Introduction to Ethics

PHIL222 - Week 1 Lecture

“Science brings society to the next level; ethics keeps us there.” ~Dr. Hal Simeroth

As a healthcare professional, you will be faced with making difficult ethical decisions. As Dr. Simeroth suggests in the quotation above, our science is moving quickly but to decide if these discoveries are social advancements is something that individual health care professionals much do. In making these decisions there are a number of issues to consider. Some have to do with the nature of ethics and morals themselves. These are decisions such as, “What is an ethical code?” and “What is the source of moral authority?” These questions ask us to reflect upon how and why we believe what we do so we can better assess whether the decisions we make are personal or individual ones, or whether they can fairly be applied to others in our community. These decisions fall into the area of meta -ethics. “Meta” is a prefix that means beyond. Therefore, “metaethics” means looking beyond the ethical to ask questions about the nature of morality itself. Metaethical questions are deep questions that explore the very foundations of ethics and the realm of moral values. The essential questions we have for class each week are like this type of question.


In addition to metaethical issues, we will also ask questions of applied ethics. Applied ethics asks us to look at the specific application of particular and often controversial ethical questions such as how we approach pain management in the end of life, the use of IVF, and the enactment of the Safe Haven Law all of which we will consider in our course. We must also be aware of our own perspective in decision making and ask whether our decisions would make sense to someone who’s cultural or social background was significantly different than our own. Applied ethical questions can be likened to the topical questions in our course which drive our discussions.


The Internet Encyclopedia of Philosophy has a good way of looking at the difference between the two:


Metaethics is a branch of analytic philosophy that explore the status, foundations, and scope of moral values, properties, and words. Whereas the fields of applied ethics and normative theory focus on what is moral, metaethics focuses on what morality itself is. Metaethics. (n.d.). Retrieved May 06, 2017, from http://www.iep.utm.edu/metaethi/


Within the study of ethics, there are many branches. We are interested in our class in the study of medical ethics including questions of autonomy, dignity, identity, personhood, and the fair distribution of scarce social goods. The core principles of medical ethics are known as beneficence and nonmaleficence. The standards of beneficence state that health care practitioners should perform acts to help people stay healthy or recover from an illness. The first duty of a healthcare professional is to support the patient’s health above anything else. Beneficence is the moral term, however there are legal aspects to medical ethics as well. From a legal perspective we may speak of a fiduciary relationship. A fiduciary duty is the a the highest form of responsibility and includes duties of loyalty, confidentiality, good faith, prudence, disclosure and care. The person who has the fiduciary duty is called the fiduciary and in this case would be the health care provider. The person who is owed the fiduciary duty is called the beneficiary and for our purposes is the patient.


In addition to beneficence, there is also the duty on nonmaleficence. Where as beneficence charges us to always perform acts to help patients, nonmaleficence is the standard of “do no harm.” The Hippocratic Oath, formulated by the Greek philosopher and physician Hippocrates, is often associated with nonmaleficence. Although physicians no longer take the Hippocratic oath the spirit of “do no harm” is still alive and well in the modernized versions that govern health care professionals. An interesting exercise is to look into the different versions of the Hippocratic Oath and consider the extent to which health care professionals duties have (or have not) changed throughout history.

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By manuscript:Unknownscan used in book: Foto de la Biblioteca Vaticanascan from book: User:Rmrfstar - page 27 of Surgery: An Illustrated History by Ira M. Rutkow, M.D. published in 1993: ISBN 0801660785., Public Domain, https://commons.wikimedia.org/w/index.php?curid=1446714

Philosophically there is an important difference between the demand to “do no harm,” and the demand to “heal.” One is a passive command that orders the healer to refrain from an action that would harm a patient. The other is an active command that order the healer to take action to help. Perhaps one of the places this distinction becomes very clear is in the question of Physician Assisted Suicide which we will consider later in the course. Many feel that a patient should be allowed to “die with dignity” but that may conflict with the “do no harm principle.” Some medical professionals allow withholding care, some believe treatment should be aimed at healing until death occurs, and other believe that it is permissible to assist a dying patient in passing. The conflict among these views is a disagreement about the principles of beneficence and nonmaleficence.


One of the reasons ethical decisions are difficult to make is because you will struggle with determining who is affected by your decision. Does your decision benefit you, your patient, or the greatest number of people? You will be studying two ethical theories, Utilitarianism and Deontology, which will give you some ethical tools to help you make these decisions. We will consider these theories in greater detail in the next weeks, but as a starting point Utilitarianism is a consequentialist theory that seeks to determine which action will produce the greatest good for the greatest number of people. It is called consequentialist because the utilitarians believe that the morality of an action could be located in its consequences or outcome. Deontology, by contrast, is considered a deontological theory. That means that it is a rule based theory that looks for the morality of the action in the rule or precedent set by an action.


What are ethics?

Sometimes, ethics are defined simply as moral philosophy. But, that definition does not help when we are faced with an ethical dilemma. A good definition of ethics is: values that are used to determine moral conduct or beliefs.
In this course we will be studying the concepts that make up that definition of ethics. These concepts include values, morals and belief. We will look at these separately.


  • Values: A person’s values can be difficult to identify because they are different for everyone. To understand the concept of values you can ask the question “does it matter” and “if so, how much?” Determine how much the decision you have make is worth to you. Not everyone will place the same amount of value on the same things. Ultimately, our values reinforce our considerations, guide our behavior and give purpose to our lives. Values influence our identity and direct our actions. Most of our decisions in life are made fairly easily; however, there are times when we are confronted with new and difficult dilemmas that demand a good framework in order to find an answer. In this course, we will be examining concepts we can use to understand and direct us to the right answers.
  • Morals: The concept of morals addresses the question, “what is right and what is wrong?” We learn about morals at a very young age, usually from our parents, friends or others who have the job of raising us. We also obtain our moral values from other environmental factors which contribute to our moral values. Some of these environmental factors that help shape our values are culture, ethnicity, class structure and a person’s social standing (Gibson, 2014).
  • Beliefs: Beliefs are interesting because sometimes we cannot explain them, even though we are given guidelines for how to make good decisions. There may be situations where we cannot explain why we believe something is right or wrong and know that we should base our decisions on facts and evidence when determining if something is true or false (Stanford, 2014). Using just our beliefs means we are basing our decisions on emotion and feelings instead of tangible proof. Beliefs are often associated with religion where we are taught to “believe” things are true and real—without concrete scientific evidence.
  • Conflict and Dilemmas: Many times these words are used interchangeably; however they have very different meanings. Conflicts create dilemmas. Dilemmas do not create conflicts. For example, a physician who is asked to treat a family member has a conflict. For this doctor, the conflict is between caring for his family member and worrying how this could interfere with his medical judgment. In other words, conflicts create the problem and dilemmas are what occur after the problem has been created. (Gibson, 2014).

Key Terms

Ethics

Morals

Beneficence

Non maleficence

Fiduciary

Hippocratic oath

Utilitarianism

Deontology

Metaethics

Applied Ethics

References

Gibson, K. (2014). An introduction to ethics. Boston, MA: Pearson Education.

Stanford, C. (2014). Ethics for health professionals. Burlington, MA: Jones & Bartlett (including quote)