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Bottom Line
• How do we make a decision when there are
conflicting prima facie duties?
• Ross says that the best we can do is make a
• “Considered decision”
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Important Concepts
• Respect for Patient Autonomy
• Principle of Nonmaleficence
• Principle of Beneficence
• Principle of Justice
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The Ethics of Care and Feminist
Ethics
• Emphasizes
• Empathy
• Concern for the needs of others
• Caring
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Carol Gilligan
• Women tend toward an
• Ethics of Care
• Men tend toward an
• Ethics of Justice
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• Relationships should be taken into account
more when making a moral decision
• Caring responsiveness to the needs of others
is often morally preferable to detached
dispassionate moral evaluation
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• Must be more aware of oppression
• Personal
• Professional
• Institutional
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Casuistry
• Case Study
• Considering each situation as unique while
trying to apply more general ethics principles
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Practical Wisdom
• Necessary for applying more general ethical
principles to individual cases and situations
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Practice over Theory
• Casuistry asserts the priority of practice over
theory
• What has worked or produced the best
results in the past
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Reflective Equilibrium and
Appeals to Coherence
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John Rawls
• No one level of ethical conviction deserves
priority
• General Moral principles
• Prima Facie Duties
• Casuistry
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Considered Judgments
• We use past experience to evaluate current
situations
• We can go from principle to case
or
• We can go from case to principle
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• Moral reasoning is dynamic
• It is never static
• New situations demand new analysis
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Conflict Resolution?
We want coherency / consistency in our
overall system of ethical convictions
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Logical Consistency
• Avoidance of outright contradiction
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Argumentative Support
• Must give good reasons for our ethical
decisions
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Liberty-Limiting Principles
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The Harm Principle
• To prevent harm to others
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Principle of Paternalism
• When someone acts like a “father” to
someone else
• Physician to patient
• To prevent someone from harming
themselves
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Principle of Extreme Paternalism
• To benefit the person
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Principle of Legal Moralism
• To prevent person from acting immorally
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Social Welfare Principle
• To benefit society
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Logical Argumentation
• Your final paper and presentation
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Standard Form
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•
•
•
(1) Premise 1 (Reason 1)
(2) Premise 2 (Reason 2)
Therefore:
(3) Conclusion (What you are trying to
convince someone to accept)
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Counter Examples
• State the one major fact against your position
• Respond to it
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