1. Biomedical Ethics

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

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

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

6. Divine Command Theories

7. Ethics Chart

8. Ethics Objectivism Relativism
Absolutism Contextual Conventionalism Subjectivism
Absolutism

9. There are universally valid moral principles
Objectivism
There are universally valid moral principles

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

11. Absolutism There is one universally valid moral principle
Immanuel Kant

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

13. Society decides moral principles
Conventionalism
Society decides moral principles
Ruth Benedict

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

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

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

17. 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

18. 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”

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

20. 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

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

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

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

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

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

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

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

28. John Stuart Mill’s Moral Theory

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

30. The Greatest Happiness Principle
Utilitarianism
The Greatest Happiness Principle
Jeremy Bentham

31. 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

32. Greatest Number of People
Everybody that your action will effect

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

34. Happiness defined
Pleasure
Absence of Pain

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

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

37. Different Kinds of Pleasure
Quality
Quantity
Mental and Physical

38. 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

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

40. 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?

41. 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

42. Mental v. Physical
Which is Superior?
Mental

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

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

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

46. Visit Aunt Go to Beach Me
My Mom
My Dad
My Aunt
My Friends
Total

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

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

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

50. Kant’s Moral Theory

51. Critique of Pure Reason
Immanuel Kant
German
Wrote on many subjects
Critique of Pure Reason

52. Requirements for Morality
Free Will
Rationality
Moral Autonomy

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

54. 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

55. 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

56. Categorical Imperative
Absolute Command of
Moral reason

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

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

59. 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

60. 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

61. Wallet Example

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

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

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

65. 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

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

67. 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?

68. 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

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

71. 2nd Formulation Always treat people as ends in themselves
never as means to an end

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

73. We use objects
not people
Pornography?

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

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

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

77. 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

78. Aristotle’s Moral TheoryBC
Greek Philosopher
Nicomachean Ethics
Student of Plato
Wrote on many subjects

79. What do you want to be when you grow up?

80. HAPPY!!!!

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

82. 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

83. Isn’t your final goal
TO BE HAPPY?

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

85. Eudiamonia
Greek for Happiness

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

87. TEMPORAL CIRCUMSTANCES
But also:
Luck
Fortune
Based upon
TEMPORAL CIRCUMSTANCES

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

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

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

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

92. The function of man is the exercise of his reason

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

94. 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!

95. How do we achieve this?
By Developing Virtue

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

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

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

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

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

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

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

103. These may change over time
Your Mean may change

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

105. 4 Primary Virtues
Wisdom
Justice
Courage
Moderation

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

107. Justice

108. Courage

109. Moderation

110. Social Virtues

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

112. Virtue Concerning Honor
Pride
(Appropriate Self-Respect)

113. We should have
Good Temper

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

115. 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

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

117. Thru Experience
Thru a Good Teacher

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

119. 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

120. 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

121. 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

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

123. 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

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

125. 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).

126. 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).

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

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

129. 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. 

130. 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.

131. Ross’ List of Prima Facie Duties
    

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

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

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

135. Duty to promote fairness
4. Justice
Duty to promote fairness

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

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

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

139. 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”

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

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

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

143. 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

144. Must be more aware of oppression
Personal
Professional
Institutional

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

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

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

148. Reflective Equilibrium and Appeals to Coherence

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

150. 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

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

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

153. Avoidance of outright contradiction
Logical Consistency
Avoidance of outright contradiction

154. Argumentative Support
Must give good reasons for our ethical decisions

155. Liberty-Limiting Principles

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

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

158. Principle of Extreme Paternalism
To benefit the person

159. Principle of Legal Moralism
To prevent person from acting immorally

160. Social Welfare Principle
To benefit society

161. Logical Argumentation
Your final paper and presentation

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

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