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Moral Reasoning in Bioethics — Comprehensive Study Notes (from Transcript)

Morality and Human Nature

  • Morality as a feature of human nature:
    • Morality is an essential part of human nature and is present in all cultures.
    • Descriptive ethics: the study of morality using the methodologies of science.
    • Fields: moral psychology, anthropology, evolutionary biology.
    • Example: Michael Tomasello’s Becoming Human: A Theory of Ontogeny
    • Purpose: Investigates the origins of cooperation from evolutionary anthropology, cognitive science, and developmental psychology; a strong example of descriptive ethics.

Culture as a Distinctive Feature of Human Nature

  • Human behavior and cognition are shaped by both biology and inherited social norms.
  • Adequate descriptions of human life require both biology and culture.
  • Example: a chemist adds ammonia to a solution and observes it turning deep blue; infers the solution contains copper ions.
  • Question: How is this possible? Through inherited scientific practices, a sociocultural phenomenon guiding behavior, perception, and cognition to yield knowledge about the world.
  • If one wants to think correctly about the natural world, methodologies of the natural sciences should be used.
  • Conclusion: culture can be understood as intrinsically normative.

Normativity is Action Guiding

  • Normative prescriptions govern how we act, speak, and think in everyday life.
  • Example: Language has correct and incorrect forms for being understood.
  • Morality is similar: it prescribes how one should behave and how one should evaluate others’ behaviors to be ethical.
  • Both language and morality adapt over time to changing cultural, social, and individual contexts.
  • There are non-moral norms as well: grammatical norms, aesthetic judgments, etiquette, etc. (Vaughn, 5).

Can we determine the right thing to do scientifically? (Overview)

  • Acknowledges a tension between empirical/biological explanations and normative conclusions.
  • The slide hints at a broad spectrum of normative traits (a diagram with many traits such as probativeness, benevolence, conscientiousness, spirituality, etc.).
  • Argument implication: Even if one studies naturalistic tendencies, this does not straightforwardly yield moral prescriptions.

Naturalistic Fallacy Revisited

  • Humans evolved to live in small, cooperative groups; loyalty to the in-group enhances survival.
  • Tribalism likely evolved due to advantages like outsider protection and shared resources.
  • Policy question: Does this imply we should only favor our own group? The slide cautions against this conclusion—tribalism can fuel conflict and harm if unchecked.
  • Relevance noted: ecological mismatch (next slide).

Ecological Mismatch

  • Idea: Human psychological propensities may be mismatched with modern environments.
  • Classic example: craving for fat and sweets, which were advantageous in scarcity but contribute to obesity in modern sedentary societies.
  • Source: Mokdad et al. (2004) Actual causes of death in the United States, 2000, JAMA.
  • Conclusion: Even without the naturalistic fallacy, looking to evolutionary origins for normative conduct is unwise.

Alpha Males and the Naturalistic Fallacy

  • The concept of an “alpha male” is perpetuated by some sources but is scientifically flawed as a universal human model.
  • Extrapolations from primate studies must be careful and context-sensitive.
  • The Wolf: Ecology and the Behaviour of an Endangered Species (David Mech) showed wolves in captivity behaved unnaturally; later work showed packs are family units with parental guidance and cooperation, not dominance.
  • Even if some natural pattern existed, it is not grounds for prescribing conduct in humans.

Can Moral Statements Be True or False?

  • Empirical truths: e.g., Water boils at 100°, John is bald, Hemoglobin carries oxygen.
  • Moral statements: e.g., Murdering children is wrong; Stealing is immoral; Cheating on your partner is wrong.
  • The challenge: Are moral claims truth-apt in the same way as empirical claims?

Ethics vs Descriptive Ethics

  • Very generally: Ethics asks, “How ought we to live?”
  • Descriptive ethics asks, “How do we in fact live?” (Vaughn, 4)

Features of Moral Norms (Dominance, Universality, Impartiality)

  • Normative Dominance: Moral norms override other norms (e.g., unjust laws vs. moral duty to resist).
  • Universality: Norms apply consistently in similar situations; universalizes general behaviors.
  • Impartiality: Equal consideration for all unless morally relevant differences exist (e.g., skin color is not morally relevant).
  • Morally relevant differences exist in specific cases (e.g., triage decisions in emergencies; use of force to prevent harm).
  • Agent-Neutrality and Agent-Relativity (see next section) relate to impartiality and the scope of moral claims.

Morally Relevant Differences: Agent-Neutrality vs Agent-Relativity

  • Agent-Neutrality: Moral norms apply equally to all agents; no one’s suffering is more important objectively than another’s.
  • Agent-Relativity: Some individuals’ suffering is more important from a subjective point of view (e.g., a parent’s obligation to feed their own child is stronger than to a stranger’s).
  • These differences illustrate how moral judgments can vary depending on perspective and relational context.

Features (Cont.): Reasonableness

  • Moral judgments must be backed by good reasons; context matters.
  • Right can mean obligatory or permissible.
    • Obligatory: it is wrong not to perform.
    • Permissible: not wrong to refrain.
  • Supererogation: acts that are praiseworthy but not required (e.g., bone marrow donation, kidney donation to strangers, donating half your income).
  • Peter Singer’s TED Talk on what we owe others (relevance to supererogation) (Vaughn, 6-8).

Absolute vs Prima Facie Moral Duties

  • Absolute principles: without exception (e.g., never torture).
  • Kant’s first formulation of the categorical imperative embodies this (never lying).
  • Prima Facie principles: apply in all cases unless overridden by a more compelling competing principle.
  • Examples:
    • Physician refuses terminally ill patient’s request to end life, citing “It is wrong to intentionally take a life.”
    • Another physician in similar circumstances treats, arguing “Ending the suffering of a hopelessly ill patient is morally permissible.”
    • Parents of an anencephalic infant donate organs to save others, arguing “Save as many children as possible.”
    • Critics argue against the organ donation as “unethical to kill to save.” (Vaughn, 8-9)

Moral Principles: Autonomy

  • Autonomy = Auto (self) Nomos (law): respect for rational self-determination.
  • Informed consent is essential.
  • Autonomy can be restricted by the harm principle and paternalism.
  • Harm Principle: We can curtail autonomy to prevent harm to others (legal system).
  • Paternalism: Overriding someone’s decisions for their own good.
  • Question: What’s the difference between weak and strong paternalism? (Vaughn, 9-10)

Weak vs Strong Paternalism

  • Weak Paternalism: occurs when a person’s decision is not fully informed or not rational (e.g., severe depression, psychosis).
    • Example: Temporarily restraining a suicidal patient to prevent harm.
    • Moral Status: Often deemed permissible.
  • Strong Paternalism: occurs when a person is competent and fully informed, but their decision is overridden.
    • Examples: Giving an experimental drug without consent; lying to a terminally ill patient to spare feelings.
    • Moral Status: Usually considered morally objectionable.

Moral Principles (cont.): Non-Maleficence and Beneficence

  • Non-Maleficence: “Above all, do no harm.”
    • There are cases where a physician must cause harm to cure (e.g., surgery, treatments with risks).
  • Beneficence: Obligation to do good, promote well-being, and prevent harm.
  • Question: Is Beneficence a general duty or solely professional?

Moral Principles: Utility

  • Utility = maximizing overall benefit while minimizing harm; “greatest good for the greatest number.”
  • Healthcare applications:
    • Balancing benefits vs. risks in medical treatments or public health policies.
    • Vaccination programs: high population benefit despite rare adverse effects.
    • Triage in emergencies: maximize survival likelihood under resource limits.
    • Cost-benefit analysis: determine if benefits justify costs given resource limits.
  • (Vaughn, 11-12)

Utility Calculations (Illustrative Scenarios)

  • Net Utility Calculations: Net Utility Score = Benefits − Harms (qualitative in table; units may vary)
  • Vaccination Program
    • Benefits: saves 10,000 lives annually; 95% effectiveness.
    • Harms/Risks: 0.01% severe side effects (~100 individuals annually).
    • Net Utility: High (benefits far outweigh harms).
    • Data: ext{Benefits} = 10{,}000 ext{ lives/year}, ext{Effectiveness} = 95 ext{%}, ext{Severe side effects} o 0.01 ext{%}
  • Triage in Emergencies
    • Prioritizes 5 patients with 80% survival; 10 patients with 20% survival may not receive care.
    • Net Utility: Moderate.
  • Allocation of Ventilators
    • Saves 30 patients (with 15 ventilators); some conditions reversible.
    • Net Utility: High.
  • New Cancer Treatment Approval
    • Extends life by 2 years for 1,000 patients; 70% QoL improvement.
    • Costs: $10M annually; reduces funds for other treatments.
    • Net Utility: Conditional (depends on cost-benefit and allocation).
  • Fluoridation of Water
    • Reduces cavities in 85% of population; saves $100M in dental costs.
    • Opposition: 5% of population.
    • Net Utility: High (population health benefits outweigh objections).

Distributive Justice: Egalitarianism and Libertarianism

  • Egalitarianism: Equal distribution of economic advantages and opportunities.
    • Examples: universal healthcare, addressing social determinants of health.
    • Associated with John Rawls’s A Theory of Justice.
  • Libertarianism: Prioritizes autonomy over equality; often favors private healthcare and limited taxation; “taxation is theft.”
    • Associated with Robert Nozick’s Anarchy, State and Utopia.

John Rawls – A Theory of Justice

  • Justice as Fairness: Society’s basic structure should be designed by principles chosen in the Original Position.
  • Original Position: A hypothetical scenario to decide principles of justice fairly.
  • Veil of Ignorance: No knowledge of socioeconomic status, gender, race, abilities, religious/political views, preferences; ensures impartial principles.

Rawls (cont.): Two Principles of Justice

  • Equal Liberty Principle: Each person has an equal right to the most extensive liberties compatible with similar liberties for others.
  • Difference Principle (Equity): Social and economic inequalities are permissible only if they:
    • Benefit the least advantaged, and
    • Are attached to positions open to all under fair equality of opportunity.
  • Maximin rule: Choose the social arrangement where the worst possible outcome is better than in any alternative system.

Difference Principle Examples

  • Benefits to least advantaged: Progressive taxation funds education, healthcare, housing subsidies.
  • Incentives for physicians in rural areas: Inequality is justified if health outcomes improve for disadvantaged groups.
  • Pandemic lockdowns: Prioritize least advantaged and allocate vaccines to the most vulnerable first.
  • Access to leadership positions: Open to all; nepotism and biases violate fairness.
  • Scholarships and financial aid; job/education access; triage systems; public scholarships.

Rawls – Implications for Bioethics

  • Equal Liberty Principle: Everyone has an equal right to basic health care as a fundamental liberty; autonomy and equitable access must be respected.
  • Difference Principle: Benefit to the least advantaged; universal health care can reduce disparities.
  • Fair Equality of Opportunity: Health care access should not be restricted by wealth, race, or social class; supports programs for students from underprivileged backgrounds to enter healthcare professions.

Equity vs Equality (Illustration)

  • Which represents equity and which equality? (Figure reference: H)
  • Equity = giving people what they need to achieve similar outcomes; Equality = giving everyone the same resources.

The Entitlement Theory of Justice – Robert Nozick

  • Core claim: The minimal state is the most extensive state that can be justified.
  • Just Acquisition: A person is entitled to holdings acquired in accordance with justice in acquisition.
  • Just Transfer: A person entitled to holdings transferred from someone else entitled to the holding.
  • No one is entitled to a holding except by (repeated) applications of 1 and justice depends on how holdings were acquired and transferred, not on distribution.

Nozick – Wilt Chamberlain Example

  • “Liberty upsets patterns”: voluntary exchanges create inequalities.
  • Scenario: Start with equal distribution (D1). Wilt Chamberlain earns $0.25 per ticket; accumulates $250,000 in a season, creating an unequal distribution (D2).
  • Key idea: To maintain a patterned distribution (e.g., equality) requires constant interference; liberty leads to inequality.

Entitlement Theory – Implications for Bioethics

  • Health care distribution: Rejects patterned or redistributive justice principles; supports voluntary exchanges for resources.
  • Redistribution critiques: Taxation for redistribution equated to forced labor; redistribution violates property rights by imposing obligations.
  • Bioethics challenges: Historical injustices (systemic racism, colonization) may not be fully addressed by Nozick’s framework; focuses on individual choice, potentially overlooking systemic barriers in access to health care.

Ethical Relativism

  • Moral Objectivism: Some moral principles are objective and apply universally.
  • Moral Absolutism: No exceptions (distinct from relativism).
  • Ethical Relativism: Moral standards depend on individuals or cultures; two types:
    • Subjective Relativism: Right and wrong depend on individual beliefs.
    • Cultural Relativism: Right and wrong depend on cultural norms.

Challenges to Ethical Relativism

  • Subjective Relativism challenges:
    • Implies moral infallibility; conflicts in disagreement reduce to taste differences.
    • Extreme implications: Genocide or infanticide could be justified if believed to be right by the actor.
  • Cultural Relativism challenges:
    • Cultures could be deemed morally infallible (e.g., slavery).
    • Prevents legitimate criticism and moral reform; denies moral progress.
  • Practical issue: Hard to identify which culture determines morality for individuals in diverse societies.

Ethics and Religion

  • Historical connection: Religion has guided morality via commandments and ethical codes; secular systems (e.g., Stoicism, utilitarianism) also shape morality.
  • Divine Command Theory: Morality is based on God’s will; right actions commanded by God; wrong acts forbidden by God.
  • Socrates’ Euthyphro Dilemma:
    • Are actions right because God commands them? (moral arbitrariness concern)
    • Does God command actions because they are right? (morality independent of God’s will)

Ethics and Religion: The Role of Ontology

  • Metaphysics: Study of the fundamental structure of reality, questions like “What does it mean to be?” and “What is existence?”
  • Ontology: The study of what exists and the kinds of entities that constitute reality; different belief systems have different ontologies (materialist, theological, animist, pantheist, etc.).

Religion, Culture, and Ontology

  • Different cultural groups may hold different ontologies; belief about what exists shapes moral principles.
  • Example: elderly parents believed to enter heaven in a state tied to beliefs about reality; social atomism vs. social holism/communitarianism affect ethical norms.
  • Ontological assumptions influence ethical norms and social organization.

Tips for Studying Philosophy

  • Engage with the material:
    • Connect ideas to real-world issues or personal experience.
    • Curiosity and effort improve understanding.
  • Summarize in your own words:
    • Break readings into sections and paraphrase key points.
    • Focus on understanding arguments, not mere memorization.
  • Identify premises and conclusions:
    • Determine supporting statements and the conclusion.
    • Question whether premises are true and whether the conclusion follows.
  • Active participation:
    • Ask questions in class, form or join study groups, engage in dialogue.
  • Office hours:
    • Use them for questions, challenging readings, and exploring ideas; they provide personalized feedback and guidance.

Notes on Key References and Concepts

  • Vaughn’s text (various pages) as a framing for many concepts: descriptive ethics, normative theories, and bioethical implications.
  • Rawls: Original Position, Veil of Ignorance, Equal Liberty Principle, Difference Principle, Maximin.
  • Nozick: Entitlement Theory, Wilt Chamberlain example, critique of redistributive justice.
  • Ethics vs Religion: Divine Command Theory and Euthyphro Dilemma as central debates.
  • Ontology-driven ethics: how differing ontologies in culture influence normative ethics and political arrangements.