Ethics – the theory

7


Ethics – the theory




Study Points



image The major ethical theories and principles applied to decision-making in health care


image The key limitations of each ethical theory


image The distinction between morals, ethics and law


image Ethical decision-making frameworks


image Ethics relating to pharmacy




Morals, values and ethics


The terms ‘ethics’ and ‘morals’, ‘ethical’ and ‘moral’, are often used interchangeably. They are almost synonymous in that an ethical action is one that is morally acceptable. However, they are not identical. Morals usually refer to practises; ethics is concerned with evaluating such practises. Morality is concerned with the standards of right or wrong behaviour, the values and duties adopted by individuals, groups and society. Personal morals arise from religious beliefs, political views, prejudices and cultural and family backgrounds.


Values are those ideals, beliefs, attitudes and characteristics considered to be valuable and worthwhile by an individual, a group or society in general. Personal values are acquired over a long period of time through interaction with family, friends, school, work, colleagues and role models, and develop and change throughout life. The way in which a person makes personal and professional judgements and choices is influenced by the way they organize, rank and prioritize values in a personal value system.


Ethics is the branch of philosophy that deals with the moral dimension of human life. Ethics deals with what is right and wrong, good and bad, what ought and ought not to be done. It is concerned with actions and judging whether an action is right or wrong and justifying this. The study of ethics is commonly grouped into three areas:



Descriptive ethics is about facts while normative ethics is about values. One cannot argue from the one to the other. The way things are is not necessarily a guide to how they should be.



Ethical theories


Ethical theories provide a framework within which the acceptability of actions and the morality of judgements can be assessed. Absolutist theories rest on the assumption that there is an absolute right or wrong. Relativistic or reason-based theories rest on the assumption that right or wrong can depend purely on what any society, group or individual believes.



Normative theories of ethics


Normative theories are distinguished by the way in which they provide ethical guidance:



These are summarized in Table 7.1.




Virtue ethics


The word ethics is derived from the Greek ethos, meaning a person’s character, nature or disposition. Virtue ethics has its roots in the work of Socrates, Plato and Aristotle, and places emphasis on the character of the person performing the action rather than on the action itself.


Virtue ethicists stress the importance of inner character traits such as honesty, courage, faithfulness, trustworthiness and integrity. Healthcare professionals are expected to demonstrate such characteristics or virtues.


Socrates (470–399 bc) taught the priority of personal integrity in terms of a person’s duty to himself.


Plato (427–347 bc) emphasized four cardinal virtues: wisdom, courage, temperance and justice. Others virtues were fortitude, generosity, self-respect, good temper and sincerity. Hierarchies of virtues have changed over time.


Aristotle (384–322 bc) was concerned with what makes a good person rather than what makes a good action. He believed that being moral involved rationally applying good sense to find the middle way between one extreme and another, for example courage is the mean between cowardice and rashness (Box 7.1).



Box 7.1   Examples of Aristotle’s moral virtues and the golden mean
























Excess Mean Deficiency
Rashness Courage Cowardice
Boastfulness Truthfulness Understatement
Irascibility Patience Lack of spirit
Vulgarity Magnificence Pettiness


Modern Aristotelians believe that ethics should be concentrating more on how people should live their lives, advising which ethical characteristics people should try to develop and habituating people into having good dispositions so that moral behaviour becomes almost instinctive.



Consequentialism and utilitarianism


For consequentialists, whether an action is morally right or wrong, depends on the action’s ‘utility’ or usefulness.


Utilitarians consider that an action should be judged according to the results it achieves. Jeremy Bentham (1748–1832) argued that actions are right if they maximize pleasure (good) and minimize pain (evil) for the majority of people. Since he believed everyone had an equal right to pleasure, everyone counted in the assessment of benefits of an action.


Later it was argued that not all forms of pleasure and happiness were equal and other values such as duty, love and respect should be considered. The goal of ethics is not only the pleasure (happiness) of the individual, but also the greatest pleasure (happiness) for the greatest number (John Stuart Mill 1806–1873).


Recent utilitarian theorists have advocated taking into account the preferences of persons concerned. This approach has become widely used in areas of applied and professional ethics and assumes that there should be equal consideration of interests. While accepting that not all have equal interests (animals compared with humans for example), all should be treated in a way that is appropriate.


The simplicity and practical usefulness of utilitarianism is one of its main benefits. If an act is likely to produce the greatest good for the greatest number, then it is right – if it does not, it is wrong.



Deontology


Deontology refers to a group of normative ethical theories that emphasize moral duties and rules. They are referred to as non-consequentialist, since some actions are inherently right or wrong, regardless of consequences. There are acts we have the duty to perform because these acts are good in themselves; and we have a duty to refrain from acts that are intrinsically bad or wrong.



Kantianism

Kantianism is the most comprehensive deontological ethical theory named after Immanuel Kant (1724–1804). He believed that people, not God, imposed morality because they were rational beings. Kant suggested that moral duty could be determined by the use of reason about the act in question. This categorical imperative exists as several versions, the two best known being:



This means that ‘unless you are able to say that everyone must act like this, then you should not act like it’. Something is morally right, or wrong, only if it applies for everyone. It would be inconsistent and irrational to decide, for example, that you could steal from others, but they could not steal from you. Thus, reason demands that we do not steal unless everyone is allowed to steal.



People must be treated as ends in themselves and not as a means to an end. This means that all people are equal and deserve equal respect. There are certain ways we must not treat people, no matter how much usefulness might be produced by treating them in those ways (e.g. not lying to a patient). A consequentialist, by contrast, does not believe it is wrong to use people as means – if the ends justify the means, lying is permissible.


This second version has been very influential in medical ethics, as it can be translated as saying it is necessary to treat people as autonomous agents capable of making their own decisions. The concept of autonomy and respecting an autonomous decision demonstrates respect for the person as an ‘end in itself’.



Ross’s prima facie duties

WD Ross (1877–1971) recognized that a number of obligations present themselves in practical situations and that we must weigh up the various options available when deciding which course of action is morally correct (Hawley 2007). Ross distinguished duties as prima facie or ‘actual’ duties. A prima facie duty is one that is always to be performed unless it conflicts with an equal or stronger duty. The stronger duty becomes an actual duty that must be carried out for the action to be morally correct. The prima facie duty to keep a promise, for example, could be over-ridden if it was not in a person’s best interests. Ross identified seven prima facie duties (see Box 7.2).



Box 7.2   Ross’s prima facie duties




Conflict of duties can only be resolved by considered judgement in a particular situation: there is no general ranking of the duties. The morally correct action is the one that produces the greatest balance of prima facie rightness to prima facie wrongness. However, the principle of non-maleficence is considered to take precedence over the principle of beneficence when they come into conflict. Ross’s theory has greatly influenced the ‘four-principles’ approach to medical ethics (see below), as it introduced the idea of sorting and weighing principles.




Principlism and the four ethical principles


‘Principlism’, introduced in the late 1970s, is now a widely applied bioethical framework for identifying key moral issues and as a starting point for looking at ethical dilemmas. It identifies four prima facie moral commitments relevant in health care and compatible with the major ethical theories. These enable a simple, accessible approach when the ethical theories themselves can be considered to be too general to guide particular decisions. Being conditional, the principles allow a stronger case to overrule a weaker one in a particular circumstance.


The four ‘principles’ are:



These are supplemented with four ‘rules’:




Autonomy


Autonomy encompasses the capacity to think, decide and act freely and independently. Respect for autonomy flows from the recognition that all rational beings have unconditional worth, and each has the capacity to determine his or her own destiny. People should be seen as ends in themselves and not treated simply as means to the ends of others.


Autonomy generally brings about the best outcome. Individuals should be allowed to develop their potential according to their own personal convictions provided these do not interfere with a like expression of freedom by others. A person’s autonomy should be respected unless it causes harm to others. Liberty should not be limited on the sole grounds that a person’s choice would harm them – competent adults should be free to risk their own health and well-being without interference. Respectfulness can be considered a characteristic of a virtuous person.


Three types of autonomy have been suggested:


< div class='tao-gold-member'>

Related posts:

  1. Oral unit dosage forms
  2. Solutions
  3. Drug evaluation and pharmacoeconomics
  4. Emulsions

Stay updated, free articles. Join our Telegram channel
Tags:
Jun 24, 2016 | Posted by in PHARMACY | Comments Off on Ethics – the theory

Full access? Get Clinical Tree
Get Clinical Tree app for offline access