Ethical theories ch 2 Purposes l l l

Ethical theories ch 2

Purposes l l l Define the terms moral philosophy & ethics Discuss the importance of ethical theory Describe utilitarianism Describe deontological ethics to survey a variety of theories as to what matters morally

Introduction l l “our focus will be on normative medical ethics, i. e. , how people should behave in medical situations” We will set aside the question: ‘uhhhh. . how people should behave in medical situations, according to whom? ’

Ethics in Nursing l Ethics - a branch of philosophy dealing with standards of conduct and moral judgment • How do professionals fulfill responsibilities? • Ethics provide basis for decision making. l l Morals - standards of right and wrong Values - ideas or beliefs

Philosophy l The intense and critical examination of beliefs and assumptions. l It offers principles for deciding what actions are most worthwhile.

Moral Philosophy l l Philosophical discussion of what is “good”, or “bad”; right or wrong, in terms of moral issues. Deal with social values or norms: respect for life, freedom, love, feeling of guilt, shame, self-esteem.

Philosophical Basis for Ethical Theory l Naturalism: view of moral judgment that regards ethics as dependent upon human nature and psychology • There is universality in moral judgment • All people have a tendency to make similar • ethical decisions Sympathy is a motivating factor in moral decision making

Rationalism l l l There absolute truths not dependent upon human nature Ethical values have an independent origin, can be known through process of reasoning Truths about world are necessary and universal and are superior to information we receive from our senses.

The Goal of Ethical Theory Generally: to provide a systematic answer to the question of how we should behave • Ethical theory provides a framework for cohesive & consistent ethical reasoning and decision making. l

Ethical Theories 1 -teleology (Utilitarianism) 2 -deontology 3 -instituation 4 -ethics of caring

Teleology (Utilitarianism) l l Looks to the consequences of an action in judging whether that action is right or wrong Consequentialists maintain that whether an action is morally right or wrong depends on the action's consequences. In any situation, the morally right thing to do is whatever will have the best consequences (have greatest utility or usefulness). Consequentialist theories are sometimes called teleological theories.

Utilitarianism l l This theory also provides the greatest good for the greatest number (sometimes violate the principle of autonomy). It is particularly useful in situation of distributive justice but tend to ignore the rights of the individuals( in the name of overall good)

Only Happiness "actions are right in proportion as they tend to promote happiness, wrong as they tend to produce the reverse of happiness. " (John Stuart Mill's Greatest Happiness Principle) ¡ In other words, judge an action by the total amount of happiness and unhappiness it creates ¡

Types of utilitarianism Act-utilitarianism: suggests that people choose actions that will, in any given circumstances, increase the overall good. ¡ Rule-utilitarianism: people choose rules that, when followed consistently, will maximize the overall good. ¡ Example: telling the truth ¡

Deontology (formalism, kantianism) l Proposes that the mortality of a decision is not determined by its consequences l It emphasizes duty, rationality, and obedience to rules

Deontology l l 'Duty Based' Ethics Deontologists deny that what ultimately matters is an action's consequences. • They claim that what matters is the kind of action • it is. What matters is doing our duty. There are many kinds of deontological theory • e. g. , The 'Golden Rule' - "Do unto others as you'd have them do unto you. "

Kantian Deontology l l Immanuel Kant (1724 -1804) is the most influential deontologist. Rejecting Consequentialism: "A good will is good not because of what it effects or accomplishes. " Even if by bad luck a good person never accomplishes anything much, the good will would "like a jewel, still shine by its own light as something which has its full value in itself. "

Categorical/Practical Imperative l 1. 2. Kant claims that all our actions should be judged according to a rule he calls: Categorical Imperative: • "Act only according to that maxim [i. e. , rule] whereby you can at the same time will that it become a universal law. " Practical Imperative: • "Act in such a way that you treat humanity, whether in your own person or in the person of another, always at the same time as an end and never simply as a means. " • Important to treat people as autonomous agents

l Deontology focused on using of the categorical imperative (can this action be a law for all people in all circumstances?

Differences l Differences between teleology and deontology can be seen when each approach is applied to the issue of abortion

Abortion l l l Teleology approach saving the mother’s life (the end , or consequences) Justifies the abortion (the mean, or act) Deontology approach consider any termination of life as a violation of the rule ‘do not kill’ and therefore, would not abort the fetus, regardless of the consequences to the mother

Moral Particularism l l l Utilizes the principles and rules of other moral theories. Embraces the uniqueness of cases, the culturally significant ethical features, and ethical judgment in each particular case. It must rely on certain relevant principles (utilitarianism, deontology) for the starting point of judgment.

Virtue Ethics l l Whereas utilitarianism and deontology emphasize whether a particular action is right or good, virtue ethics emphasizes “the person” making the judgments or doing the actions. I. e. , a virtuous person will make virtuous decisions and act virtuously. Has its roots in Aristotle (384 -322 BCE): stress on moral education, moderation, and relationships. Virtue in Greek is arete, which literally means “excellence. ”

Virtue Ethics: Focal Virtue l Beauchamp & Childress proposed four focal virtues (traits) characterizing virtuous person • • Compassion: attitude of active regard for another’s welfare with awareness and emotional response of deep sympathy. Discernment: classical concept of wisdom; sensitive insight involving acute judgment and results in decisive (crucial, important) action Trust worthy: confident belief in the moral character of another person Integrity: soundness, reliability, wholeness, and integration of moral character.

Theories of Care and Feminism l l Carol Gilligan (Harvard), In a Different Voice, 1982 Attacked Kohlberg’s theory of moral development as biased toward a male perspective who prefer abstractness and universals over the concrete and relationships. • • • While males prefer abstract principles (like utilitarianism and Kantian deontology), females show a preference for relationships with specific people. Led to much feminist thought including the “ethics of care. ” Feminism and care have been particularly influential in biomedical ethics since at the core of health care special kinds of relationships b/w health care workers and patients.

Ethics of caring l It is based on relationships l Caring is a force for protecting and enhancing client dignity

Ethics of caring l Caring is of central importance in the client –nurse relationship l E. g nurses use trust telling to affirm clients as a persons rather than objects and to assist them to make choices and find meaning in their illness experiences

Comparison of morals and ethics Morals Ethics -formal responding process -Tradition or belief about right and wrong conducted used to determine right conduct -private and personal -commitment to principles -professionally and publicly -inquiry or study of and values is usually principles and values defended in daily life (investigation) (protected). -related to an individual’s - process of questioning and perhaps changing character (virtue) one’s morals, “What I should do in this situation”.

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Moral development l l l Is a complex process that is not fully understood It is process of learning what ought to be done and what ought not to be done Different approaches to moral development exists: • Kohlberg's theory • Gilligan

Lawrence Kohlberg b. Bronxville, NY 1927 d. Boston, Mass. 1987 In 1958 he first published his stage theory of moral development in his doctoral dissertation at the Univerisity of Chicago. from http: //en. wickipedia. org He stayed at the University of Chicago until 1968, when he went to Harvard to teach and continue his research until his death.

Kohlberg's l Directly affected by Piaget’s theory of cognitive development • Focuses on the structure of thought about • moral issues rather than the specific content of moral values Emphasize fairness, rights and autonomy in a justice framework

Moral development progress through 3 levels l l l Level 1 premoral or preconventional level Level 2 conventional level Level 3 post conventional, autonomous or principled level

Theory of Moral Development ♂Level 1: Preconventional: ♂ Stage 1: Punishment and Reward ♂ Stage 2: Hedonism (self-satisfaction)/ Reciprocity (common) ♂Level 2: Conventional: ♂ Stage 3: Good Boy/Bad Girl ♂ Stage 4: Rules of society ♂Level 3: Postconventional: ♂ Stage 5: Individual Rights ♂ Stage 6: Universal Principles

l Level 1 premoral or preconventional level: - Premoral level has egocentric focus The person obey rules in order to avoid punishment / get rewards. (most in children and under - nine, in some a adolescent and adult criminal) - Fear of punishment is a major motivator of this level.

Level 2 conventional level. l Focus on social conformity “socially accepted”. l Behavior or decision in order to maintain relations /conform to laws and to those in authority because duty without respect for them and in order to avoid censure. l Guilty is more motivator than the fear of punishment as noted in level 1

Level 3 post conventional, autonomous or principled level. 1. 2. 3. 4. The relativity of some societal value is recognized Moral decision derive from principles that support individual rights Transcend particular societal rules as equality, liberty, justice. your decision based on universal ethical principles like human dignity, mutual respect & trust

Carol Gilligan ♀ ♀ Student of Kohlberg’s Later criticized his theory of moral development as being biased toward a male perspective Proposed care-orientation as an alternative method of moral reasoning Believes girls are more inclined towards careorientation so they score lower on Kohlberg’s stages because care-orientation is associated with stage 3 (good interpersonal relationships). from http: //www. albany. edu

Gilligan’s Three-Stage Theory ♀Preconventional: Egocentricism ♀Conventional: Care for others ♀Postconventional: Balancing care for self and others “The moral judgments of women differ from that of men in the greater extent to which women’s judgments are tied to feelings of empathy and compassion and are concerned

Gilligan's l Focuses on a care perspectives l Organized around the notions of responsibility, compassion (care) l The ethics of justice (fairness) is based of the idea of equality ‘everyone should receive the same treatment”

l By contrast, the ethics of care is based on premise of nonviolence that no one should be harmed or abandoned

Process of developing an ethics of care l l l Stage 1 caring for one self Stage 2 caring for others Stage 3 caring for oneself and others Each stage ends with a transitional period (a time when the individual recognize a conflict or discomfort with some present behavior and new approaches)

l Caring for one self : in this phase the concern for survival, focus is on what is best for the self and include selfishness & dependency on other. caring for others: focusing on goodness In which needs of others are often put a head of self, & there is a sense of being responsible for others (positive). - Negative: by manipulating others through a “ see how good I have been to you). l