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Chapter Two
Theories and Principles
Yuanyuan Dong
2007-9-4
Moral Theory
 Moral Philosophy include the sub-disciplines:
 1. normative ethics
 Which is the study of moral standards, general principles,
concepts, values, and theories.
 2. applied ethics
 Which is the study of ethical dilemmas, choices, and
standards in various occupations, professions, concrete
(particular, not general) situations, and the application of
moral theories and concepts in particular contexts. Such
as “medical ethics” have mentioned above.
 3. meta-ethics
 Which studies the nature and justification of moral
standards, values, principles, and theories and the
meaning of moral concepts and terms. Such as “is
morality objective?” and “why should we obey moral
obligations?”
A Key concept: Commonsense Morality
 “Commonsense morality” is a key concept of
moral philosophy. Each person in society gets
exposed to a commonsense morality. This
morality consists of a wide variety of standards
of conduct, duties, obligations, values and
principles that come from disparate sources,
such as parents, teachers, peers, religious
leaders, professionals, literature, music, the
media, and so forth. Ethicists call these
standards a “commonsense morality” because
they are the norms that most people learn and
practice without any explicit theorizing or deeper
analysis.
 Some of these commonsense morals
include principles like “do unto others as
you would have them do unto you”, “keep
your promises”, “be fair”, “always do your
best”, and so on. Some of these
commonsense values include happiness,
honesty, justice charity (or kind), courage,
integrity , community, love, knowledge, and
freedom.
 After using moral theories to change
commonsense morality, we can then
revise those theories so that they cohere
with this new database. This process of
revising commonsense morality in light of
theory and vice versa can continue
indefinitely, and is known as the method of
wide reflective equilibrium. Most ethicists
believe that this method provides the best
way of justifying moral theories.
Different Kinds of Moral Theories
 Philosophers and theologians have defended a wide variety
of moral theories, each with its own particular slant on
morality:
 Some theories emphasize individual rights and dignity;
others emphasize the common good.
 Some theories are secular; others are religious.
 Some theories focus on obligations and duties; others
focus on virtues and character.
 Some theories establish moral ideals; others settle for
practical principles.
 Some theories assess consequences in judging actions;
others assess motives.
 Some theories are human-centered; others place human
beings in a larger ecological framework.
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Different Theories
In here, beyond the textbook, I want to provide
brief summaries of some of the most influential
ones nowadays in the west.
1. divine command theory
2. utilitarianism
3. natural rights theory
4. natural law theories
5. social contract theory
6. virtue approaches theory
7. the ethics of care
8. the deep ecology theory
Utilitarianism
 Utilitarianism is often summed up as doing
‘the greatest good for the greatest number.’
 It is a consequentialist theory as it holds that
the outcomes(that is ,the consequences) of
an action are most morally important
component of that action.
 It is based on a single principle: the principle
of utility.
 It is founded by Jeremy Bentham(1748-1832)
and John Stuart Mill(1806-73).
What is utility?
 Bentham and Mill thought that utility was
pleasure or happiness.
 Other utilitarians include values such as
friendship, knowledge, health and beauty.
 Still others believe that the concept of utility
is best applied to the satisfaction of
preferences rather than any instrinsic values.
 Which holds that we should act in such
a way that we produce the greatest
balance of good/bad consequences (or
utility) for all people in the long run.
There are two types of utilitarianism:
act-utilitarianism and rule-utilitarianism.
 Act-utilitarianism holds that
individual actions should
maximize utility.
 Rule-utilitarianism holds that
actions should be based on a
system of rules that maximize
utility.
(Do not lie.)
The disadvantage of utilitarianism
 Is it right to let one patient die in order to
harvest their organs and perhaps save five
lives?
 The maximizing principles demands that not
only should we donate blood and bone
marrow as often as we can ,but also that we
may well be morally obliged to donate one
of our kidneys as well.
 A small increase in pleasure for the majority
will override a vast degree of pain for
minority.
German philosopher Immanuel Kant’s view
 According to a view developed by Kant, one
should always treat rational beings as having
intrinsic value or worth, not as mere instruments
or objects having only extrinsic value.
 Kantianism also holds that moral standards
should be universalize- able: moral principles
are rules that would be followed by all rational
beings with a good will. (A person with a good
will is motivated by the desire to do her duty’s
sake.)
 For Kant, actions must be done for the right
reasons in order to be worthy of moral praise.
 Kantianism implies that individuals should
not be sacrificed for the common good, that
we have moral duties that do not depend on
the consequences of our actions, and that
motives matter in assessing the morality of
human conduct.
 Act only on that maxim through which you
can at the same time will that it should
become a universal law. (We should behave
in such a way that we can imagine everyone
an behave.) (steal, lie)
 We should never treat people ‘simply as a
means but always at the same time as an
end’. (Treating individuals as an ‘end’ not
just a ‘means’. All people are equal and
deserve equal.)
The disadvantage of Kantianism
 It depends on freedom of will and rationality.
 Moral rules are absolute-that is they can’ be
broken.
 The moral rules can seem quite abstract
and unable to deal with the complexities of
real-life ethical dilemmas.
 Two duties may conflict, so what happens
then?
The natural rights theory
 Like Kantianism, this theory emphasizes
that importance of individual rights and
freedoms.
 According to this view, all people have
natural rights to life, liberty, and property,
and everyone in morally permitted to do
anything they wish provided that their
actions do not violate the rights of other
people.
Natural law theories
 Which hold that morality is founded on human
nature: if an action has a basis in our natural
instincts, emotions, or social relations, then it is
right; if an action goes against our natural
instincts, emotions, or social relations, then it is
wrong.
 Natural law theories also maintain that we
should strive to produce or achieve natural
goods and eliminate or avoid natural evils.
 Natural goods include life, health, and happiness.
Social Contract Theory
 Social contract theorists propose that
morality consists of a set of rules that we
agree are important to regulate society. In
justifying moral rules, social contract
theorists imagine people as existing in a
state of nature prior to the formation of
society. In order to live well, people must
cooperate; and in order to cooperate, they
need some rules for conduct. These rules
are the rules of morality, politics, and the
law.
The Ethics of Care
 A theory inspired by feminist approaches to
morality, rejects traditional approaches to ethics
on the grounds that they place too much
emphasis on duties, rights, and justice. Such
traditional theories are too abstract, legalistic,
and uncaring, according to this view of feminist.
 The ethics of care holds that our main task in life
is to love and care for ourselves and other
people. We should cultivate loving and caring
relationships in our conduct instead of relying on
abstract concepts and principles.
 In some ways, the ethics of care provides a
modern rendition of Jesus’ instruction to love
your neighbor as you love yourself.
The Deep Ecology Theory
 Which approach to morality is unlike all the
other approaches to ethics in that it is not
human-centered.
 Human-centered moral theories frame
important questions about nature in terms
of human interests, rights, obligations, and
so on.
The Deep Ecology Theory
 Deep ecologists hold that human-centered ethics
cannot adequately deal with moral issues involving
other species, the land, ecosystems, the
atmosphere, and oceans, since there are values in
nature that are independent of human interests or
rights. Thus, an ecosystem is worth preserving
because it has intrinsic, moral value, not because
we happen to value it for its economic or social
uses. Animals have rights, according to this theory,
because they also have intrinsic moral worth and
not mere instruments for the promotion of human
interests.
From many philosophers’ views
 Many philosophers who study applied ethics
prefer to work with general, ethical principles
rather than moral theories because one can use
principles to support an ethical decision or a
social policy without defending an entire moral
theory.
 Another reason for employing general principles
is that they are easier to understand, to teach
and learn than moral theories.
 Finally, since principles are expressed in very
general terms, they can be applied to a variety of
cases and interpreted in different ways. This
kind of flexibility allows one to apply principles to
diverse cases without ignoring important details.
Some of these basic moral principles are
as follows:
 Non-malignance: Do not harm yourself or other
people.
 Beneficence: Help yourself and other people.
 Autonomy: Allow rational individuals to make
free, informed choices.
 Justice: Treat people fairly; treat equals equally;
unequals unequally.
 Utility: Maximize the ratio of benefits to harms
for all people.
 Fidelity: Keep your promises and agreements.
 Honesty: Do not lie, defraud, deceive, or
mislead.
 Privacy: Respect personal privacy and
confidentiality.
The four Principles
 Autonomy
 Beneficence
 Non-maleficence
 Justice
1.Autonomy
 The principle of respecting the decisions
made by those capable of making decisions.
 It refers to an ability:
1)to reason and think about one’s own
choices
2)to decide how to act
3)to act on that decision ,all without
hindrance from other people
 Autonomy is more than simply being free to
do what one wants to do. (animals)
 In respecting a person’s autonomy we
recognize that they are entitled to make
decisions that affect their own lifes.
 In health care respecting people's autonomy
has many prima facie implications.
 It requires us to consult people and obtain
their agreement before we do things to them
- hence the obligation to obtain informed
consent from patients before we do things
to try to help them.
 Medical confidentiality is another
implication of respecting people's autonomy.
 Respect for patients' autonomy prima facie
requires us, therefore, not to deceive
patients, for example, about their diagnosed
illness unless they clearly wish to be
deceived .
 Telling the truth about terminal cancer?
2.Beneficence and non-maleficence
 Beneficence is the principle of doing ‘good’
In the medical context, this generally means
improving the welfare of patients.
 Non-maleficence involves ‘not harming
patients’, or ‘above all, do no harm’.
 There is often confusion about where nonmaleficence ends and beneficence begins.
 One way of looking at the two is to think of
non-maleficence as a duty towards all
people, whereas beneficence ,as we can’t
help everyone, is a duty we choose to
discharge on specific people.
 Medical staff, by accepting a patient, have
chosen to act beneficently towards that
patient.
 Similar to the principle of utility.
3.Justice
 The principle refers to the allocation or
distribution of resources amongst the
population.
 It demands the fair treatment of ‘equals’
within the health-care system.
 What is fair and equal distribution?
 Equality-Each person receives an equal
share of the resources available.
 Need-Each person receives resources
appropriate to how much that person needs.
 Desert-Each person receives resources
according to how much they deserve them
(in terms of contribution, effort or merit.)
 Desire-Each person gets what they want
What should we do when these principles
conflict?
 These principles should be viewed as
guidelines for conduct rather than hard
and fast rules.
 We should follow these principles in our
conduct but exceptions can be made when
they conflict with each other or with other
standards. When two principles conflict we
may decide to follow one principle instead
of another.
Moral Choices
 We make choices very waking moment of our
lives. Some of these choices are trivial or nor
important; others are profound or important.
Some choices are informed by personal
preferences, tastes, or mere whimsy. Others are
based on standards of conduct.
 Standards of conduct can regulate our actions
by providing guidance for many of the choices
we face in living.
 But, It is not easy to follow standards of conduct
all of the time since they often conflict with each
other or with our personal interests.
 People often violate accepted ethical or moral
standards for personal gain, but we usually label
such actions as immoral and selfish and we
disapprove of such conduct.
 People often must choose not between ethics (or
morality) and self-interest but between different
moral, ethical, legal, political, religious, or
institutional obligations. In these circumstances,
the key question is not “should I do the right
thing?”, but “what is the right thing to do?” These
problematic choices are known as ethical (or
moral) dilemmas. Thus, an ethical dilemma is a
situation in which a person can choose between at
least two different actions, each of which seem to
be well supported by some standard of conduct.
These choices may be between the lesser of two
evils or the greater or two goods. Sometimes
these choices involve two different ethical
standards.
 For example, when ask to give our opinion of
someone’s cooking we may decide to be less than
completely honest in order to avoid harming that
person.
 Since conflicts among various principles and
standards can arise, we must frequently exercise
our judgment in deciding how we should act. In
order to exercise our judgment, we need to
understand the particular features of a given
situation. Thus, there is an important sense in
which ethics are situational: although some
general , ethical principles should guide our
conduct, we need to base our decisions and
actions on the facts and values inherent in
particular situations.
The Oath of Hippocrates

You do solemnly swear, each by
whatever he or she holds most sacred .That
you will be loyal to the Profession of
Medicine and just and generous to its
members
That you will lead your lives and
practice your art in uprightness and honor ，
That into whatsoever house you shall enter,
it shall be for the good of the sick to the
utmost of your power, your holding
yourselves far aloof from wrong, from
corruption, from the tempting of others to
vice
The Oath of Hippocrates (continued)

That you will exercise your art solely for
the cure of your patients, and will give no drug,
perform no operation, for a criminal purpose,
even if solicited, far less suggest it
That whatsoever you shall see or hear
of the lives of men or women which is not fitting
to be spoken, you will keep inviolably secret
These things do you swear. Let each bow the
head in sign of acquiescence And now, if you
will be true to this, your oath, may prosperity
and good repute be ever yours; the opposite, if
you shall prove yourselves for sworn.
Principles of medical ethics
 Preamble
 The medical profession has long subscribed to
a body of ethical statements developed
primarily for the benefit of the patient. As a
member of this profession, a physician must
recognize responsibility to patients first and
foremost, as well as to society, to other health
professionals, and to self. The following
Principles adopted by the American Medical
Association are not laws, but standards of
conduct which define the essentials of
honorable behavior for the physician.
Ⅰ
Ⅱ
A physician shall be dedicated to providing
competent medical care, with compassion and
respect for human dignity and rights.
A physician shall uphold the standards of
professionalism, be honest in all professional
interactions, and strive to report physicians
deficient in character or competence, or
engaging in fraud or deception, to appropriate
entities.
Ⅲ
A physician shall respect the law and
also recognize a responsibility to seek
changes in those requirements which are
contrary to the best interests of the patient.
Ⅳ
A physician shall respect the rights of
patients, colleagues, and other health
professionals, and shall safeguard patient
confidences and privacy within the
constraints of the law.
Ⅴ
Ⅵ
A physician shall continue to study, apply, and
advance scientific knowledge, maintain a
commitment to medical education, make
relevant information available to patients,
colleagues, and the public, obtain consultation,
and use the talents of other health
professionals when indicated.
A physician shall, in the provision of appropriate
patient care, except in emergencies, be free to
choose whom to serve, with whom to associate,
and the environment in which to provide
medical care.
Ⅶ
Ⅷ
Ⅸ
A physician shall recognize a
responsibility to participate in activities
contributing to the improvement of the
community and the betterment of public
health.
A physician shall, while caring for a
patient, regard responsibility to the patient
as paramount.
A physician shall support access to
medical care for all people.
Adopted by the AMA's House of Delegates June 17, 2001.