Biomedical Ethics - Week 2 Lecture

SCH3145 Biomedical Ethics

Lecture 2: VALUES & ETHICAL DECISION-MAKING


Learning Outcomes

  • By the end of this lecture, students should be able to discuss:

    • Meaning and types of values.

    • Factors that may affect values.

    • How values are learned.

    • How personal values influence professional values.

    • How to apply an ethical decision-making process to an ethical dilemma.

    • Clinical ethics services.

What are Values?

  • Origin: The term "values" is derived from the Latin word "valere" which means:

    • Worth or desirability of a thing.

    • An influence on behavior, actions, and thinking, often tied to achieving intrinsic satisfaction.

  • Source: http://www.cartoonstock.com/directory/m/moral_values.asp, accessed on Feb. 14, 2011

Definitions of Values

  • Values are:

    • Important and lasting beliefs held by individuals or members of a group or culture.

    • A stance taken and expressed through behaviors, feelings, imagination, knowledge, and actions.

    • Source: Steele & Harmon 1983, p. 1

    • Ideals, beliefs, customs, modes of conduct, qualities, or goals highly prized or preferred by individuals, groups, or society.

    • Source: Burkhardt & Nathaniel, 2002, p. 67

  • Personal values and beliefs function as filters or screens of interpretation.

    • Understanding values and beliefs allows for an objective assessment of how people cope with health and illness.

    • Source: Kavanagh 1991

Values in Culture

  • Cultures emphasize values that are broadly shared by their members, which relate to cultural norms, helping identify what is judged as right or wrong, important or worthwhile.

  • Example: A solemn behavior at a funeral is a cultural norm, demonstrating the value of respect.

Variations in Cultural Values

  • Different cultures reflect values differently and with varying degrees of emphasis.

  • Australia: Identified as a 'Christian' country but has a secular government.

  • In some countries, overt expression of religion is highly valued.

    • Example: United States.

  • Norms and values can change over time or due to events and social movements, such as the 'sexual revolution'.

How are Values Learned?

  • Values are generally 'received' through cultural means, including:

    • Transmission from parents, who have differing values based on their cultural backgrounds.

    • Example: In subsistence agriculture cultures, parents might value practical survival skills which can be taught to young children.

    • Modeling by teachers or religious groups.

    • Reward and punishment:

    • Positive reinforcement for conformity.

    • Negative sanctioning through ignoring, alienating, or excluding individuals who conflict with group norms.

  • Individual development allows for responsible choices and critical analysis of values.

    • Source: Burkhardt & Nathaniel 1998, p. 95


Factors Influencing Values

Personal Influences

  • Values are central to individual lives and influenced by:

    • Cognitive development.

    • Home environment.

    • Parental teachings.

    • Personal experiences and highly-cherished goals.

    • Individual variation, impacting ethics and determining right from wrong and ethical obligations.

Community Influences

  • At a community level, values are shaped by:

    • Teachings at school.

    • Common community values, such as 'giving back' to the community.

    • General acknowledgment of resource utilization.

Professional Influences

  • On a professional level, values are influenced by:

    • Regulatory bodies and their disciplinary functions.

    • Codes of ethics guiding professional conduct.

    • Educational background and training.

    • Work expectations and environment.

    • Peer pressure and duties/responsibilities linked to one's role in an organization or societal expectations.

    • Professional relationships typically relate more closely to business dealings than personal interactions


Personal vs Professional Values Clash

  • Example of Kevin Carter (1993, Sudan):

    • Pulitzer Prize-winning photograph highlighting the conflict between sanctity of life as a universal human value vs. professional duties of a photographer.

    • Quote from The St. Petersburg Times: "The man adjusting his lens to take just the right frame of her suffering might just as well be a predator, another vulture on the scene."

  • Carter's own reflections reveal an internal conflict between empathy for suffering and professional obligations. Example quotes:

    • "My God! But it is time to work. Deal with the rest later. If you can’t do it, get out of the game."

    • Acknowledging discomfort, Carter later felt that his actions, simply witnessing the horrific scenes, might not have been inherently bad.

Values & Ethical/Moral Dilemmas

Ethical/Moral Dilemmas Defined

  • A conflict characterized by:

    • Competing moral values or principles.

    • Choosing between two equally unsatisfactory alternatives.

    • Inability to accept both principles or values simultaneously.

    • Necessity to choose one over the other.

Examples of Ethical Dilemmas

  1. The Love/Eat Dilemma:

    • An individual must choose between loving animals and eating meat, emphasizing the impossibility of choosing both values simultaneously.

  2. Endangered Species Dilemma:

    • The conflict between beliefs in the medicinal benefits of using animal parts and the moral implications of driving species to extinction.

  3. Beggars on the Street:

    • Encounter with a beggar invoking questions around empathy, personal responsibility, and social judgment, tightly bound to values.

  4. Friend in Distress vs. Academic Responsibility:

    • Balancing a promise to classmates with immediate emotional needs of a friend highlights personal vs. professional obligations.

  5. Expecting Mother with Twins:

    • A woman must make a significant choice regarding family planning, weighing personal values regarding family size and the moral implications of terminating a pregnancy.

Resolving Ethical Dilemmas

Ethical Decision-Making Process

  1. Consider Fundamental Ethical Principles:

    • Four primary principles:

      • Autonomy

      • Beneficence

      • Non-maleficence

      • Justice

    • Additional principles include confidentiality/privacy and veracity (truthfulness).

  2. Gather Facts:

    • Address non-moral elements: scientific and factual data, history, examinations, and relevant investigations.

  3. Identify the Ethical Problem:

    • Analyze the ethical matter within the context it's situated.

    • Distinguish ethical problems from legal, social, or medical issues.

  4. Consider Applicable Laws:

    • Identify relevant legal frameworks guiding management decisions.

  5. Explore Perspectives and Theories:

    • Consider additional theories like virtue ethics, feminist ethics, consequentialism, and deontology to gain diverse insights.

  6. Decision Justification:

    • State and justify the decision based on supportive principles and theories.

    • Responsibility for the decision and a plan for communicating it to relevant stakeholders is crucial.

    • Importance of documentation and evaluation of the decision that was made.