Morality and Moral Decision-Making

Introduction

What will This Course Cover?

In this class, we are going to discuss many issues of both theoretical and practical significance. For example, in each chapter, we are going to focus on one of the topics such as medical decision-making, namely, who gets to make medical decisions, and for whom? We are also going to talk about the managing of medical information; privacy issues, including genetic information; we will discuss reproductive ethics, especially the moral complication of abortion; end-of-life decision-making; and on a broader scale, our responsibility in a pandemic and global collaboration on public health.

What is the Nature of Our Discussion?

What is the Nature of Our Discussion? But before we can start discussing these issues, we should do what philosophers always do as a first step: Clarify the nature of our discussion. We are focused, in this class, on the ethical implications of these topics. This means that the technological aspect is not our focus, but a sufficient understanding of the technological issues will help us grasp their moral implications. We will be briefly introduced to the current states of technologies in the medical sciences when necessary (for example, before talking about genetic engineering, we will be introduced to the relevant medical factors). In other words, not all the knowledge we learn in this class are moral factors; some are non-moral factors.

What is the Aim of this Course?

On the other hand, although many of us have robust moral beliefs about certain matters we will discuss in this course, we need to equip ourselves with a more systematic understanding of morality to be able to articulate our position. We also need to be able to understand various perspectives so we can communicate and discuss these issues. We aim, in this course, to further our discussion on the issues in medical ethics instead of coming to assertions. This means that there isn’t, frequently, a single “right” answer for each debate; being able to navigate complex moral situations, to articulate our positions, and to communicate with others who may not have the same position as ours are the capacities we aim to train in this class.

Meta-Ethics: Relativism and Multiculturalism

Introduction: The Study of Morality

The discussion in the last section leads us to another question: if we have a number of moral theories, how do we know if a behaviour is right or wrong? What if it is right in one theory but wrong in another? Further, what about different cultures? Does each culture have their distinct and even incompatible morality? What if a behaviour is right in one culture and wrong in another? What will our final verdict rely on?

One way of expressing these ideas that is often attractive to students is that morality depends wholly on what a culture or religion believes is right. Thus, whatever moral standards a culture or religion believes in or endorses are morally correct, and that is all that can be said in determining what is right. However, this view doesn’t address questions such as what might be considered right or acceptable when people from different cultures or people with different religious views come together. It also seems to suggest that morality is always relative, and we can’t know what is moral or not. This view is known as relativism. We’ve stumbled into the realm of meta-ethical questions, and we should get some foundation here before moving into normative theories and biomedical ethics, which will make up the primary content of this course. For a deeper exploration of meta-ethics, you might consider taking an “introduction to ethics” course. Unfortunately, we simply do not have the time to fully explore meta-ethics in this course in applied ethics.

But it is very important in an applied ethics class to bear in mind at least some metaethical considerations, not least because implicit meta-ethical positions can be detected as underlying many of the things we will talk about in this course. When engaging in moral discussion we are focusing on a number of core ideas such as well-being, dignity, and so on. Even if they are defined differently in different moral systems, they are commonly viewed as important in many cultural systems. Before we move forward, the study of ethics is normally divided into three realms: metaethics, which we will shortly discuss; normative ethics, which is the focus of this lesson; and applied ethics, of which biomedical ethics is a part of. In other words, from lesson two, we will move to specific topics in biomedical ethics and in this lesson, we will first survey the basics of morality.

Ethical Subjectivism

An implicit meta-ethical position is one that works, so to speak, beneath the surface or behind the scenes of our everyday ethical concepts and debates. For instance, you have heard people say some of the following types of things: “there is no such thing as right or wrong,” “what is wrong for you is just your opinion, and I have my own opinion,” and “you are saying X is wrong because of your emotions, and I just feel differently about it, so there is no one true answer.” These comments imply an underlying belief that morality is reducible down to individual preferences. These are very laudable and important values. But, as an ethical theory, “moral subjectivism” causes some concern, and perhaps there are other ways of supporting the ideals behind these important values.

The underlying commitment of ethical subjectivism is that there are no “moral facts” in the universe, and so ethical statements are not, properly speaking, statements about the world at all. Rather, they are at best interpreted as statements about the opinions of the speaker. 3 © May not be copied or duplicated without the permission of the owner.

So, imagine you, a moral subjectivist, are observing two of your friends in a heated moral debate. Friend A says, “The government can require its citizens to wear masks for their own good” and friend B says, “The government does not have such a right.” As an ethical subjectivist, you intervene and say: “You are both right to your own morals.” If you, the moral subjectivist, are correct, then there is no debate or exchange of opinion at all. We should also note that certain stances, such as individual relativism—which maintains that everything is subjective, depending on the individual’s own preferences— prohibits discussion and is an unattractive position to have.

Cultural Relativism or Multiculturalism

Another common “implicit” meta-ethical position held by many people is known as “cultural relativism.” This is a very popular and somewhat intuitive theory that appears often in your everyday experience. For instance, you might sometimes hear your friends say something like, “Well, X may be fine for you, but in my culture, X is wrong.” Or you might hear a politician argue against intervening in another country’s affairs because “It is wrong to impose our values on other cultures.” Now, such speakers do implicitly hold the belief that ethical terms are meaningful, that is, ethical truth or falsity is relative to cultures. Someone who believes in cultural relativism thinks that there are no “universal” or “objective” ethical truths, since every culture will have different moralities.

Notice that this position seems, on the surface, very much related to the contemporary values of multiculturalism and tolerance. You may feel that it is a virtue to be tolerant of another culture’s values, even if they do not match your own, and indeed this is a very good ethical policy! There is no question at all that different cultures have different moral practices, but a rigorous ethical relativist would have to say that there is no ethical basis for suggesting (ever!) that a cultural practice is morally wrong. The implication is that people from other cultures or other time periods cannot judge or evaluate these moral values or practices as right or wrong.

For instance, if a culture had a practice that allowed some people to keep and trade others as slaves, then a “cultural relativist” would seem to have to say that “relative” to this culture, slavery is not wrong. But many have the deep intuition that certain things (like slavery) may be ethically unacceptable whether or not one’s culture allows it. Being respectful and sensitive to different cultures and cultural practices do not require one to endorse cultural relativism. In fact, cultural relativism will discourage moral discussion.

8. Is Morality Relative? Meta-Ethics Overview

Here, we will briefly talk about the three types of positions in meta-ethics, but first, I will briefly explain to you what “meta-ethics” is. Meta means beyond, and it also appears prominently in the name of another branch of philosophy you may have heard of, known as metaphysics. Metaphysics is the branch of philosophy that asks the big questions—the ones people most often associate with philosophy, such as: “Why does anything exist?” “What is the nature of time?” and “What is the nature of reality?” That is, it asks questions that go “beyond” (or meta) physics. A similar situation takes place in ethics, in that meta-ethical questions do not look for specific moral rules or facts, but rather ask about the very possibility and nature of ethics itself. For instance, it is a meta-ethical question if you ask, “Are there objective moral facts?” Or again, it is meta-ethical to ask, “Is morality a human construction based on social contracts?” To very briefly illustrate these positions, consider the following examples. Example 1 Let us consider the following position: Lying is wrong, just like 2+2=4; it is true no matter where, no matter when. Humanity could have gone extinct and it will remain true. It is a moral fact; whoever doesn’t believe in it is wrong. This position can be called moral realism—believing that there are objective moral facts. Example 2 Let us now consider a different position. Someone believes that killing innocent people is wrong because maintaining a certain population is the only way human communities could survive, so most civilizations come up with moralities that would prohibit it. This position would be considered moral constructionism—believing morality is a result of human construction. Example 3 Different cultures may have different takes on certain moral issues, such as some cultures show more respect based on one’s seniority, where other cultures seem to believe people are equally entitled to respect despite their age. In other words, respect doesn’t correspond with one’s seniority. This is an observation consistent with both cultural relativism and moral constructionism. Note that cultural differences doesn’t mean cultural relativism—we can at the same time admit that there are cultural differences while maintaining those are just different variations of similar constructions. For example, most cultures, historical or contemporary, have some sort of ideas of justice and reciprocity.

Normative Ethics

Normative Ethics 2. Looking Ahead Now that we have a basic understanding of certain metaethics positions, we are still not ready to be introduced to specific topics in medical ethics yet, which is a subject of practical ethics, or applied ethics. In this lesson, we will briefly examine a number of important philosophical schools most relevant to our ethical discussion. In the rest of the semester, we will continue to use them in our discussion, so please make sure that you understand these fundamental moral theories thoroughly before moving forward to the other lessons. 3. What Is Morality? (Part 1 of 2) Just like biology studies life and living organisms and psychology studies the mind and behavior, the discipline of ethics (or sometimes known as moral philosophy) studies morality—that is, moral principles, moral emotions, moral behaviors, and moral practice. You may be wondering if any of this yet connects with “morality” in your everyday use of the term. In fact, some of you will sense an important distinction between saying that something is “moral” and saying that it is “ethical,” and others of you will feel that these two terms are more or less interchangeable (that is, they mean the same thing). And indeed, in ethics and moral philosophy, they often are used interchangeably. In this class, as well as terms such as “moral” and “ethical”, to say something is ethical is the same as saying it is moral in this class.

4. What Is Morality? (Part 2 of 2) For the purposes of this course, the definition of morality as provided in the textbook is: “an explicit or implicit system of rules that governs the behavior and values of a certain group of people.” This may not be a comprehensive definition of morality. It is also important to consider moral emotions and moral experience, as well as our moral practice, even though they do not take the form of rules or a system of rules, they should not be excluded from the study of morality. “Ethics” and “moral philosophy” then would be best understood as “the study of morality—its concepts, practices, and justifications.” That is, “morality” is the thing, and “ethics” is the study of that thing. Of course, as I just mentioned, many writers use the terms interchangeably.

6. Normative Ethics

Normative ethics is the inquiry into the standard that determines how to act morally and lead a moral life. We will frequently engage with these schools of thoughts and apply them to specific topics such as abortion, our obligation in public health, etc. You might notice the word “norm” in normative, and indeed norms are guidelines, standards, or rules. So, in normative ethics, philosophers present theories about what rules or principles should guide our behaviour. In normative ethics, we try to figure out what we ought to do or how we ought to be. There are, to simplify a bit, three or four main types of theories within normative ethics: consequentialism, deontology, and virtue ethics. This has recently been supplemented in important ways by the ethics of care, which emerges from feminist thought.

Normative Ethics: Consequentialism

Normative Ethics: Consequentialism 2. Influential Consequentialist: John Stuart Mill (1806–1873) (Part 1 of 2) Let’s explore consequentialism first in the next few slides, before moving on to the rest of the three schools. Again, we need these tools throughout this class, so be sure to ask questions if you have any. Traditionally, this theory is most associated with philosopher John Stuart Mill. As you might guess from the word “consequentialism,” the consequentialist approach to normative ethics emphasizes that the most important question in terms of whether an action is right or wrong is the consequences of the action. To determine if something is right or wrong, these philosophers suggest we weigh the expected/likely outcomes and pick whichever course of action is expected to give the best results. 3. Influential Consequentialist: John Stuart Mill (1806–1873) (Part 2 of 2) There are various ways of interpreting “best results or consequence.” Egoism, for instance, is a consequentialist theory where “best results” means “best results for me.” However, the most famous and important consequentialist ethical theory is utilitarianism. On this theory, the “best results” is defined in terms of “overall” or “general” happiness or well-being of anyone affected by the action. This theory thus argues that, as JS Mill writes, “an action is right if and only if its expected consequences are such that overall happiness or well-being is maximized.” Mill is famous for his Principle of Utility; it states that “Actions are right in proportion as they tend to promote happiness, wrong as they tend to produce the reverse of happiness. By happiness is intended pleasure, and the absence of pain.” © 2 © May not be copied or duplicated without the permission of the owner. 4. Influential Consequentialist: Jeremy Bentham (1748–1832) Jeremy Bentham is another well-known philosopher who is known to be a consequentialist. Note that “utility” in the term utilitarianism does not mean useful, but rather is related to promoting the best outcomes as related to pleasure and pain. In short, the principle of utility requires that we aim to maximize good consequences and minimize bad consequences, to get the best possible outcome overall. One key part of utilitarianism that is often seen as a reason to accept the theory is that it is impartial. That is, when the utilitarian moral agent (the person deciding between two actions) is thinking about the outcome, they have no grounds to prefer their own or their loved one’s happiness over anyone else’s. We should be impartial, and the most important question is in fact the overall happiness or well-being of everyone. If saving a world-famous violinist from a running river brings more happiness than saving one’s own mother and one can only save one of them, utilitarianism requires the agent to save the violinist. This is inhumane. Bear in mind this problem of consequentialism as we move forward. 5. Influential Consequentialist: Peter Singer You may wonder, at this point, who holds this view. You may have heard the campaign of Effective Altruism leading by philosopher Peter Singer, arguing that we should spend resources in the most efficient way to prevent and address poverty. Feel free to look it up. Select the link Effective Altruism to learn more. In the next section, we will continue to discuss normative theories, but starting with a new school of ethics that cares more than the consequences. 6. Problems with Consequentialism Consequentialism has other problems that go beyond being “too impartial”; it doesn’t allow one to take one’s relationship to the object into account, as demonstrated in the saving one’s mother from a running river example. This leads us to think: is the outcome the only thing that matters? 3 © May not be copied or duplicated without the permission of the owner. 7. Problems with Consequentialism: An Example Let’s imagine the following situation. Select the video to learn more. The following text is the transcript from the animation: Narrator: John is admitted to the hospital with a very bad flu. Doctor White: John, we will need to keep you in the hospital overnight because you are extremely dehydrated; however, don’t worry, as you are recovering. Narrator: In the morning, Doctor Brown, the surgeon, is wandering the hallways when he hears Doctor White talking to the hospital’s councilor. Councilor: John summoned me and confessed to me he is suicidal. He lost his job, his family, and his home, and has been living on the streets with nothing else to live for. He feels nobody would miss him and he would be better off dead. I looked into his medical files but couldn’t find any traces of him in any of our public records. I am suspecting that he wandered here from another city far away. Narrator: Doctor Brown interrupts, grabbing John’s file. Doctor Brown: I have 7 patients all waiting for organ transplants. One is a violin virtuoso. Another is a nurse. A third is the head of an international charity…and look, the blood types all match. We should make this happen. Doctor White: But Dr. Brown, I think you misunderstood. John is alive and well and is recovering from a severe flu. He’s to be discharged within the hour. Doctor Brown: But, don’t you see? Nobody will miss this man, and we will be saving seven lives! Plus, we will be giving the world music, care, charity and making lives worth living possible. If he is discharged and he kills himself anyways, it will be too late to do any transplants, and then 8 people are lost…and for what? Narrator: Situations like this are sometimes brought up to demonstrate that utilitarianism is a problematic theory, because the utilitarian seems committed to saying that indeed if the “best outcome” is achieved by harvesting John’s organs, then this is the right thing to do. Of course, this is very problematic and violates John’s basic rights. It shows us that there are other considerations in morality over consequences.

Normative Ethics: Deontology

Normative Ethics: Deontology 2. Deontology We will now move to the second school of thought that will be used in the entire course—it is a school of ethics that you probably have heard of or thought of in similar terms. This is deontology (or duty-based theories). Deontology holds that moral right and wrong depends on our moral intention and duties; consequences are irrelevant to moral status. Deontology attempts to show us what is right and wrong regardless of the consequences. For a deontologist, we ought to do the right thing not because of any potential outcomes, but simply because it is the right thing to do! But how do we know what is the right thing to do? Different theories have been offered to determine what the “right thing to do” is, and the most famous theory is the one offered by philosopher Immanuel Kant (1724–1804). 3. Immanuel Kant Overview Immanuel Kant is one of the most important philosophers in the history of Western thought. According to Kant, human beings are important because of rationality, and thus ethics, must be connected to the intentions behind an action rather than to the consequences of actions. He famously argued that the “good will” (doing things for the right reasons) is the only thing in the universe that is intrinsically valuable, or “good in itself.”

Reasoning

We can thus discover our ethical duties by exercising our ability to reason. And since “reason” is the same regardless of who is reasoning (for example, everyone can calculate 10 minus 9 equals 1; there are no personal or individual differences), he concludes that we would all find the same universal ethical duties! The only reason we do not agree ethically is because we mistakenly let our reason fall under the influence of emotion, error, or superstition—just like when we calculate mathematics, we may make mistakes. In fact, morality should model itself after mathematics in Kant’s mind. To Kant, there is a moral right and moral wrong to the questions we dispute; the reason we are discussing them is because we are trying to find the “right” answer. We can observe that Kant is a moral realist (the meta-ethics school that maintains there are objective moral truths).

Categorical Imperative, Form 1

Here we are going to get a little bit into Kant’s philosophy. If you find him interesting, I strongly suggest you take a course on him. What we discuss here is only the most relevant part of his philosophy to this course, and we have to dilute his theory in order to be able to explain in a few slides what he wrote volumes of books on. The most famous idea from Kant is the categorical imperative. You may have heard of this term before, but few who have not taken philosophy classes would know what it is. But where are we supposed to find agreement on which moral principles are binding universally? Given historical and contemporary disagreements, it seems unlikely that any such universally binding moral rules exist! According to Kant, they do exist, and we can find them through exercising our rationality. The first form of “categorical imperative” is: Act in such a way that you can at the same time desire that the principle of your action become a universal law of nature. Categorical Imperative, Form 1 Example Here is how it works: imagine that you want to do an action. In order to know if it is morally acceptable, you need to step back and determine the “principle” or abstract description of your action. Once you have that principle (he calls this the maxim of the action), then you consider whether or not you can will that it become a universal law of nature. 3 © May not be copied or duplicated without the permission of the owner. Let’s say you are considering breaking a promise to a friend. Is breaking a promise in order to gain certain benefit moral or immoral? All we have to do is use form 1 of the categorical imperative. Can you will “breaking promises to gain benefit” to become a universal law, where everyone breaks promises whenever they think that they can gain benefit? There is a problem with that universal principle: if everyone breaks promises whenever they want, there won’t be such a thing as a “promise.” No one will trust a promise and no one will use “I promise” to convince others how determined they are. Promises no longer have binding power. Therefore, breaking a promise to gain benefit is immoral because if you will it to be a universal law, you will not be able to gain benefit by breaking promises. Categorical Imperative, Form 2 I will very briefly introduce the second form of the categorical imperative. You may have heard of some versions of it before. Act so that you treat humanity, whether yourself or others, always as an end and never merely as a means. This principle is very important since the idea of dignity will frequently be discussed in this course; and it is the deontologist philosophers like Kant who supply us with ideas such as human dignity. Limitations of Deontology While deontology has many merits such as granting people basic rights, autonomy, and dignity, asserting that we are all self determining and can independently think for ourselves, it also has certain limitations. First, deontology is sometimes criticized for its lack of flexibility. Second, some worry that it takes its anti-consequentialism approach too far that it entirely disregards the consequences of an action. As we can see, these two limitations were at the same time the merits of deontology—it is able to offer a universal morality and it establishes a morality independent of consequences. Morality is complex in a way that we don’t want it to be swayed by consequences sometimes, but also don’t want it to be entirely disregarded by consequences. 4 © May not be copied or duplicated without the permission of the owner. The last criticism is perhaps the most severe, which is that since morality depends on rationality (or reason) as Kant proclaims, deontology shows dubious attitudes towards non-rational beings such as people in persistent vegetative state, infants, and nonhuman animals. It also concerns how rationality is defined—certain traditional ways of defining rationality tend to think that certain people are more rational than others (for example, men are more rational than women, or certain cultures exhibit a greater extent of rationality than others)—these views can lead to sexist and Eurocentric implications. We should refute such claims and be critical of them, while preserving deontology, an extremely useful school of thought

Virtue Ethics

Normative Ethics: Virtue Ethics 2. Virtue Ethics Virtue ethics is a third main type of normative ethical theory and is the most ancient. It arguably connects with several different cultural traditions, both Eastern and Western. For example, Confucius (551BCE–479BCE) and Aristotle (385 BCE–323 BCE) are both considered sources of virtue ethics. 3. Beliefs A virtue ethicist believes that ethics is not about figuring out what to do in a particular situation, but rather about figuring out what kind of person I should be across a lifetime. They attempt to discover the highest “virtues” or “character traits” that a human being should develop in their lifetime. Often, this involves presenting a list of virtues to cultivate and a list of vices that should be discouraged. For instance, “honesty,” “benevolence,” “courage,” “sincerity,” “filial piety,” and “wisdom” might be virtues to be cultivated, whereas “vanity,” “dishonesty,” “selfishness,” “narrowmindedness,” and “cowardliness” ought to be avoided. 4. Focus Virtue ethics does not focus on what is right or wrong in a particular situation. Rather, it attempts to come to an understanding of how I ought to live my life and what kind of character traits are best. That is, it does not ask what I should do in a situation, it asks how I should be as a person. 5. Aristotle vs. Confucius Aristotle believes that through virtues, we can lead a true, fulfilling life—a good life. Confucius, on the other hand, believes that we need to cultivate our virtues—even if a happy life is not promised to us. © 2 © May not be copied or duplicated without the permission of the owner. 6. Aristotle Becoming Virtuous For Aristotle, we become virtuous by doing virtuous actions, because it is not enough to just do something once to be that way. Take, for instance, honesty. I become an honest person by telling the truth, sure. But telling the truth once does not make me an honest person! Indeed, if I have led a life of lies, but then once tell the truth, I hardly would be considered “honest.” Rather, I only have the virtue of honesty when I have developed a stable character trait to tell the truth in most situations unless there are very strong reasons to lead me to the opposite. Finding Virtue In fact, for Aristotle, no virtue is universal. Rather, virtues are found somewhere in the middle between two related vices. Take courage: for someone who never takes a stand, they are cowardly; for someone who always takes a stand even in the face of inevitable defeat, they are brazen; for someone who takes a stand when they can, but who also has the strength to sometimes surrender, that person is courageous. Living a Virtuous Life For Aristotle, there is a golden mean or “middle ground” between an excess of courage (brazenness) and a deficiency of courage (cowardliness), and this mean is the virtue of “courage.” The mean, then, or middle ground, is what is reasonable, and the virtuous person acts virtuously both because it is the right thing to do (reasonable) and because they gain fulfillment in living a virtuous life. This is the good life, and suggests a type of happiness that is not reducible to pleasure. The virtuous person is the one with the experience and the wisdom to be virtuous in the right way by practicing the art of the middle ground between the vices. 3 © May not be copied or duplicated without the permission of the owner. 9. Virtue Ethics in Biomedical Ethics In biomedical ethics, we sometimes hear of people asking what the doctor or the patient should be like, or what virtues a health care professional should embody, such as honesty, compassion, respect, and courage. When the virtues guide our action, they do not give us “hard and fast” rules to follow like, for instance, utilitarianism does. But they do harmonize with our understanding of the kinds of people we want to have in these positions in order to have a responsible and ethical health care system. Of course, in the medical world, often it comes down to what needs to be done in a split second decision. Although virtue ethics does not give us the answer by a simple formula, perhaps having a virtuous doctor being faced with that decision is a better solution than having a merely Kantian or utilitarian one trying to calculate with some formula. To the virtuous person, doing the right thing becomes second nature, and needs no such calculation.

The Ethics of Care

Normative Ethics: The Ethics of Care 2. The Ethics of Care (Part 1 of 6) Now, let’s take a look at the last school of ethics we will discuss in this lesson: the ethics of care. This normative theory has its roots in the feminist movement and points to important ways in which the other three ethical theories are based upon a “masculine” understanding of the human subject. That is, the previously discussed theories privilege an understanding of human nature as a rational, individual, self-interested subject for whom relationships are merely a secondary part of their lives. 3. The Ethics of Care (Part 2 of 6) Feminist thinkers have suggested that this (referring to content in the last slide) is a traditionally masculine and Eurocentric understanding of human experience, and that when we include the experience of all human beings (women, and various other groups), we observe that the traditional “rational individual” is not a fair way of understanding all human experience. Thus, feminist philosophers argue that a masculine way to view the world is using the moral category of individual justice while a feministic perspective affords a way to see morality in terms of care or relationships. 4. The Ethics of Care (Part 3 of 6) This important moral perspective has been articulated by feminist philosophers and also philosophers from various cultures, but has been utterly neglected by some major theories in the history of philosophy. This approach, which we will encounter several times in this course, calls into question the emphasis on the isolated individual, since we all are dependent on others at various times in our lives (such as when we are infants or have fallen ill). © 2 © May not be copied or duplicated without the permission of the owner. As a matter of fact, we may be depending on others a whole lot more than we care to admit. This perspective also leads us to question the traditional ethical value of impartiality or universal morality, since they suggest that we have a moral duty to our particular relationships: that is, I may owe my mother or my child different levels of duties than I owe to strangers. Perhaps ethical experience cannot be made wholly impartial. 5. The Ethics of Care (Part 4 of 6) For many subsequent writers in the ethics of care, a care-based moral theory is superior to the traditional approach because it is not based on abstract rules, but rather on the actual situation between people. It thus rejects the push for impartiality, since part of the moral obligations I have to the person in front of me are a result of our particular relationship. Ethics should thus be about minimizing harm and promoting relationships, and thereby finding a balance between impartiality and relatedness. Moreover, a key part of the ethics of care is the fact that we are all vulnerable (although we often forget it during our healthy moments...). We are born needing an incredible amount of care. Many of us will go through periods in our lives in which we must again be cared for extensively, especially in sickness or in old age. And we are all called upon to care for others. This aspect of relationality as a key part of human experience is something that, if missing from traditional ethics, is absolutely essential to recognize.

6. The Ethics of Care (Part 5 of 6) Moral decision-making in the ethics of care may appear to be on a “case-by-case” basis, but this is precisely because all of the details of the situation and relations are important factors that shape an appropriate response. We will observe the ethics of care at work several times in this course, such as in the writings of Susan Sherwin. 3 © May not be copied or duplicated without the permission of the owner.

7. The Ethics of Care (Part 6 of 6) In applying an ethics of care perspective, we might focus less on questions of “rights” or “justice,” and rather ask about whether or not an action or a policy is genuinely responding to the relations of the persons involved and is caring or not. For instance, justice and Kantian reasoning might suggest that we must leave to the patient the right to choose in all situations, but what about situations where the patient is not only vulnerable because ill, but also in an oppressive relationship in which they are not allowed by their partner or social group to truly choose? What if due to oppression they have never, ever, developed the rational decisionmaking skills that would allow them to choose? Are we, in such a case, actually harming them by giving them the “right” to choose? The ethics of care tells us that their situation matters greatly, and that ethics is not complete until such considerations are explored.

8. Wrap-Up In this lesson, we have talked about a number of issues. We started from what is morality, which differs from a code of what is right or wrong. Instead, in moral philosophy or ethics, we study what makes something right or wrong. We also talked about the metaethics positions of moral realism (believing that there are moral facts), and relativism (the belief that morality tracks personal or cultural preferences). We talked about how that is very different from multiculturalism which insists that different cultures can communicate and debate about moral issues given some fundamental commonalities. Then we discussed normative ethics and its four branches, consequentialism, deontology, virtue ethics, and the ethics of care. 9. Knowledge Check: Introduction Now that we are at the end of the lesson, please try to answer these questions. Again, whether you answer them correctly will not affect your grade in the class, but you will need to complete them for the unit to be marked as “complete.” If you have questions about them, don’t forget to bring them to the office hour, or ask your TA about them via email.