LEC 2: Moral Reasoning and Ethical Theories

Morals

Personal Sense of Right and Wrong

Ethics

Professional/Social Sense of Right and Wrong

Law

When wrong actions are punished by society

Moral Reasoning

The thinking processes involved in judgments about questions of right and wrong

Kohlberg’s work

Divided moral development into three levels

Pre-conventional
Conventional
Post-Conventional

Kohlberg’s work three levels of moral development

Post-Conventional

Judgment based on abstract; personal principles not necessarily defined by society’s laws

Conventional

Expectations of society and law are taken into account

Pre-conventional

Judgment based solely on a person’s own needs and perceptions

Hypothetical situations

in which no choice is clearly and indisputably right.

The Heinz Dilemma

A man’s wife is dying. There is one drug that could save her life, but it is very expensive, and the pharmacist who invented it will not sell it at a price low enough for the man to buy it. Finally, the man becomes desperate and considers stealing the drug for his wife. What should he do and why?

Punishment-obedience orientation

Fear of authority and avoidance of punishment are reasons for behaving morally

Personal reward orientation

Satisfying personal needs determines the moral choice

Good boy-nice girl orientation

Maintaining the affection and approval of friends and relatives motivates good behavior

Law and order/authority orientation

A duty to uphold rules and laws for their own sake justifies moral conformity

Punishment-obedience orientation

Stage 1 (Pre conventional)

Personal reward orientation

Stage 2 (Pre conventional)

Good boy-nice girl orientation

Stage 3 (Conventional)

Law and order/authority orientation

Stage 4 (Conventional)

Social contract orientation

We obey rules because they are necessary for social order, but rules can be changed if there were better alternatives

Morality of individual principles and conscience

Behavior that conforms to internal principles (justice and equality) and may sometimes violate society’s rules.

Social contract orientation

Stage 5 (Post conventional)

Stage 6 (Post conventional)

Morality of individual principles and conscience

Christian Compassion

The virtue of ____ in Medicine emphasized “suffering with the patient”

naturalistic and religious

At this point in time there were two schools of Medicine ____ & _____

Natural Law Theory

Thomas Aquinas in the 11th century said that a rational God made the world work rationally and gave humans the ability to discover his rationale

Natural Law Theory

“What is…ought to be.”

Thomas Aquinas

______ in the 11th century said that a rational God made the world work rationally and gave humans the ability to discover his rationale

Doctrine of Double Effect

If an action has two effects, one good, and the other evil, the action is morally permissible

Doctrine of Double Effect

▪ If there was a good intention
▪ If the good happened at exactly the same time as the evil
▪ If only the Good was actually intended
▪ If there was an important enough reason for performing the action and risking the evil outcome

Social Contract Theory

Assumes that people are fundamentally self interested and that moral rules have evolved for humans to get along with one another

Kantian Ethics

A right act always treats other humans as end-in themselves, never as a mere means

Utilitarianism

Right acts produce the greatest amount of good for the greatest number of people

1. Consequentialism
2. The Maximization Principle
3. A Theory of Value
4. A scope-of-morality premise

Four Tenets of Utilitarianism

Case-Based Reasoning

Also known as Casuistry

Case-Based Reasoning

Analyzes cases by comparing them to other cases rather than using philosophical principles

Case-Based Reasoning

Also looks at each case as a unique situation and not a precedent

Pragmatism

Whatever methods has the best outcome is the best way to go

Autonomy
Beneficence
Nonmaleficence
Justice

Principles of Biomedical Ethics (4)

Voluntas aegroti suprema lex

Autonomy

Autonomy

Recognizes the rights of individuals to self-determination

Autonomy

This is rooted in society’s respect for individuals’ ability to make informed decisions about personal matters.

Salus aegroti suprema lex

BENEFICENCE

BENEFICENCE

a practitioner should act in the best interest of the patient

primum non nocere

NON-MALEFICENCE

NON-MALEFICENCE

is a legally definable concept. Violation of ________ is the subject of medical malpractice litigation

NON-MALEFICENCE

first, do no harm

JUSTICE

concerns the distribution of scarce health resources, and the decision of who gets what treatment.

Reductio ad absurdum

This Latin phrase literally translates as “Reduce to the absurd

Reductio ad absurdum

It is a tool of logic used to simplify ethical problems