1. Retha Britz Copyright 2011 All rights reserved for this presentation 1 Some Moral Theories & Principles of Ethics [related to human research] Retha Britz

2. Ethics is:  Study of the concepts involved in practical reasoning- “good” vs “bad” & “right” vs “wrong”  Submit actions to the measure of obligation (duty e.g. duty to respect)  How we ought to do/behave [in certain situations] being moral beings  Reasons for the behaviour 2

3. 3  Research ethics based on philosophical ethics  [Competing] moral theories  Outcome of a particular ethical view depends on the ethical perspective from which it is viewed

4. Some theories relevant to [human] research:  Deontology  Utilitarianism  Principle-based ethics  Autonomy  Beneficence  Non-maleficence  Justice  Ethics from an African Perspective  ubuntu 4

5. 5 Deontology  Characteristics of actions make actions morally right or wrong  Relationship between one’s duty and morality of actions are directly related (act with the right motive/intention = good will as far as in our control)  Kantianism is leading deontological system

6. 6 Deontology (continue) Dominated medical ethics and western medicine for many centuries source of biomedical ethics Kant:  humans have a special place in creation  humans are rational beings guided by reasoning rational/reasoned choices to distinguish between right and wrong  Humans have intrinsic worth i.e. dignity because they are irreplaceable  Dignity ought to be respected

7. 7 Deontology (continue) Actions ought to comply with definite moral rules to obtain moral status Categorical Imperative “Act only on the maxim through which you can at the same time will that it becomes a universal law” “Act in such a way that you always treat humanity, whether in your own person or in the person of any other, never as simply a means but always at the same time as an end”

8. 8 Categorical Imperative in practice × Universality: Researcher not happy with results then deliberately falsifies data – scientific results would be untrustworthy × Means to an end: No IC - pt used as a mere means to researcher’s end  IC - pt makes research objectives his/her own when consenting then pt is not mere means

9. 9 Consequentialism - Utilitarianism  Concerns actions that makes the world as content (happy) as possible  Consequences of actions are the only guide to determine moral status of actions  Bentham & Mill conceived utility in terms of happiness/pleasure/good. Morality is not about pleasing God and being faithful to inflexible, abstract rules  Outcome of actions is all that matters

10. 10 Utilitarianism (continue)  Numbers and amount of happiness counts All else is irrelevant  Morality is about the bigger population - not the individual (each person’s happiness is equally important)  Research is justified if strong likelihood that it would contribute to the improvement of human condition  Are consequences all that matter?  Consent vs no consent

11. 11 Principle-based Ethics Beauchamp & Childress: 4 Prima Facie Principles  Autonomy  Beneficence  Non-maleficence  Justice Prima Facie: Principle is fulfilled unless it conflicts with an equal or stronger principle which results in a moral dilemma Kantian deontology implies people ought to act with beneficence towards others, promote well-being of others, respect others’ rights and avoid harm (non- maleficence)

12. 12 Autonomy  Being able to make decisions for oneself about the way one wants to lead his life and actioning of those decisions (Gillon, 1994)  Based on Kant’s view of intrinsic worth  Others to be treated as ends in themselves and never merely as a means  Giving the pt > balance of power in decision making  Traits of autonomy: understanding, reasoning, deliberating and independent decision making  informed consent

13. 13 Autonomy (continue)  Understand to a degree and to a degree no controlling influences or coercion e.g. buying a car  Pt’s prior expressed preferences (if known) should be honoured  An emotionally stable surrogate  Autonomy is accepted by most people although in a heavier or lighter way  For the sake of morality autonomy is very precious

14. 14 Beneficence  Beneficence and non-maleficence are seen as basis for paternalistic views (Hippocratic belief)  This paternalistic idea of beneficence changed over the last century as values have changed  Moral obligation to act for the benefit of others  If all things being equal, determine the good in a specific situation (e.g. whatever will further the pt’s interests) and balance the good against the risks of actions (e.g. risks of participating)

15. 15 Beneficence (continue)  Active principle which requires a degree of sacrifice to be fulfilled on the part of the moral agent with some degree of risk included for e.g. pt trusts researcher with confidential information  When trying to do well, there may be a risk present to possible harm  What constitutes benefit for one pt may be harmful for another. Therefore beneficence should overlap with autonomy

16. 16 Beneficence (continue)  Beneficence is exercised when attempting to benefit people with as little harm (inconvenience) as possible e.g. travel reimbursement  Beneficence is sometimes competing with the principle of respect for autonomy  Sometimes beneficence is incorporating the pt’s autonomous choices

17. 17 Non-maleficence (NM)  If all things are equal NM is to avoid harm to other people & what would be against their interests (produce more harm than good)  Moral rules that support NM is do not kill, incapacitate, cause distress, pain or suffering  Difference between NM (avoiding positive harm) and B (the demand for positive benefit)

18. 18 Non-maleficence (continue)  Passive principle which requires no action on the part of the moral agent for e.g. not pushing someone into a swimming pool  “First do no harm” = NM  Should each and every risk be disclosed to pts as part of the informed decision-making discussion?  When conflict between the principles of NM & B, the principle of NM usually outweigh the principle of B e.g. harvesting 2 kidneys from almost dead person

19. 19 Non-maleficence (continue)  Risk of harm to society needs to be taken into account - the principle of NM outweighs autonomy e.g. a pt in the community with TB who is non-compliant in taking medication regularly. This pt poses an infective risk to the public and a risk to become multi-drug resistant

20. 20 Justice  Benefits to be distributed impartially and fairly  Moral obligation to act on the basis of fair settlement between competing claims

21. 21  4 Principles should be balanced against each other to determine which weighs heavier  Principles in conflict should be balanced to find equilibrium (which can change)

22. Ethics from an  African thinking didn’t develop independently from western influences.  Many current-day African philosophers were trained in the West and teach the philosophy that they learned  Africans are human beings and as such irrespective of hx and circumstances holds views about right and wrong (that are often exactly the same as those of just about all other people) 22

23. Ethics from an (continue) Universal beliefs (Africans & Westerners): Uncontroversially pro tanto immoral:  To kill innocent people for money  To have sex with someone without her consent  To deceive people (at least when not done in self or other defense)  To steal unnecessary goods  To violate trust (e.g. to break promises for marginal personal gain) 23

24. Ethics from an (continue)  To discriminate on a racial basis when allocating opportunities  To insult people without good reason 24

25. Ubuntu Morality The principle that an action is right insofar as it respects harmonious relationships. An action is right insofar as it produces shared selfhood among people grounded on good-will (Metz)  “A person is a person through persons”  “Each person’s identity as a human being is causally and even metaphysically determined by and depends on a community”  An act is wrong to the extent that it fails to do so and tends to encourage the opposites of division and ill- will 25

26. Also  To do unto others what you would not want done unto you  Immoral to show disrespect for the aged (Wiredu) 26

27. An action is right insofar as it:  Respects a person’s dignity (wrong if degrades humanity)  Promotes the well-being of others (wrong when fails to enhance welfare of one’s fellows)  Promotes the well-being of others without violating their rights (wrong when violating rights)  Realises oneself by + engaging with others ( wrong if it does no perfect one’s valuable nature as a social being)  In solidarity with groups whose survival is threatened (wrong if it threatens a community’s way of life)  Enhances the togetherness in the community (wrong if it reduces harmony and produces discord) 27

28. 28 In a sense Kantian deontology supersedes all competing theories due to its abstractness But abstractness with no exception therefore sometimes impractical. It is not consistently and coherently possible to defend one single moral theory Other theories are Virtue Theory, Social Contract Theory, Liberal Individualism, Communitarianism, Ethics of Care etc etc

29. 29 Bibliography  BEAUCHAMP, T.L. & CHILDRESS, J.F. 2001. Principles of biomedical ethics. 5th ed. Oxford: University Press. 454 p.  GILLON, R. 2003. Ethics needs principles – four can encompass the rest – and respect for autonomy should be “first among equals”. Journal of biomedical ethics, 29(5):307-311, Oct.  GILLON, R. 1994. Principles of biomedical ethics. British medical journal, 309(6948):184- 185, 16 Jul.  HEUBEL, F. & BILLER-ANDORNO, N. 2005. The contribution of Kantian moral theory to contemporary medical ethics: a critical analysis. Medicine, health care and philosophy, 8:5- 15.  MOODLEY, K. 2011. Respect for patient autonomy. (In Moodley, K., ed. Medical ethics, law and human rights. Pretoria:Van Schaik publishers. p. 41-56.)  RACHELS, J. & RACHELS, S. 2010. The elements of moral philosophy. 6th ed. New York: McGraw-Hill p. 122-172.  VAN NIEKERK, A.A. 2011. Ethics theories and the principlist approach in bioethics. (In Moodley, K., ed. Medical Ethics, law and human rights: a South African perspective. Hatfield, Pretoria.: Van Schaik Publishers. p.19-39.)

30. 30 Activity: Case Study Use the background information discussed to identify the following:  Main moral issue  Moral theories at stake  Possible solution