2 - Theories and Principles of Healthcare Ethics

21st century

In the ______ issues resulting from technological advances in medicine will provide challenges that will necessitate reasoning about the right course of action.

Patient Protection and Affordable Care Act of 2010 (ACA 2010)

in this era, managers of healthcare organizations will find resources to carry out their charge increasingly constrained by multiple level of change, differences in payment structures, and labor shortages.

establishes the basic legal protections that until now have been absent: a near-universal guarantee of access to affordable health insurance coverage.

ethics theory and ethical decision-making tools

A foundation of _____________ can assist healthcare leaders in assessing the choices that they must make in these vexing circumstances.

Ethical understanding

becomes a form of cultural competence.

PHILOSOPHY

Chaos of thoughts, beliefs, assumptions, values, and superstitions

is the intense and critical examination of beliefs and assumptions. It is both natural and necessary to humanity.

gives coherence to the whole realm of thought and experience.

Moral Philosophy

- the philosophical discussion of what is considered good or bad or right or wrong in terms of moral issues.

Ethics

- concerned with the study of social morality and philosophical reflection on society’s norms and practices.

It offers formal process for applying moral philosophy

protecting people, ensuring the competence of members, and safeguarding the integrity and trustworthiness of the discipline.

Philosophical Basis of Ethical Theory

Professions have a vested interest in the conduct of their members for several reasons including

ethics codes

Most _______ specify that members conduct themselves honestly, fairly, and competently, and guide ethical conduct in moral situations.

American Nurses Association (ANA), the Canadian Nurses Association (CNA), and the International Council of Nurses (ICN)

Specific codes of ethics for nurses, such as those developed by the _______________, serve as guides for nurses in practice.

Naturalism

Rationalism

SCHOOL OF THOUGHTS

Naturalism

- A view of moral judgment that regards ethics as dependent upon human nature and psychology.

is the belief that everything in existence is derived from natural causes and laws— there is no supernatural or divine influence.

It emphasizes science, empirical evidence, and the physical world as the basis of all knowledge

Rationalists

- believe that there are absolute truths that are not dependent upon human nature.

They argue that ethical values have independent origins like the universe and can be known to humans through the process of reasoning.

Rejects Supernaturalism

Scientific Method

2 types of naturalism

Rejects Supernaturalism

– Everything can be explained by natural laws (e.g., physics, biology).

ex. Evolution explains human origins rather than divine creation.

Scientific Method

– Truth is discovered through evidence and testing.

ex. The brain, not the soul, is responsible for consciousness and thoughts

Rationalism

is the belief that reason, logic, and innate ideas are the primary sources of knowledge, rather than sensory experience or observation.

It argues that certain truths exist independently of the material world and can be known through reason alone

Mind Over Matter

Mathematical & Abstract Thinking

2 types of rationalism

Mind Over Matter

– Reality is understood through intellectual insight

ex. Moral laws (such as "stealing is wrong") exist as universal principles rather than being learned through experience

Mathematical & Abstract Thinking

– Rationalists value abstract principles over physical evidence.

ex. Mathematical truths (like 2+2=4) are true regardless of experience.

Deontology

Teleology

Utilitarianism

THEORIES OF ETHICS

Deontology

comes from the Greek word “deon”, which means “duty”.

is concerned with behaving ethically by meeting our duties.

ethics theory of __________ originates from the German philosopher Kant (1724-1804)

deon

which means “duty”.

formalism, Kantianism

-Occasionally, deontology is called ___________, some writers refer to this type of ethical theory as _____________-.

Immanuel Kant

• German philosopher

• Born at Konigsberg, Prussia in 1724

• After an uninspiring academic career, he surprised the world with his groundbreaking ethical theory.

• He contended that ethical rules are universal and that humans can derive certain consistent principles to guide action. He asserted that moral rules are absolute and apply to all people, at all times, in all situations.

Categorical

refers to moral rules that do not admit exceptions

imperative

denotes a command that is derived from principle.

Categorical Imperative

Practical Imperative

2 imperatives according to Kant

Categorical Imperative

is a moral principle that guides ethical decision-making. It means acting according to rules that apply universally, without exceptions.

In simple terms, before doing something, ask yourself: "Would it be okay if everyone did this?" If the answer is yes, then the action is morally right.

is a moral rule that applies to everyone, no matter their personal desires or goals. It demands actions that are always moral and should be followed by all people at all times.

Practical Imperative

means treating all people as valuable individuals (ends) rather than just tools to achieve personal goals (means).

He believed in a society based on liberty, equality, and fraternity, making his ethics a foundation for democracy.

is a way of applying the Categorical Imperative, which says that people should always be treated as valuable in themselves, not just as tools to achieve other goals. It highlights the importance of respecting everyone's dignity and worth

Raphael (1994)

“Kantian ethics is an ethics of democracy. It requires liberty, equality, and fraternity” within a politically organized society.

Teleology

using the Greek term “telos” , which refers to “ends” .

The consequentialist would say that intention simply confuses two issues: (i) whether the act itself is leading to good or bad outcomes and (ii) whether the person carrying out the act should be praised for it or not.

“telos”

which refers to “ends”

Consequentialism

Teleology is sometimes called

greatest good for the greatest number

the one finds that the goal of consequentialism is often stated as the

Utilitarianism

is the moral theory that holds that an action is judged as good or bad concerning the consequence, outcome, or result that is derived from it.

It is an important ethical philosophy that has its basis in naturalism. According to the utilitarian school of thought, the right action is that which has the greatest utility or usefulness. No action is, in itself, either good or bad.

Jeremy Bentham

The father of modern utilitarianism

According to his theory, actions can be considered to be right when they increase happiness and diminish misery and can be considered to be wrong when they have the opposite effect

He proposed that we should measure the product of an act in terms of the value of a proposed pleasure.

“Principle of utility”

By utility is meant that property in any object, whereby it tends to produce benefit, advantage, pleasure, good or happiness or to prevent the happening of mischief, pain, evil, or unhappiness to the party whose interest is considered

the principle that actions are to be judged by their usefulness in this sense: their tendency to produce benefit, advantage, pleasure, good, or happiness.

intensity, duration, certainty, propinquity, fecundity, purity

Six criteria are used to measure the pleasure including

propinquity

nearness in place or time

fecundity

the chance of being followed by sensations of the same kind

purity

the chance of it is not being followed by sensations of the opposite kind

John Stuart Mill

British Moral Philosopher (1806-1873)

He stated that the basic principle of utilitarianism is that actions are right to the degree that they tend to promote the greatest good for the greatest number.

For him, not all pleasures were equally worthy. He defined “the good” in terms of well-being and distinguished, both quantitatively and qualitatively, between various forms of pleasure

is closer to the virtue theory idea of eudemonia as a goal in that he specified qualitative distinctions rather than simply adding up units of happiness or pleasure

He believed utilitarianism to be in the spirit of the Golden Rule, “do unto others as you would have them do unto you” . Thus, the Golden Rule depicts the ideal perfection of utilitarian morality

Classical utilitarianism

is most often associated with the British philosopher Mill.

He developed the theory from a pleasure-maximizing version put forward by his mentor Bentham

greatest happiness principle

principle by John Stuart Mill, holds that the right action in conduct is not the agent’s happiness, but the happiness of all concerned.

He described the greatest sources of physical and mental suffering as “indigence, disease, and unkindness, worthlessness, or premature loss, of objects of affection. ”

Deontology (Duty-Based Ethics)

Focus: Moral rules and duties

Principle: Actions are inherently right or wrong, regardless of their consequences.

Key Thinker: Immanuel Kant (Categorical Imperative)

Example: Lying is always wrong, even if telling the truth causes harm.

Teleology (Consequence-Based Ethics)

Focus: End goals or purposes

Principle: The morality of an action is determined by its outcome or purpose.

Example: A doctor performing surgery is justified because the goal is to save a life, even if it causes temporary pain.

Utilitarianism (A Type of Teleology)

Focus: Greatest happiness for the greatest number

Principle: Actions are right if they produce the most benefit and least harm for the majority.

Key Thinkers: Jeremy Bentham & John Stuart Mill

Example: Sacrificing one person to save five would be morally justified because it maximizes overall happiness.

Deontology

values duties and rules over consequences

Teleology

focuses on the end purpose of actions

Utilitarianism

is a form of teleology that emphasizes maximizing happiness.

Act Utilitarianism

Rule Utilitarianism

Types of Utilitarianism

Act Utilitarianism

judges each individual action based on its specific consequences. An action is moral if it produces the greatest happiness in that particular situation, regardless of general rules

Each act is considered based on its net benefit.

This version of utilitarianism has received the most criticism and is not supported by modern ethicists.

It suggests that people choose actions that will in any given circumstance, increase the overall good.

Rule Utilitarianism

judges actions based on whether they follow rules that generally lead to the greatest happiness. Instead of evaluating each act separately, it focuses on long-term benefits of moral rules.

the decision maker develops rules that will have the greatest net benefit.

The development of rules to guide conduct is similar to the actions of administrators who develop policies.

It suggests that people choose rules, that when followed consistently, will maximize the overall good.

Virtue ethics

represents the idea that an individual’s actions are based upon a certain degree of innate moral virtue. First noted in the writings of Homer, and subsequently in the works of Plato, Aristotle, and early Christian thinkers,

character ethics

Virtue ethics, sometimes called

wisdom, courage, temperance, justice, generosity, faith, hope, and charity.

Western moralism emerged with the idea of cardinal virtues:

Modern and contemporary writers

also include such virtues as honesty, compassion, caring responsibility, integrity, discernment, trustworthiness, and prudence.

Moral virtue

is a character trait that is morally valued such as truthfulness, kindness, or honesty. A person with ___________ has both consistent moral action and a morally appropriate desire

ethika

The term “ethics” was derived from Aristotle’s word ____, which refers to matters having to do with character.

Aristotle

believed that good character comes from practicing virtuous behavior, not the other way around.

He thought virtues are habits of acting, feeling, and judging, developed through training and practice. In his view, virtue can be learned and improved over time.

saw virtue as excellence of character, developed through motivation, clear judgment, selfcontrol, and practice. He believed virtue comes from learning and habit, formed by consistently making good choices.

Aristotle’s traits of a virtuous character

1.Virtuous acts must be chosen for their own sake

2.The choice must proceed from a firm and unchangeable character

3.Virtue is a disposition to choose the mean

avoiding both excess and deficiency

The golden mean of virtuous behavior, for Aristotle, meant practicing moderation: ___________

“What should one be”

Aristotle did not list several moral principles. For him, the basic moral question is not “What should one do” but rather ____________-

Philippa Foot

expands on Aristotle’s idea of virtue, emphasizing that virtue isn’t just about actions but also the will behind them.

She argues that true virtue requires good intentions, not just practiced skills.

An act, like kindness or generosity, is only virtuous if done with the right motive.

Beauchamp and Childress

They propose that four focal virtues are more pivotal than others in characterizing a virtuous person

compassion, discernment, trustworthiness, integrity

four focal virtues

Compassion

– the ability to imagine oneself in the situation of another. It embodies the Golden Rule

Discernment

– It rests on sensitive insight involving acute judgment and understanding, and it results in decisive actions.

Trustworthiness

– Trust is a confident belief in the moral character of another person. It entails confidence that another will act with the right motives consistent with moral norms.

Integrity

– is perhaps the cardinal virtue. It means soundness, reliability, wholeness, and integration of moral character.

nightingale pledge

implies virtue of character as nurses promise purity, faith, loyalty, devotion, trustworthiness, and temperance

It is reasonable to say that good character is the cornerstone of good nursing, and that the nurse with virtue will act according to principle.

Moral Particularism

Utilizes the principles and rules of other moral theories. It is a form of moral theory that embraces the uniqueness of cases, the culturally significant ethical features, and -ethical judgment in each particular case (O’Neil, 2001).