Ethical Dilemmas in Life and Society **check for notes before class** What is ethics? ethical relativism: moral values varied with the individual but then how do i convince you that its right? how do you know? 1.) One way to justify your views is CONSEQUENTIALISM focus is on the consequences (not the action) specific: utilitarian= greatest good for greatest people John Stuart Mill (1806-1873) "principle of utility" - utility=happiness but happiness is individual. how do you measure happiness? split happiness into higher and lower categories lower= really good football game, good hotdog, higher happiness= of the soul and mind = museum, symphony, lecture Mills: always strive for higher happiness division between happiness: is it fair? do we know what happiness is? for every person? Utilitarianism: everyone counts ONCE, no one is special. So when calculating happiness, no one has more say in happiness. But thats not how humans work we always favor people. But, maybe thats a good thing that we have to be objective. Problems with utilitarianism: -Long term vs. short term happiness. ex.) telling someone they will die in 6 months. Its impossible to know what will happen in the long term. -Truth Telling: what if lying causes more overall happiness? do people want to know the truth? what if you lie to a large number of people? (it made them happy in the short term---but made pain for them and their families in the long term). -Utilitarian views are still subjective and we can't guarantee the consequences that we promised. must extrapolate from your own past, upbringing, ideas, morals etc. Scientifically we know the effects, but we don't know what the person would have wanted.
-Everyone is equal. Old patient has DNR, but families and friends want heroic measures. Is surviving a higher or lower happiness than the happiness(or lack there of) of the family? -What does it mean to make the rational decision?if I chose to die, can that be my choosing happiness? Death: short term families will suffer, long term happiness that the person is at peace. (or vice versa) Two kinds of utilitarianism -act: every instance where you have to evaluate something every act must be put on a scale -rule: establish a patten, generally you should do X in case Y bc it brings out the most happiness leads to rules, laws, procedures, practice 2.) Kant and Deontology Deontology says act and motivation matter.not the consequences. Action is morally right when it is in accordance with the "categorical imperative". Kant says we are all rational animals and the part that matters most, is rationality. humans follow our duties to each other, and we follow this because we are rational. This is done regardless of outcome (if people die as a result, that's fine). Kant is incredibly complex. "categorical"-always true, unchanging and "imperative" you have to do it. So, the "categorical imperative" says actions can only be ok if everyone can do it and don't use people for your own benefit. Kant says this is fundamental to every moral decision, regardless of the consequence. Is that too harsh? ex.) sick friend in the hospital and you go bc you want to be with them OR sick friend that you HATE but you still go to visit them. Kant says good is acting based on duty, so the latter is more moral. Oftentimes, he said, you have to work against your inclination. The person who can override their desire is more moral. Example of morality is becoming a doctor to help people and happening to make money as a result of it. Why is deontology useful? Happiness doesn't matter, outcomes don't matter so why is this good for medicine?--> it makes impartial decisions, that are deeper than consequentialism. As long as the action is properly motivated its okay. Also, you don't have to worry about predicting the consequences. bad consequences are regrettable, but morally okay. what happens when rules conflict? ex.) don't lie, don't harm innocent life: Nazis come and ask for the Jews you are hiding. This prioritization slides toward
Other Approaches to Ethics I. Justice and Rights: a. Distributive Justice: how to fairly distribute benefits/burdens, given scarce resources? i. This is a question of society/community not just individuals rights/justice gender, races, etc. ii. How to determine who has a right to what? what rubric? whoever yells loudest? who has the money?<-- recently often the answer in med. Where do rights come from? what's your right to medical care based on? ex.) do you deserve what you can pay for or does everyone have the right to healthcare. ex.) Italian law: everyone in the country (regardless of citizenship) gives free healthcare. what you do determines what you get? ex.) David Crosby is alcoholic and had liver transplant and continued to drink and destroyed his second liver and wanted another and had enough money. (David Crosby shouldn't get it according to this). Its an accident that we are in the US while others are sneaking into the country and so "right should be based on citizens (genetic accidents)" might not be right. Rights imply duties: if you have a right to X, someone has a duty to give me X (it could be individuals, gov't etc.) universal health care: all of us have a right to receive it, and we all have a duty to pay for it for everyone Justice does not = equality. John Rolles: what would it mean to organize society in the just way possible. he said society=cooperative venture for mutual advantage. how does he do this? What would it mean to be a justice society well we all decide what would be best for us so we all have different answers. A veil of ignorance= the way you come together to form society, you don't know who you'll be on the other side. So the way you structure on one side of the veil ensures that everyone is maximally better off (because you could be one at the bottom). There is still not equality because on the other side there will still be Bill Gates and custodians.
Ethical Principles, Multiculturalism and Religion What is ethical relativism?: what is okay is different for different people and thats okay. but it makes it impossible to to anything. How do you make a policy if we all agree to disagree. Moral principles How do we make moral decision if we do not have the time/resources/etc. to engage in the kind of complex reasons that the theories we covered the last time seem to require? Perhaps a better way is to rely on moral principles (rather than large theories) We will consider four moral principles -none are own complete theory -they don't answer every situation -they aren't coherent -some decisions endorse some principles but not others The principle of nonmaleficence Above all, do no harm (hypocratic oath) We ought to act in ways that do not cause needless harm/injury to others. So, no intentional harm: don't stab your patients, don't take advantage Also, no careless harm: cutting off wrong limb -but you can't get perfection, because medical professionals will make mistakes. So this duty is an imperfect duty. "standards of due care" reasonable standard for medical care -don't take unnecessary risks The principle of beneficence As to diseases, make a habit of two things -- to help or at least to do no harm (Hippocratic oath.). you have a duty to actually benefit the patient. We should act in ways that promote the welfare of other people. We should help other people when we are able to do so.
-do we (everyone) actually have the duty to HELP other people this principle says yes. researchers ask what is benefit?: say you have a double blind study, everyone has cancer but half of them are getting a placebo. Principles of distributive justice Justice: seeing to it that people receive that to which they are entitled -dont short-change people People s rights are recognized and protected The principle of utility (greatest good for greatest people) or Egalitarianism (everyone should get equal) or Libertarianism (no one should be forced to give anything up) how to distribute goods and services. The principle of autonomy Counters paternalism: father knows best. So doctors used to do this a lot: do what I say, I went to med school I know what I'm doing. Rational individuals should be permitted to be self-determining : everyone should have some say in what they do. -in order to be autonomous you need to understand whats going on. (consent form) how many people have huge procedures without understanding the risks. the language is impossible. consumers, patients, customers don't "care" about this. How rational do you have to make these decisions?-diploma? IQ? what if you are in incredibly pain (physical or mental)? -intentionality you must intend what you're doing, not agree to something by mistake -freedom from internal of external constraints no one can pressure you and you must have a clear mental state (no depression, mental illness etc.) patients rarely have all of these once you are in a hospital you have internal constraints (pain, stress, anxiety etc.) it is unattainable but we can strive for it
Restrictions on autonomy: liberty-limiting principles The harm principle: you can have as much freedom and autonomy as you want, as long as it doesn't harm anyone else. The offense principle: should a persons autonomy be limited if it can offend them (insulting beliefs)? can you tell a native mother that her rituals for the child is crap? you have to know what offends them, this means that doctors have to get to know their patients. But HMOs pay the doctor per patient or procedure. The principle of paternalism The social welfare principle III. Multiculturalism and Cultural Relativism i. Is there a difference?: - different societies have different moral beliefs and practices and it is impossible to judge right and wrong because it is all a matter of opinion. -differences over right and wrong so there are differences between cultures about moral values. -individuals and visitors should conform to the moral code of that society. is this okay? FGC: American doctors are asked to assist, but if the doctor doesn't, it will probably be done by some traditional healer with the chance of healing. If you don't do it, and not following the cultural traditional be considered harmful. Religion and Bioethics i. Catholicism and bioethics: a. Natural Law Theory: each human life has its own value/dignity/is unique/must not be used against its nature. don't use people to help others 1. This fact derives from the fact that we are created by God. ii. Judaism and bioethics Islam and bioethics: a. Abortions are allowed after implantation, and before ensoulment Western beliefs vs. nonwestern beliefs. what if they run counter.
September 17, 2010 Moral theories= tools for revealing things about the situation. What is the morally right outcome that I want? theories answer these differently according to what they find morally relevant Utilitarianism what the action CAUSES to happen. Not a matter of why, or what the action was. The ends justifies the means. -greatest utility for the greatest number utility: Mill= utility is happiness. He defined happiness as pleasure. Maximize pleasure for the greatest number of people. Each person is one unit; everyone is equal. Increase pleasure and decrease pain how to do this is debated. Mill thinks that each of us are best suited to figure out what makes us happiest. Act: each individual case, we should judge what would maximize utility. Ex. Sometimes lying is best sometimes its not Rule: (mill) certain kinds of actions tend to maximize happiness and we don t want to undermine those. So we have to respect these rules so in the long run more people are happier. Consequstionalist calculus: Deontology- duty based. What matters morally is not that your action brings good consequences but that you act from the right intentions. Your actions conform to a duty. Ross: principalist approach. We naturally know what these duties are, but we prioritize some over others. Ex.) sometimes autonomy is more important that beneficence. Ex.) mental health care; someone must chose to be treated. Kant: categorical imperitive: all actions were made moral whether they conformed to a rule. Must act as if all our rules are universal laws like gravity., that everyone must follow. Never treat others as means, treat them as ends. Don t use other people, they aren t tools. Therefore you cant commit suicide because that involves self love? You can t kill someone to save others with their organs/
Patients and Physicians The move away form paternalism: caveat emptor - buyer beware consumer sovereignty - patient began to be viewed as a consumer. A consumer has a little more power and knowledge. But not everyone can shop around (money, availability) or can t ask questions (lack of education). Major characteristics of three key treatment decision-making approaches: paternalistic, informed, and shared Shared decision making as an interactive process: Physicians and patients simultaneously participate in all phases of the decision-making process Together negotiate a treatment This challenges the physicians professional authority. Negotiating is impossible without health care. Some insurance plans allow only one physician, which doesn t allow shopping around. Many people seek GP care in the ER Models for the physician-patient relationship Paternalism Partnership: mixture of informed and shared. They find mutually agreeable solution. Patient tells the doctor what they need. Contract : patient is contracting for a service. Buyer=patient and physician=consumer. The contract is never equal because the physician will always know more, and the patient s life is the one on stake. Friendship (latest trend) physician must like and get to know the patient before treating them. The possible overtreatment of friends Physicians would have a hard time to deal with the constant dying of friends.! physician distancing Its easier to open up to the doctor! honesty! better treatment Friends don t wear white coats. Doctors signify authority and possible death. So someone dressed more casually might be easier to trust. Technical assistance (opposite of friendship) mechanic model. The patient as a broken part. There is no emotional connection. Doctors like this because