HSCI 319 W Midterm Review Presented by the

HSCI 319 W Midterm Review Presented by the SFU Health Ethics Club

Outline & Format We’ll present on a few specific concepts, but this is open-format so we encourage everyone to ask questions during the presentation and afterwards if there’s anything you want us to go over! Moral Theories: Deontology Consequentialism & Utilitarianism Biomedical Ethics: Justice, Autonomy, Beneficence, and Non-maleficence Political Philosophies: Paternalism, Libertarianism, and Communitarianism Practice Ethical Theories How to construct an ethics paper (time-permitting)

Key-terms Moral agent: rational individual who is capable of understanding the consequences of their actions and is held responsible for the choices they make Which groups does this definition potentially exclude as moral agents? Beneficence: Always strive to do good Non-maleficence: do no harm Justice: duty to give each individual equal and to treat similar cases similarly

Moral Theories: Deontology Kantian Deontology is a very common example of the deontological theory Moral duties and obligations bind us to certain actions Actions are morally permissible or morally impermissible in and of themselves; there is no consideration for circumstance Prima facie duties take priority over other duties, e. g. justice, beneficence, non-maleficence A fundamental duty: To not use another person as a means to some end You might liken this to moral laws

Moral Theories: Deontology (Kantian) Central to Kantian Deontology is what he calls the Categorical Imperative: a universally binding, unconditional, or absolute moral requirement The Categorical Imperative is to act in such a way that each moral action follows the principle of universalisation, i. e. an action is morally permissible if we can say that it would be beneficial were everyone else to also behave in that way—this is not to say that the categorical imperative is based on self-interest or preservation Similar to the “Golden Rule” in Christian dogma, but differs in that Kant would say that we do good not for the expectation that it will be reciprocated (as the Golden Rule implies), but because it is a moral imperative in and of itself Problems? Cannot use “immoral” actions as a means to justify a greater good (therefore in opposition to consequentialist theories) e. g. It is always wrong to steal, regardless of circumstance e. g. A physician is obligated to preserve life

Moral Theories: Utilitarianism A consequentialist theory that stands in direct opposition to deontology for its emphasis on context and circumstance Morally permissible actions are those that will conceivably maximise the greater good, while minimising the greatest overall harm Operates on the Principle of Utility: We ought to maximise beneficial outcomes and minimise harmful consequences for the greatest number of people Cost-benefit analysis Two subclasses of utilitarianism: Rule utilitarianism – As a general rule, use principles that benefit all people and acknowledge and protect individual rights in most cases e. g. justice, non-maleficence, beneficence—but these may be overridden by circumstance, unlike deontology Act utilitarianism – make decisions on a case-by-case basis by weighing the potential good with the potential harm The more people involved, the trickier it becomes

Moral Theories: Utilitarianism Utilitarian decision-making may be applied as such: 1. First, apply Rule utility: Use generalised rules that, in most cases, will benefit all people and acknowledge and protect the individual rights of moral agents—based on prima facie notions of justice, equality, human value, etc. § n. b. Unlike deontology, these principles are not absolutely binding and may be overridden in some cases 2. If circumstances do not allow the application of rule utility, use Act utility: make decisions on a case-by-case basis, anticipating potential consequences and using some kind of rational process to conclude which action will produce the best possible scenario for the most amount of people § e. g. Coventry: During WWII, Winston Churchill was notified that the British city of Coventry was going to be bombed by the Nazis within 48 hours. This information was only obtained by successfully deciphering a coded Nazi communications line—but, Churchill faced a serious dilemma. Being able to decipher the Nazi’s encrypted code without their knowledge would provide a huge military advantage, but if he ordered an evacuation of the city, the Nazis would figure out that the British had deciphered the Nazi’s code and would change it. Churchill had to decide whether the military advantage of deciphering the code was worth more utility than the innocent civilian lives in the city of Coventry. Churchill chose the former. Utilitarianism grants moral permissibility to sacrificing some people if the consequent benefit will be greater for more people Problems? Relies on “perceived consequences”—how can we be sure what consequences our actions will have? If you were in Churchill’s position, what would you have done? How might a deontologist react?

Moral Theories: Biomedical Ethics Four principles: Respect for autonomy Beneficence Non-maleficence Justice Moral community: group of moral agents who agree to limit their behaviour in order to achieve personal and social benefits (e. g. professional code of ethics)

Moral Theories: Political Philosophy-based Liberalism: focuses on self-determination, autonomy, and freedom from paternalistic influences, e. g. State interference in personal affairs such that personal freedoms are restricted unnecessarily Mill’s Harm Principle: We should be granted all possible freedoms up to the extent that the exercising of one’s personal freedom does not infringe on the freedom of another. (n. b. this is not “anarchy”) Problems: Reconciling population health interventions without limiting freedoms of individuals Is absolute autonomy always the most ethical policy? Paternalism: the policy of people in power to restrict the freedoms of those dependent on them “for their own good” Thoughts? Should doctors be considered the be-all-end-all of treatment? But should patients, presumably without medical degrees, be able to make medical decisions? Communitarianism: moral decisions are made based on what is best for the group/society—utilitarian influences Should people who are strictly opposed to abortion or physician-assisted suicide have to pay, through their taxes, for these services? Should vaccines be mandatory to protect the community? What if there is a large group who refuse vaccination on religious grounds? Should that right be overridden for the benefit of the community’s health?

Scenario: Compulsory Vaccinations? When is it ethically justifiable to mandate a vaccination? How would you argue this from a utilitarian or deontological perspective? What would the opposing view say? Answer using principles of: Autonomy Beneficence Non-maleficence Justice

Scenario: Smoking in Hospitals How might a liberalist respond to the proposal of banning smoking on hospital grounds? How might Mill’s Harm Principle be applied in this case? Consider also the rights of hospital staff and other patients—does either scenario inappropriately infringe upon their freedoms? What are the implications for one’s autonomy? Would such a ban constitute an unjust exercise of paternalism?

Questions?

Writing Ethical Arguments Writing an ethics paper (or essay, as will be on your midterm): 1. Highlight relevant components of the scenario: Who is the primary person involved? Who are third parties, and what is their interest and potential biases? Which rights are potentially being violated, e. g. religious rights, threats to autonomy, threats to the inherent human value, etc. ? 2. State your position and theory from which you will be arguing (deontology, utilitarianism, etc. ) § Thesis: Should take the form of, “I will argue from a deontological perspective that x is morally impermissible on the grounds that x is a violation of y. ” 3. Objective: Ethical issues are sensitive, but appealing to emotions is not a good way to win an argument. Avoid phrases like, “x seems intuitively wrong, therefore …” 4. Deductive: If the premises of your argument are true, then your conclusion should necessarily follow i. Premise 1 “If this, then that” ii. Premise 2 “And if this, then that” iii. Conclusion, “Given 1 and 2, x is morally permissible”

argument should be able to be boiled down into several simple “Skeleton Paper” An premises followed by a conclusion—a “skeleton” paper q Example from a paper I wrote for HSCI 319 W q Prompt on Professional Ethics: “A physician in Canada is conducting a routine checkup on an 8 year old boy, during which she notices bruising on his body that appears to be inflicted by some kind of object. Worried he is being abused, she calls his parents to inquire about the bruising, to which they respond that they are originally from a culture where “paddling” is an accepted form of discipline and that it is okay because it is not harmful to the child. Should the physician report the abuse, or should she respect the cultural and parental rights over the boy? ” o I argued that professional ethics obligates the physician to report the abuse because: i. iii. iv. v. The BC CF&CS Act states that any physician is legally obligated to report cases of suspected child abuse § 43 of Canadian Criminal Code states that parents may only administer “reasonable” physical discipline, which excludes the use of physical objects “Paddling” is a form of discipline with a physical object Given premise i. and ii. , “paddling” constitutes child abuse under the Canadian Criminal Code Therefore, the physician is obligated to report the case

Thanks everyone for coming! Slides will be posted at: https: //sfuhealthethics. wordpress. com Twitter: @SFU_ethics Facebook group: SFU Health Ethics Club