M1 - Introduction to Ethics and Power

Ethics

The study of what is right and wrong; rules or principles for what’s considered moral

Ethical Dilemma

Situations where the question of right and wrong becomes critical, often involving complex factors and not allowing all options to be chosen simultaneously

Moral Compass

Framework that individuals use to guide decision-making

• Has multiple influences including but not limited to: religion, citizenship duties, institution, profession, family/friends

Ethical Theories

Deontological Ethics

Consequentialist Ethics

Care-based Ethics

Deontological Ethics

Focuses on duty or responsibility rather than the consequences

• Also known as duty-based ethics

Consequentialist Ethics

Decision-making guided by the potential consequences of actions

Care-based Ethics

Focuses on care and nurturing others in decision-making

Distinguishing Law, Morality, and Ethics

Although they are sometimes used interchangeably, Law, Morality, and Ethics have distinct differences

Law

Formal rules governing behaviour as society members; Upheld by state and court systems

• Specifies ‘must do’ and ‘must not do’

Narrower focus than morality or ethics; can be just or unjust and subject to ethical assessment

Silent on many matters where morality and ethics have much to say (e.g. a racist joke)

Morality

Informal framework of values, principles, beliefs, customs, ways of living; Not usually enforced by state but subject to social pressures to conform

• Often inherited from family, community, or culture

• e.g. Christianity, Stoicism, Buddhism

Can be applied habitually w/o conscious thought

Risk: Living an “unexamined life” (Socrates) by accepting ready-made answers w/o reflection

Ethics

Branch of philosophy that asks “What should I do?”

• Process of reflection where decisions are shaped by values, principles, and purpose, rather than unthinking habits or social conventions

• Ethical decisions are based on conscious reflection, giving effect to values, principles, and purpose in pursuit of a proper goal

Requires thinking about issues the law can’t or doesn’t address; puts moral systems under scrutiny

Ideally, ethical beliefs shape laws and moral systems, leading to their evolution

Provides a toolkit for questions of good and right

Power

The possession of authority/control over others. Includes:

• Ability to express needs, wants, feelings

• Ability to be free from exploitation, marginalization, cultural imperialism

• Ability to define the context and structure within which people operate

Power and Ethics

If not guided by ethical obligation, power can cause oppression, illness, injury

• Unnecessary power can be an enabling factor for exclusion

Five Faces of Oppression (Young)

Iris Marion Young’s framework describing different forms of oppression in society (can be overlapping)

1. Violence

2. Exploitation

3. Marginalization

4. Powerlessness

5. Cultural Imperialism

Violence

Using force to oppress others

• Example: hate crimes, racist attacks, intimidation.

Exploitation

Using cheap labour for profit without adequate compensation (often impacts racialized people or recent migrants)

• Example: migrant workers being underpaid while companies profit heavily

Marginalization

Exclusion from participation or confining groups to lower social standing based on race, gender, class (often a structural issue)

• Example: barriers that make it harder for disabled people or racialized communities to access jobs or education

Powerlessness

Inhibition to develop capacity due to lack of access to power, limiting self-determination

• Example: workers with no say in workplace policies or communities lacking political representation

Cultural Imperialism

The dominant culture (often of the ruling class) sets norms and imposes them on all others, disregarding different traditions

• Example: schools or media presenting mainly one cultural perspective as universal

Social Justice Approach in Ethics

To transform ethical decision-making to accommodate, cultural differences, acknowledge existing oppression, remove barriers of exclusion, and ensure everyone’s stories are accounted for

Principilism

A branch of deotonlogical ethics often used in biomedical ethics

• Based on 4 principles

Principilism Principles

1. Autonomy

2. Beneficence

3. Non-maleficence

4. Social Justice

Autonomy

Respect for the voluntary decision-making capacities of autonomous, rational, and competent persons, without coercion (In Western culture, it often focuses on the individual’s right to decide)

Beneficence

Ensuring the provision of maximal benefits to clients or associated people

Non-maleficence

The duty not to intentionally hurt or injure a patient

Social Justice

Fair distribution of beneficiaries (like making sure resources, medicine, or organs are handed out fairly to everyone)

Critiques of Principalism

1. Imperialist

2. Cultural Assumptions

3. Inadequate

Imperialist

Principilism rooted in Western (specifically Greek) philosophy

Cultural Assumptions

Fails to account for cultural differences (e.g. individual autonomy in the West vs. collective family decision-making in some Asian cultures)

Inadequate

Struggles to account for non-autonomous or conflicting principles

Other Issues with Traditional Biomedical Ethics

1. Individual Focus

2. Autonomy Overemphasis

3. Social Justice Undervalued

4. Medical Professionalism

5. Implicit Bias

Individual Focus

Overemphasis on individual patients and their healthcare rather than broader socio-cultural issues impacting health outcomes

Autonomy Overemphasis

Patients may lack adequate resources or knowledge for truly informed decision-making

Social Justice Undervalued

Historical marginalization and inequities persist for different groups despite healthcare reforms

Medical Professionalism

HCPs may make decisions for patients, assuming lack of intelligence or education

Implicit Bias

Inherent biases and power imbalances based on intersectional categories lead to inequities in care and outcomes

Intersectionality

Indicates multiple indicators of oppression based on different demographic or social categories

Intersectionality Visualization

Can be visualized as a “wheel” where

• Center represents people with privileges and proximity to power (e.g. white, cisgender, men)

• Progressing towards the outside of the circle represents marginalized groups (e.g. dark skin colour, transgender, intersex/non-binary individuals)

Reimagined Ethics and Power in Kinesiology (Joseph and Krieger)

This framework expands upon biomedical ethics by adding two key components

1. Vulnerability

2. Context/Relationship

Vulnerability

Recognizes susceptibility of individuals (patients, practitioners, researchers) due to factors like lack of resources, intellectual foundation, or the experience of marginalization

Context/Relationship

Emphasizes cultural understanding and positions the healthcare system as a “broker,” valuing the broader socio-cultural bakcground

Reimagined Ethics and Power Effects

1. Shift in weight

2. Transformation

3. Focus

Shift in Weight

Social justice is given most dominant weight, differing from traditional principles where all four principles are equally weighted

Transformation

Moves from deontological and utility-based ethics towards care-centric ethical solutions

Focus

Ensuring the well-being of patients prioritizing a “patient-first” or “client-first” perspective that considers broader socio-cultural issues from the client’s background

Ethical Practices

EP = Theoretical/Intellectual Understanding + Informed Action

Key Strategies:

• Familiarize yourself w/ different cultures to be more culturally sensitive

• Make alliances with marginalized groups

• Be open to adapting innovation, learning about new cultures and their health understandings/treatment

• Seek additional supervision when needed

Cultural Sensitivity

Guiding questions for culturally safe and appropriate healthcare:

• What practices are culturally safe and appropriate for individuals?

• How do power differentials affect decision-making processes?

• How can autonomy and self-determination be promoted while ensuring safety and well-being?

• How can collaboration with individuals and communities be fostered to respect and incorporate diverse cultural values and beliefs?