Transcript Ethics Key concepts - University of Otago

Louise Delany
Department of Public Health
University of Otago




Part 1: To place issues on patients’ rights
in their broad ethical context
So, what is ethics, where do ideas on
ethics come from, some central ideas?
I’ll identify some of the main ethical
approaches, key concepts, and theories
Part 2: Environmental concerns and
radiation ethics
Saturday, July 18, 2015
Louise Delany, Public Health. Otago
2
Louise Delany, Public Health.
Otago
Saturday, July 18, 2015
3




Ethics, values, principles, morals,
philosophy and law
Many of these concepts are used to mean
much the same: ‘she acted
ethically/morally” . Not always though..
In particular, law is based on values, and
may reflect ethical or moral principles.
But law is not the same as morality.
A law must be complied with, while an
ethical principle – that’s not in law ‘should’ be complied with. No binding
force.
Saturday, July 18, 2015
Louise Delany, Public Health. Otago
4

Ethics tries to answer the questions:
◦ What should I – and we as a society –
do?
◦ How ought I to live?

What matters, how best to live

Values are: ‘beliefs about what
matters” (Andrew Moore)
Saturday, July 18, 2015
Louise Delany, Public Health. Otago
5

Ethics is about being sceptical and
questioning. Ethics asks why.

Ethics is about imagining a better world and
cooperating with others to achieve it
Saturday, July 18, 2015
Louise Delany, Public Health. Otago
6
We decide if something is right or wrong
according to:
◦ Its consequences ‘the right thing to do is that
which will bring about the best consequences’
◦ The intrinsic nature of the possible course of
action: there are duties and rights which are
important, independent of consequences. The
status of moral rules comes from their intrinsic
reasonableness or rightness (or divine
command).
◦ What a good person , someone with the right
motivation, would do (virtue ethics).
Saturday, July 18, 2015
Louise Delany, Public Health. Otago
7
Saturday, July 18, 2015
Louise Delany, Public Health. Otago
8
Balance:
weighing up
what is best –
pros and cons
Limits: Are there
always some rights
you just can’t
jump over?
Internal compass:
perhaps what is
right is what a good
person would do in
the situation.
Louise Delany, Public Health.
Otago
Saturday, July 18, 2015
9




Hansson’s metaphors for these three approaches - or what
he calls ‘thought patterns’
The balance represents weighing. When we have several
actions we can choose, seems sensible to weigh up the
option with the largest net advantage, ie sum of advantages
minus sum of disadvantages
(consequentialism/utilatarianism)
The fence represents limits. There are certain boundaries you
just can’t cross. Lying is always wrong even if telling the truth
results in harm. (intrinsic moral duties and rights)
The compass represents orientation. “being ethical means
more than ... weighing or staying within given limits. An
ethical person should have an inner sense of moral
orientation.” (virtue ethics)
Saturday, July 18, 2015
Louise Delany, Public Health. Otago
10



Consequences of human action – is
good achieved by the act?
The act itself: intrinsic nature,
deontological theories – does the act
in itself satisfy an obligation or duty?
The agent or person doing the acting:
virtue theories – does the agent have
virtuous ways and reflect them in
action?
Saturday, July 18, 2015
Louise Delany, Public Health. Otago
11
◦ The consequentialist says: that depends.
◦ If stopping to help would improve the
person’s chances of living, and no
other bad consequences will occur,
then I should help.
◦ But if I am in charge of a very amateur
group of mountaineers, then on
weighing the balance of the overall
welfare of society with the welfare of
the sick individual - maybe leave him.
Saturday, July 18, 2015
Louise Delany, Public Health. Otago
12
◦ The response of a duties and rights
philosopher: person who acts on moral rules
based on intrinsic duties and rights will need to
know what those rules and therefore duties are.
This approach emphasises the worth and rights of
the individual, so maybe I should help. If duties
only owed to those who are fully conscious humans
(and this person is definitely vegetative by now), no
duty to help?
◦ The ‘virtuous person” It’s right to save the sick
mountaineer, because that is what a person with
the virtue of benevolence, motivated by real
concern for others, would do.
Saturday, July 18, 2015
Louise Delany, Public Health. Otago
13
◦ The main example of consequentialist theory is
utilitarianism (of which there are several brands).
◦ The ‘greatest happiness principle’: actions are
right insofar as they tend to promote the greatest
happiness of the greatest number, wrong as they
tend to promote the reverse” (Bentham/Mills)
◦ Concept of the greatest good for the greatest
number
◦ Future oriented
Saturday, July 18, 2015
Louise Delany, Public Health. Otago
14



Hard to work out the greatest good
in many circumstances – how do you
value and rank things which just
can’t be compared?
Which is best: 100 elective knee
operations or saving one critically
injured child from death?
Utilitarianism devalues individuals
and individual rights (because of
concern with majority good)
Saturday, July 18, 2015
Louise Delany, Public Health. Otago
15



Kant critiqued consequentalism: how can
something be morally right or wrong,
given that what happens as a result not
wholly under your control? Doing the right
thing may have disastrous consequences,
the wrong thing may have great results.
“Lying, stealing and murder are
intrinsically wrong; they cannot be made
right by their creation of happiness”
Central idea: people are ends in
themselves, who have values and goals
and make decisions. People must never be
treated as means to others’ ends.
Saturday, July 18, 2015
Louise Delany, Public Health. Otago
16



Human rights – and of course patients’ rights belongs to the ‘intrinsic moral duties and
rights’ tradition – the importance of human
beings as ends in themselves.
But some of the same problems: how do we
know what rights we humans have? The list
keeps changing. Societies differ. Can we even
say there is a ‘right to health’?
One school of thought was that human beings
have rights as part of their nature – natural
rights, we are born with them (or, maybe,
because God gave us them). Neither version of
this view is so fashionable these days.
Saturday, July 18, 2015
Louise Delany, Public Health. Otago
17



Disregarding consequences can produce
very strange results, not intuitive to
ignore them
How do we know what is ‘intrinsically’
right or wrong? Kant thought that the
most basic ideas of right and wrong are
universal. But societies differ, refusing a
blood transfusion for the dying child may
be only ethically right thing.
The individual, rather than community or
society as a whole, has too much focus.
Saturday, July 18, 2015
Louise Delany, Public Health. Otago
18



Emphasis on motivation has much
intuitive appeal. Eg giving a gift to a
friend right is good if you act on affection
– but giving out of a sense of duty, or
because of the consequences – not really
morally good?
Virtue ethics and acting on good
motivation often means that there is no
right answer – circumstances differ. The
virtuous person acting with general
concern for the other thinks through the
options. (eg sometimes telling a lie may
be right).
Virtue theorists stress relationship with
others
Saturday, July 18, 2015
Louise Delany, Public Health. Otago
19


The liberal/libertarian considers that
there is a very limited role for the state.
The state can only restrict people’s rights
if the ‘harm’ principle applies –
restrictions are justified to stop someone
from harming a third party.
Very influential in western political
culture
Saturday, July 18, 2015
Louise Delany, Public Health. Otago
20


The libertarian definitely doesn’t like
paternalism, defined by the libertarian as
when people in authority attempt to
restrict freedoms or influence behaviour
of others allegedly in their own best
interests.
Hence libertarians may see seatbelt laws,
or restrictions on tobacco promotion, as
paternalistic and to be opposed.
Saturday, July 18, 2015
Louise Delany, Public Health. Otago
21



This approach critiques liberalism’s
idea that the individual is allimportant. Perhaps even the idea of
the individual separate from social
context is not very meaningful
Important idea of common good, idea
of shared values, ideals, and goals of a
community
Communitarians emphasise the goods
that are held or enjoyed in common ,
eg clean air and water. These goods
are best obtained by collective action.
Saturday, July 18, 2015
Louise Delany, Public Health. Otago
22


This quick scamper through major
approaches in ethical thought does them
no justice!
Other ideas which enrich our thinking:
Māori perspectives and values; feminist
theories
Saturday, July 18, 2015
Louise Delany, Public Health. Otago
23

These ideas very influential in shaping the way
our society thinks, and our health disciplines
◦ Utilitarianism particulary clear in public health
ethics
◦ Bioethics particularly clear in clinical ethics, for
instance with stress on value of autonomy – hence
importance of informed consent, other concepts
fundamental to patients’ rights. And of course
research ethics


Utilitarianism and human rights thinking both
profoundly influential in thinking on radiation
ethics in a broad sense, going beyond
professional practitioner ethics.
Fundamental to recommendations and law on
standards, dose limits and exposures.
Saturday, July 18, 2015
Louise Delany, Public Health. Otago
24



Justification – connected both to idea that
benefits must outweigh risks, consequentialist
ideas, utilitarianism, the common good – the
balance. But can also be seen as acting with the
right reasons and motives (the inner compass)
Optimisation – linked also with ideas on weighing
and utilitarianism linked to respect for human
rights and ‘limits’
Dose limits: corresponds to the fence metaphor –
limits; linked to respect for human rights
Louise Delany, Public Health.
Otago
Saturday, July 18, 2015
25


Some risk of harm to some one is inevitable
(of course, hopefully miniscule)
The risks of harms, and the hope of benefits,
fall on different people and groups (more
risk, less benefit, for the health practitioner
than the patient)
Louise Delany, Public Health.
Otago
Saturday, July 18, 2015
26




Draws on the same philosophical roots as
Western ethical traditions in general
These include utilitarian concepts; and
Ideas that certain acts are right or wrong in
themselves
Virtue ethics get in there also somehow
Louise Delany, Public Health.
Otago
Saturday, July 18, 2015
27
A systematic account of the moral relations
between human beings and their natural
environment. Environmental ethics assumes
that moral norms can and do govern human
behaviour towards the natural world. A
theory of environmental ethics, then, must
go on to explain what these norms are, to
whom or to what human beings have
responsibilities, and how these
responsibilities are justified.
From Des Jardins (p 12)
Louise Delany, Public Health.
Otago
Saturday, July 18, 2015
28
 Anthropocentric
ethics
 Non-anthropocentric ethics
Louise Delany, Public Health.
Otago
Saturday, July 18, 2015
29


‘Intrinsic’ value versus ‘instrumental’ value
Example:
◦ An anthropocentric approach values a tree because
of its instrumental value – that is, the uses the tree
has as fuel or building material, or the beauty it
adds to the land where we live.
◦ While a non-anthropocentric person sees the tree
as having some sort of value in itself – maybe even
a right to exist, whether by itself or as part of an
ecological system.
Louise Delany, Public Health.
Otago
Saturday, July 18, 2015
30





Environmental ethics of the anthropocentric kind
fits well with health – because of the central values
about people.
Environmentalists and health workers join forces
on such issues as air quality, toxic wastes,
polluted water.
What about people who aren’t born yet?
Some anthropocentric approaches now take
account of future generations of people. Can be
fitted in to both utilitarian and rights-based ideas.
That is, future people ‘count’ in the weighing of
benefits and harms. Or future people have rights
just like present people.
Louise Delany, Public Health.
Otago
Saturday, July 18, 2015
31




More diverse
Some are concerned with animal rights
Biocentric views: life itself has intrinsic value.
Human beings are not inherently different or
superior to other living things
Ecocentric views go further than biocentric –
holistic. The concern should not be just life
and living things, but all natural objects:
rivers, mountains, ecosystems.
Louise Delany, Public Health.
Otago
Saturday, July 18, 2015
32

Deep ecologists are at one rather radical end
of the ecocentric spectrum! Some criticisms:
◦ Idea that deep ecologists are misanthropic and
fascist – with humans having no value greater than
others, and are a sort of cancer on the earth
◦ Idea that deep ecologists disadvantage people in
developing countries, western cultural imperialism.
Louise Delany, Public Health.
Otago
Saturday, July 18, 2015
33


The environment is increasingly recognised as important in
radiological protection, as seen in ICRP 103 (2007), certainly
more so than in 1990 recommendations.
In its 2007recommendations, ICRP indicates its intentions to
develop a clearer framework:
◦ ‘in order to assess the relationships between exposure and
dose, and between dose and effect, and the consequences
of such effects, for non-human species, on a common
scientific basis’.
◦ At this stage, however, ICRP does not propose to set any
form of ‘dose limits’ with respect to environmental
protection.
Louise Delany, Public Health.
Otago
Saturday, July 18, 2015
34



For the environment, it would seem that
ICRP sees a role for
‘consequentialist/utilitarian’ concepts,
but not perhaps a rights-based approach.
Not all environmentalists would agree with
this approach!
Louise Delany, Public Health.
Otago
Saturday, July 18, 2015
35






A new treatment for people with cancer has just been invented
– it’s 2015
The treatment has several major advantages: it is very safe to
use for the health practitioner, and is extremely effective, with
no major side-effects, for those it cures. Magical.
The main disadvantage is very high waste production.
Furthermore NRL has stopped taking radioactive waste
products for the foreseeable future, unfortunately due to more
seismic events (NB - this isn’t true!)
Storage of the waste products in very deep mine shafts in NZ is
the only practical solution
The waste will exist for thousands/millions of years, and is
very likely to seep into water systems, more general
ecosystems, with consequences for forests (well on track to
complete regeneration by 2080)
Following application for resource consent, a new
environmental group: ‘EARTH’ (Environmentalists Against
Radiological Toxic Harms) has just formed. A new health group
has also formed: ‘CURE’ (Clients Using Radiological Expertise)
Louise Delany, Public Health.
Otago
Saturday, July 18, 2015
36




Could each group of about 10-12 divide in two
Could one half of each group represent CURE, and the other half
represent EARTH
Please stick to assigned positions, justify reasons for position on ethical
grounds, come to some consensus and report back.
CURE people: what justifies an anthropocentric approach: why do sick
humans have more value than the trees and creatures they support
◦ Do trees and their creatures not ‘count’ (utilitarian language). Why/why not?
◦ Do trees and their creatures have ‘rights’ (rights language). Why/why not?


EARTH: do you take an anthropocentric or non-anthropocentric
approach? What justifies your positions? What counts for you, who has
rights, what should be protected – against what? Do you base your views
on instrumental or intrinsic values of the environment?
For both:
◦ What implications do the time scales have in this situation?
◦ Where do rights of future people come in? (or for that matter, future creatures)
Louise Delany, Public Health.
Otago
Saturday, July 18, 2015
37
Louise Delany, Public Health.
Otago
Saturday, July 18, 2015
38