Ethical theories ch 2

Purposes Define the terms moral philosophy & ethics Define the terms moral philosophy & ethics Discuss the importance of ethical theory Discuss the importance of ethical theory Describe utilitarianism Describe utilitarianism Describe deontological ethics Describe deontological ethics to survey a variety of theories as to what matters morally

Introduction “our focus will be on normative medical ethics, i.e., how people should behave in medical situations” We will set aside the question: ‘uhhhh....how people should behave in medical situations, according to whom?’

Ethics in Nursing Ethics - a branch of philosophy dealing with standards of conduct and moral judgment How do professionals fulfill responsibilities? Ethics provide basis for decision making. Morals - standards of right and wrong Values - ideas or beliefs

Philosophy The intense and critical examination of beliefs and assumptions. It offers principles for deciding what actions are most worthwhile.

Moral Philosophy Philosophical discussion of what is “good”, or “bad”; right or wrong, in terms of moral issues. Deal with social values or norms: respect for life, freedom, love, feeling of guilt, shame, self-esteem.

Philosophical Basis for Ethical Theory Naturalism: view of moral judgment that regards ethics as dependent upon human nature and psychology There is universality in moral judgment All people have a tendency to make similar ethical decisions Sympathy is a motivating factor in moral decision making

Rationalism There are absolute truths not dependent upon human nature Ethical values have an independent origin, can be known through process of reasoning Truths about world are necessary and universal and are superior to information we receive from our senses.

The Goal of Ethical Theory Generally: to provide a systematic answer to the question of how we should behave Ethical theory provides a framework for cohesive & consistent ethical reasoning and decision making.Ethical theory provides a framework for cohesive & consistent ethical reasoning and decision making.

Ethical Theories 1-teleology (Utilitarianism) 2-deontology3-instituation 4-ethics of caring

Teleology (Utilitarianism) Looks to the consequences of an action in judging whether that action is right or wrong Looks to the consequences of an action in judging whether that action is right or wrong Consequentialists maintain that whether an action is morally right or wrong depends on the action's consequences. In any situation, the morally right thing to do is whatever will have the best consequences (have greatest utility or usefulness). Consequentialist theories are sometimes called teleological theories.

This theory also provides the greatest good for the greatest number (sometimes violate the principle of autonomy). This theory also provides the greatest good for the greatest number (sometimes violate the principle of autonomy). It is particularly useful in situation of distributive justice but tend to ignore the rights of the individuals( in the name of overall good) It is particularly useful in situation of distributive justice but tend to ignore the rights of the individuals( in the name of overall good) Utilitarianism

Only Happiness  "actions are right in proportion as they tend to promote happiness, wrong as they tend to produce the reverse of happiness." (John Stuart Mill's Greatest Happiness Principle)  In other words, judge an action by the total amount of happiness and unhappiness it creates

Types of utilitarianism  Act-utilitarianism: suggests that people choose actions that will, in any given circumstances, increase the overall good.  Rule-utilitarianism: people choose rules that, when followed consistently, will maximize the overall good.  Example: telling the truth

Deontology (formalism, kantianism) Proposes that the mortality of a decision is not determined by its consequences Proposes that the mortality of a decision is not determined by its consequences It emphasizes duty, rationality, and obedience to rules It emphasizes duty, rationality, and obedience to rules

Deontology 'Duty Based' Ethics Deontologists deny that what ultimately matters is an action's consequences. They claim that what matters is the kind of action it is. What matters is doing our duty. There are many kinds of deontological theory e.g., The 'Golden Rule' - "Do unto others as you'd have them do unto you."

Kantian Deontology Immanuel Kant ( ) is the most influential deontologist. Rejecting Consequentialism: "A good will is good not because of what it effects or accomplishes." Even if by bad luck a good person never accomplishes anything much, the good will would "like a jewel, still shine by its own light as something which has its full value in itself."

Categorical/Practical Imperative Kant claims that all our actions should be judged according to a rule he calls: 1. Categorical Imperative: "Act only according to that maxim [i.e., rule] whereby you can at the same time will that it become a universal law." 2. Practical Imperative: "Act in such a way that you treat humanity, whether in your own person or in the person of another, always at the same time as an end and never simply as a means." Important to treat people as autonomous agents

Deontology focused on using of the categorical imperative (can this action be a law for all people in all circumstances? Deontology focused on using of the categorical imperative (can this action be a law for all people in all circumstances?

Differences Differences between teleology and deontology can be seen when each approach is applied to the issue of abortion Differences between teleology and deontology can be seen when each approach is applied to the issue of abortion

Abortion Teleology approach saving the mother’s life (the end, or consequences) Teleology approach saving the mother’s life (the end, or consequences) Justifies the abortion (the mean, or act) Justifies the abortion (the mean, or act) Deontology approach consider any termination of life as a violation of the rule ‘do not kill’ and therefore, would not abort the fetus, regardless of the consequences to the mother Deontology approach consider any termination of life as a violation of the rule ‘do not kill’ and therefore, would not abort the fetus, regardless of the consequences to the mother

Moral Particularism Utilizes the principles and rules of other moral theories. Embraces the uniqueness of cases, the culturally significant ethical features, and ethical judgment in each particular case. It must rely on certain relevant principles (utilitarianism, deontology) for the starting point of judgment.

Virtue Ethics Whereas utilitarianism and deontology emphasize whether a particular action is right or good, virtue ethics emphasizes “the person” making the judgments or doing the actions. I.e., a virtuous person will make virtuous decisions and act virtuously. Has its roots in Aristotle ( BCE): stress on moral education, moderation, and relationships. Virtue in Greek is arete, which literally means “excellence.”

Virtue Ethics: Focal Virtue Beauchamp & Childress proposed four focal virtues (traits) characterizing virtuous person Compassion: attitude of active regard for another’s welfare with awareness and emotional response of deep sympathy. Discernment: classical concept of wisdom; sensitive insight involving acute judgment and results in decisive (crucial, important) action Trust worthy: confident belief in the moral character of another person Integrity: soundness, reliability, wholeness, and integration of moral character.

Theories of Care and Feminism Carol Gilligan (Harvard), In a Different Voice, 1982 Attacked Kohlberg’s theory of moral development as biased toward a male perspective who prefer abstractness and universals over the concrete and relationships. While males prefer abstract principles (like utilitarianism and Kantian deontology), females show a preference for relationships with specific people. Led to much feminist thought including the “ethics of care.” Feminism and care have been particularly influential in biomedical ethics since at the core of health care are special kinds of relationships b/w health care workers and patients.

Ethics of caring It is based on relationships It is based on relationships Caring is a force for protecting and enhancing client dignity Caring is a force for protecting and enhancing client dignity

Caring is of central importance in the client –nurse relationship Caring is of central importance in the client –nurse relationship E.g nurses use trust telling to affirm clients as a persons rather than objects and to assist them to make choices and find meaning in their illness experiences E.g nurses use trust telling to affirm clients as a persons rather than objects and to assist them to make choices and find meaning in their illness experiences Ethics of caring

Comparison of morals and ethics EthicsMorals - formal responding process used to determine right conduct -professionally and publicly -inquiry or study of principles and values (investigation) - process of questioning and perhaps changing one’s morals, “What I should do in this situation”. -Tradition or belief about right and wrong conducted - private and personal -commitment to principles and values is usually defended in daily life (protected). - related to an individual’s character (virtue)

End of Chapter

Moral development Is a complex process that is not fully understood Is a complex process that is not fully understood It is process of learning what ought to be done and what ought not to be done It is process of learning what ought to be done and what ought not to be done Different approaches to moral development exists: Different approaches to moral development exists: Kohlberg's theory Kohlberg's theory Gilligan Gilligan

Lawrence Kohlberg b. Bronxville, NY 1927 d. Boston, Mass In 1958 he first published his stage theory of moral development in his doctoral dissertation at the Univerisity of Chicago. He stayed at the University of Chicago until 1968, when he went to Harvard to teach and continue his research until his death. from

Kohlberg's Directly affected by Piaget’s theory of cognitive development Directly affected by Piaget’s theory of cognitive development Focuses on the structure of thought about moral issues rather than the specific content of moral values Focuses on the structure of thought about moral issues rather than the specific content of moral values Emphasize fairness, rights and autonomy in a justice framework Emphasize fairness, rights and autonomy in a justice framework

Moral development progress through 3 levels Level 1 premoral or preconventional level Level 1 premoral or preconventional level Level 2 conventional level Level 2 conventional level Level 3 post conventional, autonomous or principled level Level 3 post conventional, autonomous or principled level

Theory of Moral Development ♂ Level 1: Preconventional: ♂ Stage 1: Punishment and Reward ♂ Stage 2: Hedonism (self-satisfaction)/ Reciprocity (common) ♂ Level 2: Conventional: ♂ Stage 3: Good Boy/Bad Girl ♂ Stage 4: Rules of society ♂ Level 3: Postconventional: ♂ Stage 5: Individual Rights ♂ Stage 6: Universal Principles

Level 1 premoral or preconventional level: Level 1 premoral or preconventional level: - Premoral level has egocentric focus - The person obey rules in order to avoid punishment / get rewards. ( most in children and under nine, in some a adolescent and adult criminal) - Fear of punishment is a major motivator of this level.

Focus on social conformity “socially accepted”. Focus on social conformity “socially accepted”. Behavior or decision in order to maintain relations /conform to laws and to those in authority because duty without respect for them and in order to avoid censure. Behavior or decision in order to maintain relations /conform to laws and to those in authority because duty without respect for them and in order to avoid censure. Guilty is more motivator than the fear of punishment as noted in level 1 Guilty is more motivator than the fear of punishment as noted in level 1 Level 2 conventional level.

- The relativity of some societal value is recognized - Moral decision derive from principles that support individual rights - Transcend particular societal rules as equality, liberty, justice. - your decision based on universal ethical principles like human dignity, mutual respect & trust Level 3 post conventional, autonomous or principled level.

Carol Gilligan ♀ Student of Kohlberg’s ♀ Later criticized his theory of moral development as being biased toward a male perspective ♀ Proposed care-orientation as an alternative method of moral reasoning ♀ Believes girls are more inclined towards care- orientation so they score lower on Kohlberg’s stages because care-orientation is associated with stage 3 (good interpersonal relationships). from

Gilligan’s Three-Stage Theory ♀ Preconventional: Egocentricism ♀ Conventional: Care for others ♀ Postconventional: Balancing care for self and others “The moral judgments of women differ from that of men in the greater extent to which women’s judgments are tied to feelings of empathy and compassion and are concerned with the resolution of real as opposed to hypothetical dilemmas.” Gilligan, 1982

Gilligan's Focuses on a care perspectives Focuses on a care perspectives Organized around the notions of responsibility, compassion (care) Organized around the notions of responsibility, compassion (care) The ethics of justice (fairness) is based of the idea of equality ‘everyone should receive the same treatment” The ethics of justice (fairness) is based of the idea of equality ‘everyone should receive the same treatment”

By contrast, the ethics of care is based on premise of nonviolence that no one should be harmed or abandoned By contrast, the ethics of care is based on premise of nonviolence that no one should be harmed or abandoned

Process of developing an ethics of care Stage 1 caring for one self Stage 1 caring for one self Stage 2 caring for others Stage 2 caring for others Stage3 caring for oneself and others Stage3 caring for oneself and others Each stage ends with a transitional period (a time when the individual recognize a conflict or discomfort with some present behavior and new approaches)

Caring for one self : in this phase the concern for survival, focus is on what is best for the self and include selfishness & dependency on other. Caring for one self : in this phase the concern for survival, focus is on what is best for the self and include selfishness & dependency on other. caring for others: focusing on goodness caring for others: focusing on goodness In which needs of others are often put a head of self, & there is a sense of being responsible for others (positive). In which needs of others are often put a head of self, & there is a sense of being responsible for others (positive). - Negative: by manipulating others through a “ see how good I have been to you).