Biomedical Ethics Lecture 6

EDITH COWAN UNIVERSITY

SCHOOL OF MEDICAL SCIENCES

SCH3145 BIOMEDICAL ETHICS

LECTURE 6 NOTES

LEARNING OUTCOMES

  • Goals of Lecture:

    • Identify different ethical theories.

    • Explain the purpose of ethical theories.

    • Explain Utilitarian, Rights, and Virtue Theories.

    • Apply these ethical theories to a given scenario (tutorial case study).

ETHICAL THEORIES

  • Purpose of Ethical Theories:

    • Provide an ordered set of moral standards.

    • Offer effective guidance to resolve ethical dilemmas.

    • Establish a framework for morally appropriate actions.

    • Reference: Mappes & Zembaty (1991) pp. 4-5.

  • Characteristics of Ethical Theories:

    • Explanatory Role: Account for why an action is considered 'right' or 'wrong' and why a person's character may be deemed good or bad.

    • Ethical Theory Functions: Defines what qualities make actions or individuals morally commendable.

    • Variety of Theories: No single theory is categorically superior or inferior to others, as per Vaughan (2010, p. 31).

EIGHT CONDITIONS FOR ETHICAL THEORIES

  • Beauchamp & Childress' eight criteria:

    1. Clarity: The theory should not be vague or obscure.

    2. Coherence: Must be internally consistent without contradictions.

    3. Comprehensiveness: Should include all justifiable norms and judgments (e.g., autonomy, nonmaleficence, beneficence, justice).

    4. Simplicity: Morality can be complex, but key points should be distilled effectively.

    5. Explanatory Power: Should offer insight into understanding morality, including rights vs. obligations.

    6. Justificatory Power: Must provide grounds for beliefs, not merely reformulating existing beliefs.

    7. Output Power: Should lead to moral judgments that are not already contained within the original moral judgments considered.

    8. Practicability: Must be applicable in real-world situations, not abstract or beyond reach.

CLASSIFICATION OF ETHICAL THEORIES

  • Types of Ethical Theories Include:

    • Consequentialism/Telological Theories

    • Utilitarianism (Act and Rule)

    • Rights-based Theories

    • Virtue-based Ethics

    • Deontology (Kantian Ethics)

CONSEQUENTIALISM

  • Overview:

    • Also referred to as consequence-based or teleological theories stemming from the Greek word "telos" meaning 'final purpose.'

  • Principles:

    • The right course of action is determined by the best possible outcomes.

    • Actions, motives, or intentions themselves are not inherently right or wrong.

    • A 'right' act leads to the best consequences under any given circumstance.

    • To determine the ethically justifiable action, all possible options and consequences should be evaluated to choose the best action for the greatest number.

    • Reference: Mappes & De Grazia (2001, p. 6).

UTILITARIAN THEORIES

  • Characteristics of Utilitarianism:

    • Considered the most important consequentialist theory.

    • Focuses on the value of well-being, happiness, welfare, and personal satisfaction.

    • Accepts one basic ethical principle: utility, where moral rules, actions, and behaviors are justified based only on their outcomes.

    • The goal is to produce the maximum positive value over disvalue.

    • Principle of utility is absolute; actions must align accordingly.

  • Utilitarian Outcomes:

    • The best balance of good over evil should be sought, weighing all outcomes.

    • In cases where undesirable outcomes are inevitable, the least undesirable option should be selected.

    • Aim for the greatest good for the greatest number, affirming equal worth of all affected individuals.

UTILITARIAN CASE STUDY

  • Hypothetical Scenario:

    • A 5-year-old girl is in renal failure not responding to dialysis. She needs a transplant, but the outcome is uncertain.

    • Doctors recommend the procedure; however, her siblings are too young, and the mother is not histocompatible. The father is.

  • Father's Response:

    • Initially considers donating but ultimately refuses, citing fears and a lack of courage. He suggests the doctor claim he is not histocompatible for 'medical reasons.'

    • Physician's Concern:

    • Expresses discomfort agreeing to the father's request, considering the ethical implications.

UTILITARIAN RESPONSE TO THE CASE

  • Utilitarian Considerations:

    • Analyze probable consequences of the father's possible actions.

    • Assess potential outcomes for the child (likely death without transplant, uncertain transplant success).

    • Evaluate surgical risks for the father (e.g., anaesthetic risk of 1 in 10,000 to 15,000).

    • Consider implications for the family if the father were to be impaired or die.

    • Explore risks of misleading the family against potential harms and future consequences.

    • A strict utilitarian might recommend tissue typing of the siblings and consulting with the parents.

ACT UTILITARIANISM VS. RULE UTILITARIANISM

  • Act Utilitarianism:

    • Each situation is assessed independently without a fixed moral rule; rules serve as guides.

    • Focuses solely on actions that produce the greatest good is considered, leading to situational ethics.

  • Rule Utilitarianism:

    • Stresses the importance of moral rules, suggesting that these should be formulated deriving from utility.

    • Actions are based on rules that, if generally followed, would yield the greatest balance of good over evil across all involved.

ISSUES WITH ACT UTILITARIANISM

  • Challenges:

    • Extensive calculations needed for evaluating all possible consequences.

    • Difficulties arise in assigning weightings to varying human actions.

    • Conflicts may arise when evaluating anxiety against inconvenience.

    • Need to question if actions should be evaluated as right or wrong merely on their outcomes.

    • Often inconsistent with the experiences of moral life, especially in scenarios with competing interests.

ISSUES WITH RULE UTILITARIANISM

  • Critiques:

    • Moral rules can be overturned based on specific circumstances, especially in biomedical contexts.

    • Examples include lying to a patient can be justified, or laws regarding assisted dying.

    • Some argue that assisted death should occur if rules benefit overall social welfare, thus showing responsiveness to changes in societal practices.

CRITICISM OF UTILITARIAN THEORIES

  • Concerns Raised:

    • It is almost impossible to accurately predict every possible outcome.

    • Disagreements exist regarding which consequences should be assessed and whose interests are most significant.

    • Focusing solely on preferences can disregard morally unacceptable preferences (e.g., causing harm to others).

    • The subjective nature of utility calls for an acceptable threshold, raising concerns about morality's implications and potentially unjust outcomes.

VIRTUE THEORIES

  • Description of Virtue Ethics:

    • Everyday ethical decisions often require deep consideration of consequences, leading individuals to instinctively decide actions.

    • Virtue theory claims that cultivating the right qualities in a person leads to ethical actions.

    • Moral Virtue:

    • Defined as the character traits from deeply rooted motives seen as morally valuable.

  • Emphasis on Personal Qualities:

    • Focuses on the emotional and personal nature of ethical decision-making in healthcare.

    • Virtue ethics promotes beneficence through character development.

CLASSICAL PHILOSOPHY IN VIRTUE ETHICS

  • Aristotle's Philosophy:

    • A virtuous individual lives a "proper human life."

    • The focus shifts from merely performing right actions to the agent's character and motives behind those actions.

    • Virtue theory emphasizes cultivating morally valuable traits rather than adhering strictly to prescriptive rules.

DEFINITION OF VIRTUE

  • Character Traits:

    • Virtues are socially valuable and reliably present traits.

    • A truly virtuous person lives a "proper human life".

    • The distinction is made between external performance and internal character; moral approval is granted when motives align with wider social values.

VIRTUES IN PROFESSIONAL ROLES

  • Ethical Expectations in Healthcare:

    • Healthcare practitioners (HCPs) are expected to embody certain virtues aligned with professional standards.

    • Relevant attributes are achieved through adherence to the expected standards of medical practice.

  • Caring as a Key Virtue:

    • Reflects the ethical basis for biomedical relationships and practices, termed as the "ethics of care".

    • Compassion, discernment, trustworthiness, integrity, and conscientiousness are five focal virtues in healthcare, associated closely with Hippocratic principles.

MISTAKES IN BIOMEDICAL PRACTICE

  • Investigating Medical Errors:

    • Bosk's study categorizes errors as:

    1. Technical

    2. Judgmental

    3. Normative

    • Generally, less blame is attributed to errors concerning technical and judgmental categories.

CASE STUDY ON VIRTUE THEORY

  • Ethical Evaluation of the Father's Actions:

    • The father's fear and perceived lack of courage may impact his compassionate intentions toward his child.

    • The physician's concerns about maintaining moral integrity might reflect self-deceptive behavior in passing on white lies.

CRITICISM OF VIRTUE THEORIES

  • Questions Raised:

    • The nature of virtue may vary depending on cultural, social, and temporal factors.

    • Debate exists as to whether certain virtues are universally applicable or should take precedence over rights and obligations.

    • Ethical concerns arise when evaluating whether some virtuous actions may be inherently unethical.

RIGHTS THEORIES

  • Types of Rights:

    • Positive Rights:

    • Rights that obligate others to provide goods or services (e.g., right to wellbeing).

    • Negative Rights:

    • Rights that prevent others from interfering in an individual's actions (e.g., right to liberty).

  • Obligations Linked to Rights:

    • If an individual has a positive right, others are obligated to provide it; if a negative right exists, others must abstain from interference.

    • The relationship between rights and obligations is context-specific and shaped by individual beliefs and societal values.

RIGHTS CASE STUDY

  • Analysis of the Father's Rights:

    • The father possesses rights to autonomy, privacy, and decision-making integrity, in addition to access to information regarding the risks of donation.

    • The child's possible rights revolve around medical need and parental obligations for a kidney donation, despite challenges in enforcement regarding siblings.

    • The physician's role entails balancing the rights of the father and child, considering ethical implications regarding the refusal of donation.

IMPACT OF RIGHTS THEORIES

  • Critiques of Rights Theory:

    • Potential overemphasis on individual rights and autonomy can neglect the significance of community and social relationships in shaping moral frameworks.

    • Critics argue the theory contributes to declining community values and a diminished commitment to social welfare, particularly within industrialized societies.