HEALTH CARE ETHICS NU MANILA

LECTURE: Theories and Principles of Health Ethics (Week 1)

DATE OF LECTURE: - - -
TEACHER: Dr. Anna Katharina G. Peña

life and, more broadly, in defining the

RESPECT ACRONYM
“good”.
 Two key concepts: Good and right. When we
 Recognize – the inherent worth of all human speak of good, we refer to a goal at which
beings. we aim; when we speak of right, we have a
 Eliminate – derogatory words and phrases more moral juridical framework in mind.
from your vocabulary.  Knowing what is good starts a train of activity
 Speak – with people not at them or about aimed at achieving it; the rules we may use
them. to determine, and how we achieve what we
 Practice empathy – walk awhile in other’s consider to be a “good” are what is
shoes. objectively “right”; the right course of action.
 Earn – respect from others through respect-  Goods may be intrinsic goods (“good in
worthy behaviors. themselves”) or instrumental goods (goods
 Consider – other’s feelings before speaking that serve as the means for achieving
and acting. another, usually higher, good). It is the
 Treat – everyone with dignity and courtesy. intrinsic good that has escaped definition.
The quest for the summum bonum, the
Philosophy ultimate good, that which is good in itself, is
 A way of thinking about certain subjects such sometimes seen as the greatest good in a
as ethics, thoughts, existence, time, meaning, hierarchy of goods (rationality, for Aristotle),
and value. sometimes as the common denominator of
 4 R’s: Responsiveness, reflection, reason, and all other goods (pleasure, for the hedonist),
re-evaluation. and, at times, as an almost mystical, religious
 The aim is to deepen the understanding. good (God, for the religious).
 The hope is that by doing philosophy, we learn
to think better, to act more wisely, and Scientific, Naturalism, Humanism, & Morality.
thereby help to improve the quality of all our
lives.  Scientific - methods and principles of
science.
Ethics  Naturalism – everything arises from natural
properties and causes.
 Ethics derives from the Greek words ‘ethos’  Humanism – focusing on the potential
and morals, derived from the Latin, ‘mores’. goodness of human beings, emphasizing
Both derive from the word for custom, common human needs, and seeking rational
manners, or the disposition peculiar to a ways of solving human problems.
given people.  Morality – the distinction between right and
 Moral philosophy is a discipline concerned good; wrong or bad behavior.
with what is morally good and bad and
morally right and wrong. Health Care Ethics
 Ethics deals with such questions at all levels.
Its subject consists of the fundamental issues  Field of applied ethics that is concerned with
of practical decision-making, and its major the vast array of moral decision-making
concern includes the nature of ultimate situations that arise in the practice of
value and the standards by which human medicine in addition to the procedures and
actions can be judged right or wrong. the policies that are designed to guide such
 Ethics searches for a way of life (secular practice
ethics, Christian ethics), seeks rules of
conduct (applied ethics), and inquiries
about ways of life and conduct (metaethics).
 Thus, as in ancient times, ethics remains
largely concerned with seeking the “good”

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HEALTH CARE ETHICS NU MANILA
LECTURE: Theories and Principles of Health Ethics (Week 1)
DATE OF LECTURE: - - -
TEACHER: Dr. Anna Katharina G. Peña

Feelings  Apartheid is a policy that is founded on the

idea of separating people based on racial or
ethnic criteria.
 Ethics concerns what my feelings tell me is
right or wrong. Social accepted behavior
 Many equate ethics with feelings
 Feelings are too subjective.
 Following your feelings does not always  Ethics consists of the standards of behavior
mean you’re doing an ethical act. our society accepts.
 Many people tend to equate ethics with their  E.g., actors and actresses or event political or
feelings. But being ethical is clearly not a TV personalities do things that society
matter of following one’s feelings. “accept” but are ethically wrong.
 A person following his or her feelings may  Finally, being ethical is not the same as doing
recoil from doing what is right. “whatever society accepts”. In any society,
 In fact, feelings frequently deviate from what most people accept standards that are, in
is ethical. fact, ethical. But standards of behavior in
society can deviate from what is ethical. An
Religion entire society can become ethically corrupt.
 Nazi Germany is a good example of a
morally corrupt society.
 Ethics has to do with religious beliefs.
 Nor should one identify ethics with religion. What is Ethics?
Most religions, of course, advocate high
 Science of the highest goods
ethical standards. Yet if ethics were confined
 Science of the supreme ideal of human life
to religion, then ethics would apply only to  The study of what is right or good in human
religious people. conduct or character.
 But ethics applies as much to the behavior of
 Ethics has two things. First, ethics refers to well-
the atheist as to the people of the devout
founded standards of right and wrong that
religious person.
prescribe what humans ought to do, usually
 Religion can set high ethical standards and
in terms of rights, obligations, benefits to
can provide intense motivations for ethical society, fairness, or specific virtues. Ethics, for
behavior. example, refers to those standards that
 Ethics, however, cannot confined to religion
impose reasonable obligations to refrain from
nor it is the same as religion.
stealing, murder, deception, and fraud.
 Ethical standards also include those that
The Law enjoin virtues of honesty, compassion, and
loyalty. Also includes relating to rights, such as
the right to privacy. Such standards are
 Being ethical is doing what the law requires. adequate standards of ethics because they
 “Ethics ≠ Law” means being ethical is also not are supported by consistent and well-
the same as following the law. founded reasons.
 The law often incorporates ethical standards  Secondly, ethics refers to the study and
to which most citizens subscribe. But laws, like development of one’s ethics. Standards. As
feelings, can deviate from what is ethical. mentioned above, feelings, laws, and social
 Our own pre-Civil War slavery laws are one norms can deviate from what is ethical.
obvious example of laws that deviate from
what is ethical.

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HEALTH CARE ETHICS NU MANILA
LECTURE: Theories and Principles of Health Ethics (Week 1)
DATE OF LECTURE: - - -
TEACHER: Dr. Anna Katharina G. Peña

What is right? based theory would decide that what is right

also maximizes some good. The right this to
 In decision-making, we should draw on the
do, then, is the good thing to do.
ethical notion that loyalty should never take
 Jeremeny Betham and John Stuart Mill are
precedence over other ethical values such
considered father of utilitarianism, the most
as honesty, trustworthiness, personal
common form of consequence-oriented
responsibility, and so on. If loyalty trumped all
reasoning is utilitarianism.
else, then we can imagine the tight situations
 To utilitarianism, the good resides in the
where we do what is ethically improper out
promotion of happiness
of a sense of loyalty to another person or an
 John Stuart Mill defined happiness as a set of
organization.
higher-order pleasures such; intellectual,
aesthetic and social enjoyment rather than
Healthcare Ethics = Applied Ethics
sensual pleasure.
 The purest form of this line of reasoning is Act
Utilitarianism, in which the decision is based
 Moral judgments about; Actions & Conditions
on listening to possible alternative actions,
 Framework for discussing: Medical issues &
weighing each with regard to the amount of
Medical decision-making.
pleasure or utility it provides, and selecting
 Ethics is a complex area. It is concerned with
the course of action that maximizes pleasure.
the kind of people we are. This could be
 There is some criticism that this hedonistic
called the “ethics of being”. It is also
form of reasoning leads to a situation in which
concerned with the things we do or fail to do.
one group derives pleasure from the pain of
This could be called the “ethics of doing”.
others and justifies its actions on the basis of
The ethics of doing has at its focus: on what
utility.
we do, and how we decide what we ought
 To overcome this objection, some newer
or ought not to do.
consequentialist formulations have required
 Ethics is about right and wrong in human
the principle of equal consideration of
conduct. Ethics is about choices, dilemmas,
interest to be shown. equal consideration of
and grey areas. It explores the question of
interest tells us that individuals is not allowed
what we ought to do, rather than simply
to increase his share of happiness as expense
discuss what people could do or actually do.
of other.
 In order to know what to do in a given
 Utilitarianism are also referred to as
situation, we need to explore the issue
Teleological Theory.
carefully in terms of the action involved, its
consequences on others, and the context in
Proper Intrinsic Goods
which it takes place.
o Life, consciousness and activity
o Pleasure and satisfaction of all or certain
Theories and Principles of Health Ethics kinds
 The test of a useful theory of ethics is its ability o Happiness, beatitudes, contentment
to make sense of the world and provide o Truth
guidance about how to act in it. o Knowledge and true opinion of various kinds,
 Teleology; Utilitarianism, Deontology, Feminist wisdom
ethics, Communitarianism. o Beauty, harmony, proportion in object
contemplated
Teleological (Consequence – oriented) theories o Aesthetic experience
 This theory judges the rightness or wrongness o Morally good dispositions or virtues
of decision based on outcomes or predicted o Mutual affection, love, friendship,
outcomes. Those following a consequence- cooperation
o Just distribution of goods and evils
o Harmony and proportion on one’s own life

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HEALTH CARE ETHICS NU MANILA
LECTURE: Theories and Principles of Health Ethics (Week 1)
DATE OF LECTURE: - - -
TEACHER: Dr. Anna Katharina G. Peña

o Power and experiences of achievement A type of consequentialist theory that has

o Self-expression become powerful in bioethics is utilitarianism.
o Freedom  Jeremy Bentham (1748–1832) introduced
o Peace Security both the name “utilitarianism” and the most-
o Adventure and novelty recognized statement of its central thesis: The
o Good reputation, honor esteem greatest happiness of the greatest number is
the measure of right and wrong, and it is
common to hear people today use the
phrase “the greatest good for the greatest
number”
 For Bentham, the “good” is defined very
simply as “happiness.” He claimed that
happiness was something that could be
calculated by measuring and adding up
pleasure and subtracting pain. Thus any
action that brings about greater happiness
 Utilitarianism system are referred to as for more people is a right action under
teleological theory, taken from the Greek Bentham’s brand of utilitarianism
word “telos”, which means “end”. Often,  John Stuart Mill (1806–1873) refined this idea
individuals attempt to use utilitarian theory of Utilitarianism and strengthened the notion
when they seek to divide scarce resources that pleasure and freedom from pain are the
such a s health care. They might justify the
only two things desirable as ends in
denial of a single individual access to a heart
themselves.
transplant if the money could be spent on
providing vaccines to thousands.

As a nurse, what do we mean when we talk about

“doing the right thing”?

Some people think that to do the right thing

means to act with the intention of doing good. Thus,
a person is doing the right thing (acting ethically)
when he or she does something with the right
intention, such as helping another person or  Mill refined this idea and strengthened the
preventing harm to another. Others claim that notion that pleasure and freedom from pain
having a good intention is not enough. It also matters are the only two things desirable as ends in
what people do and what the outcomes of their themselves.
actions are.  According to Mill, everything else we desire is
desired because, ultimately, it brings us
Utilitarianism pleasure or freedom from pain.

 A form of ethical theory that is concerned Utilitarianism applied in health care ethics:
with the outcomes of actions.
 Claims that it is the action itself that is right or Originally, utilitarian theories were designed
wrong, not the person performing the action. for and applied to legislative matter. It is easy to see
 As such, it is a form of a more general theory how this theory can be applied to other realms of
called “consequentialisms”. moral life and why it has become particularly
attractive in the realm of health care ethics,
bioethics.

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HEALTH CARE ETHICS NU MANILA
LECTURE: Theories and Principles of Health Ethics (Week 1)
DATE OF LECTURE: - - -
TEACHER: Dr. Anna Katharina G. Peña

1. Many of the ethical problems we face in  However, there are some goods that can be
medicine are directly about people’s achieved only through means that most of us
happiness. would consider wrong.
 The very term “quality of life” acknowledges  For instance, there may be times when a
that pleasure and pain are variables in life patient asks that her family not be informed
of her diagnosis or prognosis because the
and need to be assessed as other life
patient does not want to worry them and
conditions change.
fears the disruption in their lives that such
 It is in the forefront of decisions about
information would bring. Yet it may seem that
withdrawing or withholding treatment as a the family could provide valuable support for
means to end suffering. the patient. In fact, you may know this
 One reason to respect autonomy is the idea particular family well enough to know that
that only the patient can make an accurate telling them about the patient’s illness would
determination about what course of action bring more support and hence greater well-
will bring him or her the greatest happiness, being to the patient than not telling.
and we should therefore accept that  By utilitarian reasoning, it would be not just
determination as reflective of the greatest acceptable, but required, that you disclose
good. this information to the family.
2. In medical ethics we are inevitably  However, respecting patient confidentiality is
concerned with the distribution of medical an important element of patient care.
resources. Although we do not generally  Even if you were right in your assessment of
have to make these decisions at the the situation, most clinicians would agree
patient’s bedside, we do need to be that it is absolutely wrong to disclose patient
prepared to address these issues in a larger information without the patient’s consent.
context and understand their implications for
patient care. Distributing resources so that Thus, following utilitarian reasoning could put
the greatest number of people can get the one in a situation in which breaking ethical standards
most benefit from them is a direct is required. This is a strong indictment of utilitarianism
application of utilitarian theory.
2. True calculations of happiness are impossible
Utilitarianism has been criticized as being too  Another criticism of utilitarianism is that in
simplistic and unable to adequately cope with the practice it is impossible for an individual or
complexities of real-life situations. We will examine even a group to accurately calculate all the
three of these claims. pleasure and freedom from pain that any
1. Utilitarianism requires us to do whatever act specific act will entail.
will bring about the greatest good, even if  For one thing, we can never be completely
that means doing something we would sure that our actions will produce their
otherwise consider immoral. intended results.
2. True calculations of happiness are  Second, even if they do produce the desired
impossible. outcome, how can we foresee all the
3. Utilitarianism does not consider issues of implications of these actions and assess the
distributive justice. effects they will have on all people, however
remotely connected to the act or its
outcome?
1. Utilitarianism requires us to do whatever act will
 In considering the total calculation of
bring about the greatest good, even if that
pleasure and pain, it is imperative to account
means doing something we would otherwise
for all people who will be affected by the
consider immoral.
action both now and in the future.
 If we can bring about a good, then,
according to utilitarian theory, we are
required to do that action.

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HEALTH CARE ETHICS NU MANILA
LECTURE: Theories and Principles of Health Ethics (Week 1)
DATE OF LECTURE: - - -
TEACHER: Dr. Anna Katharina G. Peña

Solution: Supporters of utilitarianism generally realize that they are practicing “divine
reply to this criticism by pointing out that even command deontology.” Rather, they are
though not all consequences are foreseeable, the upholding and following the dictates of their
major ones are. For most situations, most of the time, religion.
a reasonable enough calculation can be made.  An example of deontology is the belief that
killing someone is wrong, even if it was in self-
3. Utilitarianism does not consider issues of defense. (ethics) The ethical study of duties,
distributive justice. obligations, and rights, with an approach
 Utilitarianism only requires that happiness be focusing on the rightness or wrongness of
maximized, not that there be any sense of actions themselves and not on the goodness
fairness regarding who gets to be happy. or badness of the consequences of those
 In the general formulation of utilitarianism, it is actions.
equally as legitimate to make rich people
happy by buying them yachts as it is to make Natural Law & Man’s Law
poor people happy by buying them homes.
 In health care, this would mean there is no
rationale for distributing resources other than
to make sure that the resources do some
good.
 Utilitarian would argue that if this is the case,
if fairness or justice is generally a method of
increasing happiness, then this is a suitable
goal and can be made a criterion for
distributing health care resources, not
because justice or fairness is good in and of
itself, but because promoting it will promote
happiness in general.

Deontology
 The major contender to consequentialist
theory is deontological theory.
 “Deontology” is derived from the Greek word  Aristotle wrote that nature is organized for
“deon” meaning “duty”. good purpose.
 The defining difference between  It claims to provide an objective and
consequentialism and deontology is that universal foundation. Moral rules based on
deontologists believe that actions are right or natural law, like the dictates of science, are
wrong insofar as they satisfy a moral portrayed as objective and existing
obligation or duty, regardless of whether that independent of personal, social, or cultural
maximizes the good. beliefs. Typically, they argue that moral
 There are many forms of deontological behaviors such as kin altruism, reciprocal
theory, but what they have in common is the altruism, feelings of sympathy, and
determination that the action is morally right consolation are evolutionary traits that have
if and only if it conforms to one’s moral duties contributed to human survival.
and obligations.  The use of the natural law theory can either
 One of the earliest and most prevalent forms be right or wrong. The use of natural law is
of deontology is known as “divine dependent on person’s intention.
command” theory. In this theory, the duties  E.g., of mis-use of natural law: man is for
and obligations that are to be followed are procreation, therefore any man can
those that have been given to people by procreate to any woman as long as they will
God. Most adherents to this theory do not bear offspring.

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HEALTH CARE ETHICS NU MANILA
LECTURE: Theories and Principles of Health Ethics (Week 1)
DATE OF LECTURE: - - -
TEACHER: Dr. Anna Katharina G. Peña

Examples of why natural law is rightfully used: Examples of Divine Command Theory
 Drunkenness is wrong because it injures the
health and worse, destroys one's ability to 1. Orthodox Church has a very strong pro-
reason, which is fundamental to man as a life stand. Orthodox Jewish patients often
rational being. taking a more stringent interpretation of
 Theft is wrong because it destroys social God’s command to respect and
relations, and man is by nature a social preserve life.
animal. 2. Jehovah’s Witnesses, although agreeing
with the duty to respect and preserve life,
Kantian Ethics claim that there is a higher duty, given by
divine command, not to ingest blood,
 Morality is only possible in a community of and therefore refuse blood transfusions
beings that possess the natural attributes of 3. Even people who do not identify with a
rationality and free will. Thus, we cannot justly particular religious’ tradition may have
hold someone responsible for his/her actions their own sense of what God requires of
unless that person can know right from them.
wrong; and unless that person is capable of
doing right and avoiding wrong. Knowing Reflecting on the work of Immanuel Kant:
what’s right or wrong is different from doing o Kant believed that all moral duties and
what’s right or wrong. obligations could be determined through the
 For Kant, and all deontological theorists, the application of practical reason
morality of human action cannot be o Kant’s view, apply our powers of reason to
separated from intent. Morally good actions ascertain which rules of obligation we should
arise out of good intentions and morally bad act on.
actions arise out of bad intentions. o according to Kant, we must act in
 E.g., The head hunters: since they are accordance with our obligations, which are
capable of knowing right from wrong governed by rules.
therefore they are ethically wrong. But if a o Kant provides us with a formula for
special child commits something bad, then determining which rules (or maxims, as he
he is not liable of his/her action. calls them) are a valid reflection of our duties
 Immanuel Kant (1724–1804) is the central and obligations
figure in modern philosophy. He argues that o This formula, or test, is called the “categorical
the human understanding is the source of the imperative.” It is also known as the
universalizability criterion: “Act only on that
general laws of nature that structure all our
maxim by which you can at the same time
experience; and that human reason gives
will that it should become a universal law.” In
itself the moral law, which is our basis for colloquial terminology, “We should act only if
belief in God, freedom, and immortality. we can desire that all others act in the same
Therefore, scientific knowledge, morality, way”.
and religious belief are mutually consistent
and secure because they all rest on the same Application of Immanuel Kant’s formula,
foundation of human autonomy, which is “Categorical imperative or universalizability
also the final end of nature according to the criterion” in the health care and medical settings:
teleological worldview of reflecting
judgment that Kant introduces to unify the o First criterion, the categorical imperative
theoretical and practical parts of his requires us to test this action to see whether,
philosophical system. in doing so, we would be appropriately
discharging our obligation to the patient.

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HEALTH CARE ETHICS NU MANILA
LECTURE: Theories and Principles of Health Ethics (Week 1)
DATE OF LECTURE: - - -
TEACHER: Dr. Anna Katharina G. Peña

o Second criterion of the categorical sometimes refer to as the “institution of

imperative is that no person should be medicine.”
treated merely as a means but, rather, as an  The patient, family’s patient, community
end. of people directly involved with the
patient’s care, health care institution,
Kantian ethics has become almost synonymous and society in which the patient lives.
with deontology. This is evidence of the strong These are roles, norms, and expectations
impact that it has had on ethical theory in general derived from this community that have
and medical ethics in particular. It is very common to serious implications for how health care
find this sort of reasoning in articles about medical providers should conduct themselves in
ethics and even in the way health care providers talk the practice of medicine. Professional
about their obligations toward patients. associations play an important part in
disseminating this information and
Feminist Ethics conducting public discourse on the
evolution of standards and practices.
 Much of the work of daily living revolves
 Communitarians claim that, just like
around people and relationships, and
everything else, moral principles, rules,
because morality is about how we
and customs are derived from the
understand the world and how we should
community itself.
act in it, we need to look to these
relationships and associated values to
understand morality.
 When one is in a relationship with another it is
expected that each party will give special
consideration to the needs of the other over
the needs of people in general.
 There rarely exist relationships between two
people or groups with absolutely identical
strengths and weaknesses
 Health care provider–patient relationship
 Being open to and responsive to the needs
of others with whom we have a relationship
has been termed an “ethics of care” even
though it is not a full-fledged ethical theory.
 Feminist theorists have suggested that
another way of being moved to moral action
is through the emotions. Thus, our emotions
may help us to recognize what people and
situations are in need of moral consideration.

Communitarianism
 All people and principles owe their
existence to and are partly constituted
by a community or group of
communities. Thus a community, or
nested set of communities, is integral to
the identity of all people.
 In medical ethics, communitarians
emphasize the importance of taking
seriously the community that we

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