Biomedical Ethics

Introduction to Philosophy “Philos” = Love “Sophia” = Wisdom “Philosophy” = Love of Wisdom

A Formal Definition of Philosophy: The rational, critical investigation of the fundamental questions of life that resist solutions by empirical science

Right or Correct Behavior Ethics The Study of Right or Correct Behavior

Divine Command Theories

Ethics Chart

Ethics Objectivism Relativism Absolutism Contextual Conventionalism Subjectivism Absolutism

There are universally valid moral principles Objectivism There are universally valid moral principles

There are no universally valid moral principles Relativism There are no universally valid moral principles

Absolutism There is one universally valid moral principle Immanuel Kant

Contextual Absolutism There are several universally valid moral principles and context decides which one to follow The Ten Commandments Aristotle

Society decides moral principles Conventionalism Society decides moral principles Ruth Benedict

The individual decides moral principles Subjectivism The individual decides moral principles Jean Paul Sartre Friedrich Nietzsche

Methods of Justification Meta-Ethics The study of Concepts Methods of Justification and Knowledge of Ethics

Normative Ethics The study of rational guidelines for behavior How people “ought” to act

The study of how people do act Describes how people do act Descriptive Ethics The study of how people do act Describes how people do act

Naturalistic Fallacy Confusing what “is” With what “ought” to be Confusing how people do act With how they “ought” to act “Ought” does not equal “is”

Biomedical ethics is a branch of normative ethics Business ethics Sports ethics Etc.

Biomedical Ethics Ethical issues associated with the practice of medicine Advance reasoned analysis to clarify and resolve ethical issues Practice of medicine in most inclusive way

Criteria for Ethical Theories 1. Clear, well-defined concepts 2. Consistent statement No Contradictions

3. Should tell us how to act in all situations Abortion Euthanasia Death Penalty Sex and Love

4. The Simpler the better Occam’s Razor Less likely to make mistake Easier to follow

5. Should be based upon the most complete evidence available Many decisions lead to wrong action because of incorrect information

Consequentialist Theories Moral theories that judge right / correct behavior based upon the consequences of the actions

Utilitarianism John Stuart Mill The right action in any situation is that action which creates the greatest amount of happiness

Cost-Benefit Analysis A form of Utilitarianism Actions are evaluated based upon their corresponding cost and the anticipated benefits of the action

John Stuart Mill’s Moral Theory

John Stuart Mill (1806-1873) English Member of Parliament Wrote on many subjects

The Greatest Happiness Principle Utilitarianism The Greatest Happiness Principle Jeremy Bentham

Greatest amount of happiness For the greatest number of people Act to create the Greatest amount of happiness For the greatest number of people As per a disinterested spectator

Greatest Number of People Everybody that your action will effect

Disinterested Spectator Your happiness cannot be more important than anyone else’s

Happiness defined Pleasure Absence of Pain

Hedonism The goal is to experience as much pleasure as possible Usually physical pleasure

Epicureanism The goal is to experience as much pleasure as possible without experiencing any pain Only the best wine, food No hangovers

Different Kinds of Pleasure Quality Quantity Mental and Physical

Quality of Pleasure How many McDonald’s hamburgers equals a Filet Mignon? None because the quality is different! Some pleasures are simply better than others

Quantity of Pleasure Whatever you enjoy, isn’t more of it better?

Point of Diminishing Returns But we reach a point in our pleasure where more is not better but actually painful How many pieces of candy do you like? 5,10,15,? How about a 1,000?

Paradox of Hedonism The more pleasure you derive from something, the more you need of it next time to receive the same amount of pleasure Drugs and Alcohol

Mental v. Physical Which is Superior? Mental

Why? Based upon empirical evidence Ask those who have experienced both They agree that mental is superior

Why is Mental Superior? 1. Greater Permanence 2. Safer 3. Less Expensive

Act Utilitarianism An action is right if it produces more total happiness than any other alternative action available at the time

Visit Aunt Go to Beach Me -10 +10 My Mom +8 -8 My Dad +6 -6 My Aunt +10 -10 My Friends 0 0 Total +14 -14

Rule Utilitarianism After many acts, we develop a principle that if general followed would create the greatest amount of happiness for all people involved

2. Focuses too exclusively on the future Criticisms 1. Requires too much 2. Focuses too exclusively on the future 3. Can lead to injustice

Deontological Ethics Greek: “Deon” = “Duty” Moral theories that judge right / correct behavior based upon the intrinsic value of human beings

Kant’s Moral Theory

Critique of Pure Reason Immanuel Kant 1724-1804 German Wrote on many subjects Critique of Pure Reason

Requirements for Morality Free Will Rationality Moral Autonomy

We are not here to be Happy To be Worthy of Happiness But To be Worthy of Happiness

If happiness were the goal of human life Then we would be controlled by our instincts not reason The more you know the more pain and suffering you experience

Good Will Only thing in the world that cannot be perverted Although we might not always be able to do the right thing We must always want to do the right thing

Categorical Imperative Absolute Command of Moral reason

Deontological Ethics Morality based upon duty It is our duty to follow the Categorical Imperative

Moral Worth of an Action Based Upon Our Intentions Not The Consequences of the Action

1. Because doing what is right has intrinsic value Why? 1. Because doing what is right has intrinsic value 2. Since we are not God, we cannot guarantee that what we intent to happen will actually happen

We are only responsible for what we have complete control over Therefore We are only responsible for what we have complete control over OUR INTENTIONS

Wallet Example

(without contradiction) 1st Formulation Act only on the maxim that you could will to be a universal law of nature (without contradiction)

What is a Maxim? An Intention Or Reason for doing something

What is a Universal Law of Nature? Something that must happen whether or not we want it to Example: Gravity

Without Contradiction? Every time we are going to act We are to think about why we want to take that action Then imagine how we might write out a statement expressing our reasons for action

If the action we are thinking about taking is morally wrong Then we will see a contradiction in the sentence stating our intentions

Example We want to borrow money from a bank But we have no intention of paying the money back to the bank What would a statement look like expressing this intention?

It is morally acceptable no intention of keeping my promise to sign a promissory note to pay back the money when I have no intention of keeping my promise to pay the money back

Contradiction? I make a promise with no intention of keeping the promise

2nd Formulation Always treat people as ends in themselves never as means to an end

Because human beings have intrinsic value Don’t use people Why? Because human beings have intrinsic value Rationality Free Will Moral Autonomy

We use objects not people Pornography?

Conscience? We might think of the Categorical Imperative as our conscience The sense of what is right or wrong in our behavior and motives

Deontological Medical Ethics Ultimate worth of the Individual Maximum Individual autonomy Respect for the individual

Virtue Theories Mainly concerned with what kind of a person we are A virtuous person will act correctly in situations

Greek: “teleos” = end / purpose Teleological Ethics Greek: “teleos” = end / purpose Moral theories that judge right / correct behavior based upon a particular goal or purpose or consequences of the action

Aristotle’s Moral Theory 384-322 BC Greek Philosopher Nicomachean Ethics Student of Plato Wrote on many subjects

What do you want to be when you grow up?

HAPPY!!!!

Teleological Ethics of Aristotle The end or goal of man is to be happy Isn’t your ultimate desire to be Happy?

All things aim toward happiness Why do you want to be rich? Why do you want a nice car? Why do you want a nice spouse? Intermediate Goals

Isn’t your final goal TO BE HAPPY?

Why do you want to be Happy? Silly Question Because Happiness is the Ultimate Goal in Life

Eudiamonia Greek for Happiness

Eudiamonia Defined To live well Well-being Human flourishing Self-sufficient Family Friends Fame Wealth

TEMPORAL CIRCUMSTANCES But also: Luck Fortune Based upon TEMPORAL CIRCUMSTANCES

Example Wonderful family tragically killed in accident Would you still be happy? Probably not!

How do we understand happiness? By answering the question: What is the function of Man?

The function of a thing will help us determine what a “good” thing really is

Example What is the function of a knife? To cut Therefore a good knife cuts good and is therefore sharp

The function of man is the exercise of his reason

Is a man who uses his reason A Good Man Is a man who uses his reason The rational man

What does it mean to be rational? To live in such a way that will enable you to satisfy your purpose Which is to be happy!

How do we achieve this? By Developing Virtue

The virtuous man is the most excellent man Arete Virtue Excellence The virtuous man is the most excellent man

The middle point between two extremes What is Virtue? The Relative Mean between two extremes The middle point between two extremes The “Golden Mean”

Relative v. Absolute Mean is the exact mid-point between two extremes Aristotle is not talking about this!

This is what Aristotle is talking about Relative Mean This is what Aristotle is talking about

Specific Circumstances Based Upon? The Individual’s Physical Intellectual Genetic Specific Circumstances

How much should you drink? For Example How much should you drink?

Considerations Weight? Physical Constitution? How much food have you consumed? What’s your mental and emotional state?

These may change over time Your Mean may change

You need to know yourself Possessing Virtue means that you also know yourself Your Limits Your Strengths Your Weaknesses

4 Primary Virtues Wisdom Justice Courage Moderation

What are the two extremes that wisdom is the middle point of?

Justice

Courage

Moderation

Social Virtues

The Virtue is to be Generous Concerning Money The Virtue is to be Generous

Virtue Concerning Honor Pride (Appropriate Self-Respect)

We should have Good Temper

We are not born with virtue Virtue is not Natural We are not born with virtue

This is Good If we had to be born with virtue and were not That would be it There would be nothing we could do about it

How do we develop Virtue By Developing Character Qualities Through Practice Through Habits

Thru Experience Thru a Good Teacher

Virtue Ethics in Medical Ethics Emphasizes Virtuous Character Truthfulness Compassion Sincerity Courage

as opposed to the performing of actions In virtue ethics Emphasizes who we are as opposed to the performing of actions In virtue ethics Agents performing the actions are the focus In action-based approaches to ethics The principle thing emphasis is the doing the right thing

For Example Suppose someone does what is wrong (?) but has extraordinary compassion (Lies to a patient) Recovering from a serious car accident and does not tell of the death of a family member as passenger

Suppose someone does what is right (?) but is mean and nasty (Tells the patient the truth) Recovering from a serious car accident and does not tell of the death of a family member as passenger

Prima Facie Duties W.D. Ross (1877-1971) English Philosopher The Right and Good (1930)

Prima Facie Duties “at first sight” A prima facie duty is a conditional duty There is no absolute prima facie duty Any duty can be overridden depending upon the circumstances

Right or correct action is relative to Moral Relativism Right or correct action is relative to 1. The Situation 2. Important Factors

not because of its consequences, Common sense tells us in some situations that an action (keeping a promise) is right, not because of its consequences, but because of what has happened in the past (we made the promise).

may be "more of a duty" than another duty (fulfilling a promise). Conflicting Duties Common sense also tells us in some situations that we have more than one duty and that one duty (relieving distress) may be "more of a duty" than another duty (fulfilling a promise).

Elements of Ross’ Moral Theory A variety of relations among individuals are morally significant

promiser-promisee, creditor-debtor, wife-husband, child-parent, friend-friend, etc

Nonmaleficence is generally more important than beneficence. There are a few general "rules of thumb" to follow when prima facie duties conflict For example: Nonmaleficence is generally more important than beneficence. 

Each situation must be judged separately.   However, there is no ranking among the prima facie duties that applies to every situation.  Each situation must be judged separately.

Ross’ List of Prima Facie Duties     

1. Fidelity Duty to fulfill (explicit and implicit) promises/agreements into which one has entered     

Duty to make up for wrongful acts previously done to others 2. Reparation Duty to make up for wrongful acts previously done to others

Duty to repay others for past favors done for oneself 3. Gratitude Duty to repay others for past favors done for oneself

Duty to promote fairness 4. Justice Duty to promote fairness

Duty to improve the conditions of others 5. Beneficence Duty to improve the conditions of others

Duty to improve one's own condition 6. Self-Improvement Duty to improve one's own condition

Duty not to injure others 7. Nonmaleficence Duty not to injure others

Ross says that the best we can do is make a “Considered decision” Bottom Line How do we make a decision when there are conflicting prima facie duties? Ross says that the best we can do is make a “Considered decision”

Important Concepts Respect for Patient Autonomy Principle of Nonmaleficence Principle of Beneficence Principle of Justice

The Ethics of Care and Feminist Ethics Emphasizes Empathy Concern for the needs of others Caring

Carol Gilligan Women tend toward an Ethics of Care Men tend toward an Ethics of Justice

Relationships should be taken into account more when making a moral decision Caring responsiveness to the needs of others is often morally preferable to detached dispassionate moral evaluation

Must be more aware of oppression Personal Professional Institutional

Casuistry Case Study Considering each situation as unique while trying to apply more general ethics principles

Practical Wisdom Necessary for applying more general ethical principles to individual cases and situations

Practice over Theory Casuistry asserts the priority of practice over theory What has worked or produced the best results in the past

Reflective Equilibrium and Appeals to Coherence

John Rawls No one level of ethical conviction deserves priority General Moral principles Prima Facie Duties Casuistry

Considered Judgments We use past experience to evaluate current situations We can go from principle to case or We can go from case to principle

Moral reasoning is dynamic New situations demand new analysis It is never static New situations demand new analysis

Conflict Resolution? We want coherency / consistency in our overall system of ethical convictions

Avoidance of outright contradiction Logical Consistency Avoidance of outright contradiction

Argumentative Support Must give good reasons for our ethical decisions

Liberty-Limiting Principles

To prevent harm to others The Harm Principle To prevent harm to others

Principle of Paternalism When someone acts like a “father” to someone else Physician to patient To prevent someone from harming themselves

Principle of Extreme Paternalism To benefit the person

Principle of Legal Moralism To prevent person from acting immorally

Social Welfare Principle To benefit society

Logical Argumentation Your final paper and presentation

Standard Form (1) Premise 1 (Reason 1) (2) Premise 2 (Reason 2) Therefore: (3) Conclusion (What you are trying to convince someone to accept)

Counter Examples State the one major fact against your position Respond to it