Week 3 - Non-consequentialism

WEEK 3: NON-CONSEQUENTIALISM (PART 2)

Applied Health Ethics

Instructor Information

  • Name: Jean-Christophe Bélisle-Pipon, PhD

  • Position: Assistant Professor in Health Ethics

  • Department: Faculty of Health Sciences

  • University: Simon Fraser University

  • Date: September 18th, 2025

CORE FOUNDATION OF ETHICS

Moral Grounding

  • The essential question posed: What should be the core foundation of ethics?

  • Key consideration revolves around determining moral grounding in ethical theories.

THE BIG THREE + PRINCIPLISM

Overview of Foundational Ethical Theories

  1. Virtue Ethics

    • Originates from: 384 BC, Stagira, Greece (Aristotle)

    • Key Concept: Virtuous character; the rightness of actions is based on whether an action aligns with relevant virtues.

  2. Deontologism

    • Originates from: April 22, 1724, Königsberg (Immanuel Kant)

    • Key Concept: Duty; the rightness of actions is determined by their intrinsic nature irrespective of consequences.

  3. Consequentialism

    • Originates from: 1748, London, UK (Utilitarianism)

    • Key Concept: Utility; the rightness of actions depends solely on their outcomes.

VIRTUE ETHICS

Moral Character

  • The premise of morality relies on an individual's moral character rather than merely following rules or principles.

Definition and History

  • The term “virtue” is derived from Latin virtus, stemming from the Greek arête, meaning “excellence.”

  • Virtue ethicists believe that human flourishing is the highest goal of humanity.

  • Key Figure: Aristotle's work in Nicomachean Ethics articulates this perspective.

Aristotle's View

  • Virtue is defined as a habitus (good habit) or a disposition that aims for the good.

  • Indicates a dual meaning of virtues: both as traits that render individuals good and as dispositions facilitating a good life.

VIRTUE ETHICS IN PRACTICE

Criteria for Designing Virtuous Actions

  1. Model of the Wise Person (phronimos)

  2. Measure of the Golden Mean (mesotes)

  3. Right Practical Reason (orthos logos)

  • The virtuous agent employs personal judgment, free from rigid adherence to a moral code, engaging in deliberation to determine right action.

EUDAIMONIA

Teleological Perspective

  • Virtue ethics is teleological, asserting that human beings pursue a telos (purpose), specifically eudaimonia or the “good life.”

  • Definition of Eudaimonia: Refers to happiness, prosperity, or bliss.

  • Key Terms:

    • Teleological: Pertaining to the purpose of events or phenomena.

    • Telos: The endpoint of a goal-oriented process.

ARISTOTLE ON FLOURISHING

  • Virtue ethics emphasizes not merely following rules but aspiring to moral excellence.

  • It advocates for cultivating virtues aiding individuals in becoming better persons and leading good lives.

MORAL ACTION AND MOTIVATION

Acting Morally

  • Importance of action stemming from virtue, where the right action must be taken with appropriate motives.

  • Example: Saving a drowning friend should originate from authentic compassion, not obligation to rules.

CASE STUDY: VACCINE REFUSAL IN LONG-TERM CARE

Scenario Description

  • Context: Early 2021 during COVID-19 vaccine rollout in a long-term care (LTC) facility.

  • Key Characters: Maria, a trusted nurse, hesitant to take the vaccine due to safety concerns.

  • Complications arise regarding the facility's vaccination requirement and potential trust erosion among residents' families.

Decision-Making Options

  1. Strict Enforcement: Immediate termination unless vaccinated; prioritizes resident safety but disregards Maria’s fears.

  2. Accommodation and Dialogue: Allows Maria time, requiring testing and discussion; balances respect for autonomy with safety.

  3. Relational Mediation: Facilitates discussion among Maria and others focusing on shared responsibilities; emphasizes community bonds, potentially leading to resolution.

RESOLUTION FRAMEWORK USING VIRTUE ETHICS

Step 1: Identify Relevant Virtues

  • Compassion: Understand Maria’s fears and the residents’ vulnerabilities.

  • Courage: Willingly face fears for others.

  • Integrity: Align actions with professional commitment.

  • Practical Wisdom (phronesis): Balance duty, evidence, and community well-being.

Step 2: Key Question

  • What would a good nurse and leader do in this situation to support human flourishing?

Step 3: Weigh Options by Virtues

  • Strict Enforcement: Shows safety institutional integrity but lacks compassion.

  • Accommodation: Compassionate but may compromise courage and integrity.

  • Relational Mediation: Models compassion, courage, practical wisdom, fostering trust.

Step 4: Reasoned Conclusion

  • Option 3 reflects virtuous character cultivation and community well-being.

CONSEQUENTIALISM IN HEALTH ETHICS

Appeal of Consequentialism

  • Clear Decision Rule: Choose options yielding the best overall outcome.

  • Practical in Emergencies: Useful for triage and public health planning.

  • Population Focus: Aligns with goals of maximizing health, minimizing harm.

  • Adaptability: Same guiding principles apply in various contexts.

Critique of Consequentialism

  • Virtue ethics perceived as personal and lacking political collectivity.

  • Need for shared interpersonal rules in public ethics for diverse moral outlooks.

PRINCIPLISM

Core Principles of Moral Action

  1. Non-maleficence: Avoid causing unnecessary harm.

  2. Beneficence: Promote welfare through actions.

  3. Autonomy: Respect individuals' right to self-determination.

  4. Justice: Treat similar cases equitably based on equality, need, or desert.

SCHEMATIC UNDERSTANDING OF PRINCIPLES IN BIOMEDICAL ETHICS

  • Features of Principlism: Resolves ethical dilemmas by applying four principles to biomedical scenarios.

  • Authors: Tom L. Beauchamp & James F. Childress, Principles of Biomedical Ethics (1979).

IN-DEPTH EXPLORATION OF FOUR PRINCIPLES

1. Autonomy

  • Definition: The freedom of individuals to govern themselves and make decisions regarding their destinies.

  • Discussed under Kantian ethics, fundamentally positioned against the commodification of individuals.

  • Requires free and informed consent, respectful treatment, honesty, privacy preservation, and advance directives.

2. Beneficence

  • Definition: Action directed toward the good of the patient; moral imperative of healthcare professionals.

  • Evolution: Early notions of positive beneficence and utility transformed to balance benefits and harms.

  • Aspects include saving life, alleviating suffering, and improving comfort.

3. Non-maleficence

  • Definition: The ethical obligation not to inflict harm on others.

  • Based on the ancient adage primum non nocere – first, do no harm.

  • Involves making judgments regarding necessary treatment actions and their intended versus expected effects.

4. Justice

  • Definition: Addresses resource distribution fairly, considering individuals’ needs.

  • Challenges include ensuring equitable treatment in institutional settings and resource allocation.

ADDITIONAL LEARNING MATERIALS

Assignments and Activities

  • Critical Commentary (Deadline: September 23rd) - Analyze and reconstruct arguments from recent Canadian news stories related to health ethics.

Evaluation Checklist for Assignments

  • Ensure claims are backed up by quotations, identify reasoning errors, provide a reconstructed argument based on an ethical theory, and follow formatting requirements.

Conclusion

  • To apply principlism effectively, focus on identifying ethical dilemmas, specifying the conflicting principles involved, engaging in deliberation, and arriving at a resolution that justifies balancing competing ethical values.

TUTORIALS AND CLASS SCHEDULE

  • Class details with dates and topics related to health ethics and moral reasoning.