1. From Ethical Theory to Practice
Robert Scott Stewart, Ph.D.
Professor of Philosophy
Chair, Philosophy & Religious Studies
Cape Breton University

2. Different Levels of Ethical Inquiry
Meta-Ethics: Defining the meaning of moral concepts. E.g., Are ethical claims relative or universal? What does the term ‘good’ mean? What role does reason play in ethical judgments?
Normative Ethics: What principles ought to guide us making ethical decisions?
Practical Ethics: An examination of particular issues in ethics. E.g., Is euthanasia defensible? Are clinical drug trials involving children acceptable? Should we allow genetically modified foods on the market?

3. Methods for ethics Name the issue(s)
Collect and analyze the facts (all stakeholders + law and administrative policies)
Ethical analysis of the issue(s) given the facts
Suggestion of alternatives
Implementation and follow-up (Handbook for Bioethics Committee Members)

4. Ethical Theories: Utilitarianism
The greatest happiness principle:
“Actions are right in proportion as they tend to promote happiness; wrong as they tend to produce the reverse of happiness.” - John Stuart Mill ( )
A “consequentialist” theory of value. Actions aren’t right or wrong in themselves: it always depends on the context and the (expected) consequences.

5. Utilitarianism: Pros
Straightforward: provides one principle as the moral test of all actions (monistic theory of value).
Intuitive appeal: we all seek happiness
Has particular appeal with respect to ‘public’ morality or law. I.e., Social programs ought to aim for the biggest bang for the buck – high satisfaction, low cost (cost-benefit analysis: efficency).

6. Utilitarianism: Cons
How do we measure happiness (or pleasure)? Is my happiness (or unhappiness) comparable to yours?
Possibly inconsistent with individual rights. E.g., in cases where trampling of my rights would produce overall utility.
Possibly inconsistent with other things of value like loyalty and friendship.

7. Deontology Kant and the first version of the categorical imperative.
“Act as if the maxim of your action were to become through your will a universal law of nature.”
Immanuel Kant ( )
A secular version of the golden rule: “Do onto others as you would have them do onto you.”
I.e., universalize your actions

8. Deontology Kant’s second formulation of the categorical imperative.
“Always treat humanity, whether in your own person or that of another, never simply as a means but always at the same time an end.”
Kant ( )
Persons vs. things or mere objects
Dignity and autonomy

9. Deontology: Pros
Straightforward: provides one principle (with two formulations) as the moral test of all actions (monistic theory of value).
Intuitive appeal: humans do typically feel special and hence deserving of respect by not being used and by being allowed to make decisions over their own lives.
Good ground for individual rights.

10. Deontology: Cons Too restrictive and context independent.
Is it always wrong to lie? Are there no exceptions?
Should we never assess the morality of our actions by their consequences?
Offers no clear path when we have conflicting obligations.

11. The impact of Utilitarianism and Kant
Despite their problems, utilitarianism and Kantian deontology provided the two main ethical theories in use until the late 20’th century (and are still tremendously influential today).
Alternatives:, (1) care rather than justice, (2) virtue ethics, (3) case studies (casuistry), (4) pluralism.

12. 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.

13. 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.”

14. Cases
Don’t worry so much about theory. Look at actual cases and formulate principles on the basis of these.
But is this possible with no guidance from principles at all?

15. Pluralism
W.D. Ross ( ) complained that utilitarianism and Kantian deontology erred in claiming that there was only one ethical principle (the greatest happiness principle or the categorical imperative). This was the main reason why neither had been able to secure complete acceptance.
Utilitarianism too forward looking
Deontology too backward looking
A need for plurality of ethical principles which would incorporate elements of the two main theories.

16. Principalism
An increasing interest in applied ethics through the 1980’s and 90’s.
Recognition (by some) that ethical theory as it stood not adequate to the task of applied ethics.
Tom Beauchamp (Georgetown) and James Childress (Virginia), Principles of Biomedical Ethics (1979, 5’th ed., 2001)

17. Four Principles Autonomy Nonmaleficence Beneficence Justice
Application and use various contexts: e.g., codes of ethics and research ethics.

18. Tri-Council Policy Statement
Respect for Human Dignity
Respect for Free and Informed Consent
Respect for Vulnerable Persons
Respect for Privacy and Confidentiality
Respect for Justice and Inclusiveness
Balancing Harms and Benefits
Minimizing Harm
Maximizing Benefit

19. CNA Code of Ethics for Registered Nurses
Safe, Competent, and Ethical Care
Health and Well Being
Choice
Dignity
Confidentiality
Justice
Accountability
Quality Practice Environments

20. Concluding Remarks
No single paradigm for ethics: principalism is one attempt to incorporate various strands into one comprehensive system
Not meant to be algorithmic
Hardest decisions are ones where principles clash and we have obligations pointing in different directions.
Sound judgment and humility required