Ethics DEFINITIONS Values Morals Ethics Ethical dilemma THE CONCEPT OF ETHICS ‘ethics’ is derived from the Greek term ethos, which means customs, habitual usage, conduct, and character  DEFINITIONS Values - are concepts or ideals that give meaning to an individual’s life and provide a framework for decisions and actions. They can include religious beliefs, family relationships, prejudices, and roles. Morals - can be defined as the standards of right and wrong associated with individuals, groups, and society in general. Ethics - can be defined as declarations of what is right or wrong and what ought to be. Ethical dilemma - ethical dilemmas arise when moral claims conflict with each other – and represent a difficult problem seemingly incapable of a satisfactory solution, or a situation involving choice between equally unsatisfactory alternatives THE CONCEPT OF ETHICS Ethics is a branch of philosophy (the study of beliefs and assumptions) dealing with the moral dimension of life. The word ethics is derived from the Greek term ethos, which means customs, habitual usage, conduct, and character. The word Morals is derived from the Latin mores, which means custom or habit. Morals are the basic standards for what we consider right and wrong. Morals or standards are often based on religious beliefs and, to some extent, social influence and group norms. Each person (and each society) has a differing set of values, most commonly derived from societal norms, religion, and family orientation. These provide the framework for making decisions about the actions people take. Having a good understanding of one’s own beliefs and values is helpful when you are faced with an ethical dilemma. An ethical dilemma occurs when an individual must choose between two unfavourable alternatives and requires the application of critical thinking. Decisions regarding ethical and moral issues are primarily concerned with what is “right” or “best” for an individual, their families and society in general. This requires some knowledge of ethics, morality, and the process of ethical decision-making.

Common ethical (moral) theories Teleology - actions are ‘right’ or ‘wrong’ according to the balance of their good or bad consequences Utilitarianism is a teleological theory that judges acts based on their utility or usefulness Deontology - actions are performed out of duty or moral obligation; every person is an end and not solely a means to another person’s end. Virtue theory - places value on the moral character of the actor rather than acts or outcomes of acts COMMON ETHICAL (MORAL) THEORIES ETHICAL THEORIES An ethical theory is a moral principle or a set of moral principles that can be used to assess what is morally right or morally wrong in a given situation Several theories have been developed by philosophers to help guide decision-making. By analyzing the common moral theories and noting that they often conflict with one another, it is possible to see where ethical dilemmas come from. Aristotle proposed the principles embodying the ethics of virtue in the third century BC. Scottish and German philosophers of the 18th and 19th centuries put forward the theories and systems that, for the most part, form the bases of moral philosophy and medical ethics today. John Locke (d. 1704) wrote A Second Treatise on Government, which is the basis for a libertarian ethics. The concept of autonomy came from David Hume's (d. 1776) An Enquiry concerning the Principles of Morals. Consequentialism, or the utilitarian ethic, came from John Stuart Mill (d. 1873), who wrote On Liberty. Immanuel Kant (d. 1804), the German philosopher, wrote on the categorical imperative, and proposed the ethics of duty or "deontology." A contemporary American philosopher, John Rawls, proposed the ethics of distributive justice. Major theories: A. Teleology has no strict principles, duties or moral codes to determine conduct in particular situations - actions are ‘right’ or ‘wrong’ according to the balance of their good or bad consequences - Utilitarianism is a teleological theory that judges acts based on their utility or usefulness B. Deontology: actions are performed out of duty or moral obligation. Every person is an end and not solely a means to another person’s end. C. Virtue theory: places value on the moral character of the actor rather than acts or outcomes of acts Others include: D. Altruism: the proper goal of a person’s actions is the welfare of society E. Egoism: the proper goal of a person’s actions is self-interest and self-preservation (opposite of altruism) F. Rights: justified claims that individuals and groups can make upon others or upon society G. Distributive Justice: distribution of rights and responsibilities as well as goods and services by some measure of fairness H. Casuistry: bases decisions on the analysis of similar previous cases I. Feminist theories – Ethics of care

Bioethical principles Four Major Bioethical Principles in Healthcare The Principle of Autonomy The Principle of Non-Maleficence The Principle of Beneficence The Principle of Justice  ETHICAL PRINCIPLES WITHIN HEALTHCARE Medical ethicists have generally adopted principle-based ethics as their basic guide for practice today. It is a neutral ethics devoid of the philosophical controversies engendered by one or another of the systems based upon libertarianism, utilitarianism, deontology, distributive justice, or a theology which reflects a given religious creed. Such principles enable varying weight to be given to various duties, rights and responsibilities and so help to guide action when applied to every-day ethical decision-making. Principle-based ethics developed by the American philosophers, Thomas Beauchamp and James Childress, have been widely accepted in the biomedical field. The Four Major Bioethical/Moral Principles in Healthcare 1. The Principle of Autonomy - an individual's action ought to be the result of his or her own choices; Persons ought to be self-determining; 2. The Principle of Non-Maleficence - aAvoid harm; 3. The Principle of Beneficence - act in ways that promote the well being of others; prevent or remove harm; promote good.  4.The Principle of Justice  - treat similar cases in similar ways; distribute all benefits and burdens equally; distribute goods and services based on need.  Further principles have been proposed such as fidelity (faithfulness) and veracity (truthfulness) and other personal virtues, although some can be considered to be covered under the umbrella of the main principles outlined above.

Ethical decision-making within healthcare Ethical decision-making usually involves at least one of four basic principles: autonomy, non-maleficence; beneficence; and justice. Principles for ethical decision-making: - respect the autonomy of the individual - avoid harm - where possible achieve benefit - consider, fairly, the interests of all those affected ETHICAL DECISION-MAKING WITHIN HEALTHCARE Ethical decisions are not made in a vacuum. Many factors influence decision-making, for example, religious beliefs; personal life experiences; professional codes of ethics; socio-cultural changes; legal issues; and advances in science, technology and health. A combination of such factors is likely to be involved.  Ethical decision-making usually involves at least one of four basic concepts or principles: non-maleficence; beneficence; autonomy, and justice.   Principles for ethical decision-making: -  respect the autonomy of the individual - avoid harm - where possible achieve benefit -  consider, fairly, the interests of all those affected

Framework for ethical decision-making Begin by learning to recognise a moral issue Step 1: Gather all relevant information Step 2: Identify and clarify the ethical problem(s) Step 3: Analyse the problem by considering the various ethical theories or approaches Step 4: Explore the range of options or possible solutions Step 5: Make a decision Step 6: Implement and then reflect on the decision FRAMEWORK FOR ETHICAL DECISION-MAKING The following framework may be useful when discussing a particular case in a health care team setting – a guide not a recipe. Step 1: Gather All Relevant Information - gather as much relevant information about the situation as possible in order to get the facts clear; establish the facts of the situation and identify what you don’t know; identify all the relevant parties involved; identify expectations and responsibilities; consider the context of the decision-making (clinical issues; patient preferences; quality of life/death social issues; legal and professional aspects) Step 2: Identify and Clarify the Ethical Problem(s) - review the situation and identify the ethical problem(s) being faced and the values that are in conflict; identify the type of ethical problem(s) faced and the decision(s) to be made; identify the roles and relationships of all those who may be involved in the decision; consider duties and preferred outcomes; consider what ethical principles such as autonomy, beneficence, non-maleficence, justice, fidelity and veracity that might be involved, and how they may conflict and which should be given priority; identify what other factors may influence the decision and what further information is needed Step 3: Analyse the Problem by Considering the Various Ethical Theories or Approaches - consider the ethical theories of utilitarianism, deontology, and virtues and any relevant ethical concepts Step 4: Explore the Range of Options or Possible Solutions - identify the anticipated outcome of the various possible solutions; be fair and open-minded (be aware of own value-system); apply critical thinking and logically valid argument; look for best consequences overall; consider what would a virtuous person do; consider the impact of each option on those involved, including society as a whole; consider what if everyone in similar circumstances did the same, i.e. formulate your choice into a general maxim for all similar cases; are you comfortable with the decision?; explore how each option compares with the basic principles of each theory; identifying preferences for resolution of the problem Step 5: Make a Decision - chose the option which you feel is the right thing to do; justify the decision (explain and support decision); anticipate criticisms and formulate responses Step 6: Implement and then reflect on the decision - carry out your decision; assess the outcomes as the processes go forward; evaluate and reconsider; continue to seek new insights into the situation; consider its relevance for a wider range of situations and concerns;  use this situation as a foundation from which to grow and develop; consider what you have I learned that will be useful in the future, what you would I do in another similar situation and what would I change.