Transcript Moral Theories

Some Moral Theories & Principles of
Ethics [related to human research]
Retha Britz
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Retha Britz Copyright 2011 All
rights reserved for this
presentation
Ethics is:
 Study of the concepts involved in practical
reasoning- “good” vs “bad” & “right” vs “wrong”
 Submit actions to the measure of obligation (duty
e.g. duty to respect)
 How we ought to do/behave [in certain situations]
being moral beings
 Reasons for the behaviour
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Research ethics based on philosophical
ethics
[Competing] moral theories
Outcome of a particular ethical view depends
on the ethical perspective from which it is
viewed
Some theories relevant to [human]
research:
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Deontology
Utilitarianism
Principle-based ethics
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Autonomy
Beneficence
Non-maleficence
Justice
Ethics from an African Perspective
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ubuntu
Deontology
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Characteristics of actions make actions
morally right or wrong
Relationship between one’s duty and
morality of actions are directly related (act
with the right motive/intention = good will as
far as in our control)
Kantianism is leading deontological system
Deontology (continue)
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Dominated medical ethics and western medicine
for many centuries
source of biomedical
ethics
Kant:
 humans have a special place in creation
 humans are rational beings guided by reasoning
rational/reasoned choices to distinguish between
right and wrong
 Humans have intrinsic worth i.e. dignity because
they are irreplaceable
 Dignity ought to be respected
Deontology (continue)
Actions ought to comply with definite moral rules to
obtain moral status
Categorical Imperative
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“Act only on the maxim through which you can at
the same time will that it becomes a universal
law”
“Act in such a way that you always treat humanity,
whether in your own person or in the person of
any other, never as simply a means but always at
the same time as an end”
Categorical Imperative in practice
× Universality: Researcher not happy with
results then deliberately falsifies data –
scientific results would be untrustworthy
× Means to an end: No IC - pt used as a mere
means to researcher’s end
IC - pt makes research objectives his/her own
when consenting then pt is not mere means
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Consequentialism - Utilitarianism
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Concerns actions that makes the world as content
(happy) as possible
Consequences of actions are the only guide to
determine moral status of actions
Bentham & Mill conceived utility in terms of
happiness/pleasure/good. Morality is not about
pleasing God and being faithful to inflexible, abstract
rules
Outcome of actions is all that matters
Utilitarianism (continue)
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Numbers and amount of happiness counts
All else is irrelevant
Morality is about the bigger population - not
the individual (each person’s happiness is equally important)
Research is justified if strong likelihood that it
would contribute to the improvement of
human condition
Are consequences all that matter?
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Consent vs no consent
Principle-based Ethics
Beauchamp & Childress: 4 Prima Facie Principles
 Autonomy
 Beneficence
 Non-maleficence
 Justice
Prima Facie: Principle is fulfilled unless it conflicts with an equal or stronger
principle which results in a moral dilemma
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Kantian deontology implies people ought to act with
beneficence towards others, promote well-being of
others, respect others’ rights and avoid harm (nonmaleficence)
Autonomy
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Being able to make decisions for oneself about the
way one wants to lead his life and actioning of those
decisions (Gillon, 1994)
Based on Kant’s view of intrinsic worth
Others to be treated as ends in themselves and
never merely as a means
Giving the pt > balance of power in decision making
Traits of autonomy: understanding, reasoning,
deliberating and independent decision making
informed consent
Autonomy (continue)
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Understand to a degree and to a degree no
controlling influences or coercion e.g. buying
a car
Pt’s prior expressed preferences (if known)
should be honoured
An emotionally stable surrogate
Autonomy is accepted by most people
although in a heavier or lighter way
For the sake of morality autonomy is very
precious
Beneficence
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Beneficence and non-maleficence are seen as
basis for paternalistic views (Hippocratic belief)
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This paternalistic idea of beneficence changed
over the last century as values have changed
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Moral obligation to act for the benefit of others
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If all things being equal, determine the good in a
specific situation (e.g. whatever will further the
pt’s interests) and balance the good against the
risks of actions (e.g. risks of participating)
Beneficence (continue)
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Active principle which requires a degree of
sacrifice to be fulfilled on the part of the
moral agent with some degree of risk
included for e.g. pt trusts researcher with confidential
information
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When trying to do well, there may be a risk
present to possible harm
What constitutes benefit for one pt may be
harmful for another. Therefore beneficence
should overlap with autonomy
Beneficence (continue)
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Beneficence is exercised when attempting to
benefit people with as little harm (inconvenience)
as possible e.g. travel reimbursement
Beneficence is sometimes competing with
the principle of respect for autonomy
Sometimes beneficence is incorporating the
pt’s autonomous choices
Non-maleficence (NM)
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If all things are equal NM is to avoid harm to
other people & what would be against their
interests (produce more harm than good)
Moral rules that support NM is do not kill,
incapacitate, cause distress, pain or suffering
Difference between NM (avoiding positive harm)
and B (the demand for positive benefit)
Non-maleficence (continue)
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Passive principle which requires no action on
the part of the moral agent for e.g. not
pushing someone into a swimming pool
“First do no harm” = NM
Should each and every risk be disclosed to
pts as part of the informed decision-making
discussion?
When conflict between the principles of NM &
B, the principle of NM usually outweigh the
principle of B e.g. harvesting 2 kidneys from
almost dead person
Non-maleficence (continue)
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Risk of harm to society needs to be taken
into account - the principle of NM outweighs
autonomy e.g. a pt in the community with TB
who is non-compliant in taking medication
regularly. This pt poses an infective risk to
the public and a risk to become multi-drug
resistant
Justice
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Benefits to be distributed impartially and
fairly
Moral obligation to act on the basis of fair
settlement between competing claims
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4 Principles should be balanced against each
other to determine which weighs heavier
Principles in conflict should be balanced to
find equilibrium (which can change)
Ethics from an
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African thinking didn’t develop independently
from western influences.
Many current-day African philosophers were
trained in the West and teach the philosophy
that they learned
Africans are human beings and as such
irrespective of hx and circumstances holds
views about right and wrong (that are often
exactly the same as those of just about all other
people)
Ethics from an
(continue)
Universal beliefs (Africans & Westerners):
Uncontroversially pro tanto immoral:
 To kill innocent people for money
 To have sex with someone without her
consent
 To deceive people (at least when not done in self or
other defense)
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To steal unnecessary goods
To violate trust (e.g. to break promises for marginal
personal gain)
Ethics from an
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To discriminate on a racial basis when
allocating opportunities
To insult people without good reason
Ubuntu Morality
The principle that an action is right insofar as it
respects harmonious relationships. An action is
right insofar as it produces shared selfhood
among people grounded on good-will (Metz)
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“A person is a person through persons”
“Each person’s identity as a human being is causally
and even metaphysically determined by and
depends on a community”
An act is wrong to the extent that it fails to do so and
tends to encourage the opposites of division and illwill
Also
 To do unto others what you would not want done
unto you
 Immoral to show disrespect for the aged (Wiredu)
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An action is right insofar as it:
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Respects a person’s dignity (wrong if degrades humanity)
Promotes the well-being of others (wrong when fails to
enhance welfare of one’s fellows)
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Promotes the well-being of others without violating
their rights (wrong when violating rights)
Realises oneself by + engaging with others (wrong if it
does no perfect one’s valuable nature as a social being)
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In solidarity with groups whose survival is threatened
(wrong if it threatens a community’s way of life)
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Enhances the togetherness in the community (wrong if
it reduces harmony and produces discord)
In a sense Kantian deontology supersedes all
competing theories due to its abstractness
But abstractness with no exception therefore
sometimes impractical. It is not consistently and
coherently possible to defend one single moral
theory
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Other theories are Virtue Theory, Social Contract Theory,
Liberal Individualism, Communitarianism, Ethics of Care
etc etc
Bibliography
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BEAUCHAMP, T.L. & CHILDRESS, J.F. 2001. Principles of biomedical ethics. 5th ed.
Oxford: University Press. 454 p.
GILLON, R. 2003. Ethics needs principles – four can encompass the rest – and respect for
autonomy should be “first among equals”. Journal of biomedical ethics, 29(5):307-311, Oct.
GILLON, R. 1994. Principles of biomedical ethics. British medical journal, 309(6948):184185, 16 Jul.
HEUBEL, F. & BILLER-ANDORNO, N. 2005. The contribution of Kantian moral theory to
contemporary medical ethics: a critical analysis. Medicine, health care and philosophy, 8:515.
MOODLEY, K. 2011. Respect for patient autonomy. (In Moodley, K., ed. Medical ethics,
law and human rights. Pretoria:Van Schaik publishers. p. 41-56.)
RACHELS, J. & RACHELS, S. 2010. The elements of moral philosophy. 6th ed. New
York: McGraw-Hill p. 122-172.
VAN NIEKERK, A.A. 2011. Ethics theories and the principlist approach in bioethics. (In
Moodley, K., ed. Medical Ethics, law and human rights: a South African perspective.
Hatfield, Pretoria.: Van Schaik Publishers. p.19-39.)
Activity: Case Study
Use the background information
discussed to identify the following:
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Main moral issue
Moral theories at stake
Possible solution