2. Theory of Health Care Ethics
Chapter 1
Theory of Health Care Ethics

4. Why Study Ethics?
Because health care is changing, you need tools for making necessary and difficult decisions.
It will help you better understand patients, fellow professionals, and the system in general.
It will assist you in building and maintaining your career.

5. Types of Ethics Normative ethics Metaethics
Is the study of what is right and wrong.
Metaethics
Is the study of ethical concepts and theories.

6. Types of Normative Ethical Theories
Authority-based
Egoistic
Natural law
Deontological
Teleological
Virtue

7. Ethical Relativism
Ethical relativism purports that there is no absolute theory for ethics.
However, this lack of a complete theory does not mean everything is relative.
People need to make rational decisions about ethics-based issues.
Therefore, ethics theories are useful.

8. Egoism as Ethics Theory
Egoism is based on the idea that one’s self interest is the basis his or her ethics decisions.
Theory is not helpful in health care ethics because professionals are taught to set aside self-interest.
The interests of the patient should come first.

9. Authority-based Ethics Theory
Decisions about ethics (right or wrong) are based on central authority such as in a theology or an ideology.
For health care ethics, there may difficulty deciding which authority is the correct one.
However, knowing this view of ethics helps with understanding patients and health policy decisions.

10. Virtue Ethics Theory Is founded in the writings of Aristotle.
Everything moves from potentiality to actuality.
Character development allows you to actualize your highest good.
Eudaimonia should be sought as the highest good.

11. Virtue Ethics Theory
Eudaimonia means that you seek to build your character and increase virtue.
Professional education seeks to develop people of high character.
People who work toward eudaimonia become persons of practical wisdom.

12. Virtue Ethics Theory
Principles of ethics can help to define your character and assist with your actions. See Chapter Two for more information.
Virtue ethics is criticized as being elitist.
Virtue ethics requires the balancing of conflicting obligations.
People with practical wisdom can make appropriate ethical decisions.

13. Natural Law Theory It is founded in the writings of St. Thomas Aquinas
It assumes that nature is rational and orderly.
Humans are part of the natural world and are given the ability to be rational.
Our natural reason allows us to distinguish right from wrong.

14. Natural Law Theory
Reason is also action in that humans can choose to do good or evil.
The Principle of Double Effect helps us decided which action is good.
Good is also defined as that which helps to maximize potential, such as preserving life, gaining wisdom, and knowing God.

15. Natural Law Theory
In natural law, there are some acts that are not ethical because they violate the ability to reach one’s potential.
People who support social responsibility can use natural law as a foundation for actions.
Understanding natural law also assists with patient relations.

16. Deontology Theory Comes from the Greek word “deon” meaning “duty.”
It is sometimes called duty-based ethics.
One of the main theorists is Immanuel Kant.
The world exists in the form of things we can experience directly (phenomenal world) and things that exist independently of the intellect (noumenal world).

17. Deontology Theory
Free will makes ethics possible and without it we would not need ethics.
Areas of character can be used for good or evil.
Therefore, the only true good is good will.
The ability to choose to do good is what makes us human.

18. Deontology Theory
Actions are judged by their intention and not just their outcomes.
Kant attempted to define a rational principle for making moral judgments.
The principle is the categorical imperative.
People can never be used as a means to an end; they must be respected.

19. Deontology Theory
The Golden Rule is not a synonym for the categorical imperative.
Kant believed that we must act based on duty to moral law and not on the consequences of our actions.
Practicing this is its pure form is difficult in modern society.

20. Kant and Virtue Ethics
Pure Kantian ethics is absolute in its definition of duty but virtue ethics allows for grey areas.
Kant does not assist with deciding among lesser evils and greater goods
Virtue ethics allows the use of tools to make these decisions

21. Deontology and Policy
Health care professionals recognize a duty to the patient
Health care managers also have a duty to the patient, but they have duties to the organization and community as well.
Conflicting duties must be considered in policy making.

22. Non-Kantian Deontology
Recent proponents of the deontology tradition include John Rawls and Robert Nozick.
These theorists deal with the idea of justice through our actions.
Their thinking influences health care reform, public health, and other health areas.

23. John Rawls
John Rawls worked to define the characteristics of a just society.
He examined justice as fairness and applied it to societies that respect the rule of law.
His work is based on the idea of a social contract between members of a society.

24. Self Interest and Justice
Rawls used a hypothetical or mind experiment called the original position to explain why rational people would protect everyone’s self interests.
In this mind experiment, he also included the concept of the veil of ignorance to help us understand why we would care about self interests.

25. Self Interest and Justice
If we were in the original position, we would all be equal.
Therefore, we could all be treated in the same way in a society.
Therefore, it would be in our self interest to make sure that everyone is given an equal share of benefits and burdens.

26. Basic Principles of Justice
The first principle of justice for Rawls is liberty.
This principle is also a priority over all other principles of justice.
People should have equal right to basic liberties (see the Bill of Rights).

27. Basic Principles of Justice
The second principle for Rawls is justification of inequalities.
He uses the difference principle to justify when social and economic inequities are appropriate.
Physicians are a classic example of the difference principle.

28. Rawls’ Opponent Robert Nozick is also considered to be a deontologist.
He represents the conservative tradition and has great influence in the debate over health care reform.
Nozick emphasizes the autonomy and the rights of the individual.

29. Nozick and Social Goods
For Nozick, there is no social good that requires sacrifice.
We are only “other people”.
We should influence people to take steps to improve their own situations.
Theories like Rawls supports defeat voluntary agreements.

30. Nozick and Distributive Justice
For Nozick, there is no principle of distributive justice.
He finds justice in acquisition and owned resources.
Historical injustices are not addressed in his theory except to suggest that society could be organized to maximize the position of the least well off.

31. Consequentialism Theory
Through Mill’s work, this theory is also known as utilitarianism.
For this theory, your intentions are irrelevant; all that counts is the outcome.
Greatest Good for the Greatest Number is often used as a summary of the theory.

32. Consequentialism Theory
Has two main types
Classical or act utilitarianism.
Each act considered on its own
Rule utilitarianism.
Develop rules that net the greatest benefit

33. Consequentialism Theory
Rule utilitarianism is used to make health care policy.
Exceptions can be made under special circumstances.
Rule utilitarianism also allows for negative consequentialism or preventing the greatest harm for the greatest number.

34. Consequentialism Theory
Preference utilitarianism argues that good is honoring preferences and bad is frustrating preferences
Preferences must be known or a substituted judgment can be used

35. Consequentialism Theory
Criticisms of utilitarianism include
The minority is not protected when the greatest good for the greatest number is the goal.
Some say this theory means that the ends justifies the means.
These criticisms are not valid because respect for autonomy and liberty is essential to the theory.

36. Use of Ethical Theories
There is no pure ethical theory; each has strengths and weaknesses.
However, health care professionals must make complicated ethics decisions
The ability to understand theory enhances your decision making tool kit.

37. In Summary…