An act is moral if it brings more good consequences than bad ones. What is the action to be evaluated? What would be the good consequences? How certain are the good consequences? What would be the bad consequences? How likely is it that they would occur? How extensive are the bad consequences? Are there alternatives? Right actions = more pleasure than pain Wrong actions = more pain than pleasure The happiness of all people is to be considered equally 300/330 appleby 1

Utilitarianism checklist: þ What is the action to be evaluated? þ No action is intrinsically right or wrong þ What would be the good consequences? þ How certain are the good consequences? þ What would be the bad consequences? þ How likely is it that they would occur? þHow extensive are the bad consequences? þ Are there alternative possible actions? þ Perform same calculation for these actions 300/330 appleby 2

DEONTOLOGY An act is right if it conforms to a moral rule. It is your duty to do what is right. An act cannot be judged by its consequences. Immanuel Kant ( ) Kantian deontology is an ethic of respect for persons  for oneself  for others 300/330 appleby 3

DEONTOLOGICAL thinking ACT ONLY ACCORDING TO THAT MAXIM [principle or rule of conduct] BY WHICH YOU CAN AT THE SAME TIME WILL [intend or desire] UNIVERSAL LAW THAT IT SHOULD BECOME A UNIVERSAL LAW ACT SO THAT YOU ALWAYS TREAT HUMANITY [whether in your own person or in that of any other] NEVER SIMPLY AS A MEANS, BUT ALWAYS AT THE SAME TIME, AS AN END. RATIONAL PERSONS [as autonomous beings] HAVE THE CAPACITY TO MAKE THEIR OWN DECISIONS 300/330 appleby 4

Virtue Ethics asks these questions What kind of person should I be? What character traits do I value and want to develop? What kind of community do I want to foster? Family; student body; colleagues; educational or medical institution How can I promote human well-being, or human flourishing, within the context of my life-span? What leads to consistency or integrity within my own experiences of perceptions, feelings and actions? 300/330 appleby 5

“Natural Law” Aristotle’s Virtue Theory is a form of “Natural Law” theory 1.RATIONALITY  Morality is grounded in the human capacity for reasoning / intelligence  Humans are free and autonomous  Make own choices & carry them out 2.TELEOLOGY  Natural law is embedded in the nature of the universe  Everything in the universe has its own natural purpose or end  discovered, not created, by people 300/330 appleby 6 “Natural Law” has 2 main components or elements: RATIONALITYTELEOLOGY RATIONALITY and TELEOLOGY

Care Ethics  moral obligations arise out of our relationships with others and our mutual duties of caring What does it mean to be “caring”  caring = being attentive to the needs of others  respectful caring = sustained attention and response to needs of patients & their families 300/330 appleby 7

What can a feminist ethic of care offer?  The subordination of women is morally wrong and harms both women and men.  Both men and women should be treated as equals  Both are deserving of justice rather than discrimination or privilege  Moral obligations arise out of our relationships with others and our mutual duties of caring  Human persons are interdependent and formed through personal relationships.  Maintain caring relations  Avoid harm; Respond to need  Recognize and respond to vulnerability 300/330 appleby 8

The 4 Principles of Bioethics are: 1. Autonomy 2. Beneficence 3. Non-maleficence (also called non-malfeasance, but this term is not generally used in Canada) 4. Justice 300/330 appleby 9

Scenario 2: Conjoined Twins – BC p.38 One of the twins is much stronger than the other If separated from her sister, the weak one will certainly die If surgical separation is not performed, the stronger sister’s organs will be burdened by sustaining both twins Both would be likely to die within 2 years 300/330 appleby 10

HUSBAND – NO SURGERY – surgical separation will save the stronger twin only by killing the weaker twin – let nature take its course with no surgery Which moral theories could help the husband explain his view? Choose ONE moral theory and apply it in support of the husband WIFE – ATTEMPT THE SURGERY – why let both die when one twin could be saved Which moral theories could help the wife explain her view? Choose ONE moral theory and apply it in support of the wife 300/330 appleby 11

Imagine that you were the potential surgeon. Using a moral theory not yet applied, make your argument in favour of performing the surgery. Imagine that you were one of the nurses caring for the twins. Using a moral theory not yet applied, make your argument either in favour of or against performing the surgery. 300/330 appleby 12 Now, imagine that you are the clinical ethicist who has been consulted to assist with the decision-making. Use the four principles of health care ethics to help resolve the ethical dilemma. What will you recommend? (**Not making a recommendation is NOT an option**)