Transcript What do you think about these different types of justice? Are some

An Introduction to Ethics
Paul Snelling
& Kate McMahon-Parkes
Exercises in RED
Definitions
Moral philosophy is …enquiry about norms
and values, about ideas of right and wrong,
and what should and should not be done.
Raphael 1994
A moral or ethical statement may assert that
some particular action is right or wrong or
that actions of certain kinds are so.
Mackie 1977
Three senses of Ethics
•Personal ethics
Edwards 1996
• may be intuitive / ‘gut feeling’
•e.g. what do you feel about abortion, euthanasia etc?
•What has contributed to these beliefs?
•Group ethics - Ethical codes eg NMC
•May conflict with personal ethics. E.g. The NMC directs us
to respect the wishes of a pregnant woman over the rights of
her unborn child. So a mother with a full term pregnancy
could refuse treatment which could then result in the baby
dying. How would you feel if you had to care for such a
patient? Why?
•Philosophical ethics – e.g. deontology, utilitarianism
Ethical approaches linked to
Healthcare
• Kant (1724-1804).
• Person /individual based
– Believed in duty (Deontology)
– Constant conflict between what we should do and
what we want to do
– If something is wrong for one person, it is wrong for
everyone (categorical imperative)
• Eg if killing or lying is wrong for me, it is wrong for everybody
– Argued that a bad means does not justify a good
end.
– Strong emphasis on autonomy and individual rights
Example of Kantian approach
An axe murderer is chasing James.
You let James hide in your house.
If the axe murderer asks you if James is
hiding in your house, according to Kant,
you would tell him ‘yes’…..
But WHY?
Example of Kantian approach cont
Why would you tell the axe murderer where James is?
Because…..
a) Lying is wrong
b) Because a bad means (i.e. lying) does not justify a good
end (i.e. saving James)
c) Because it is the axe murderer’s responsibility to ‘do the
right thing’. An autonomous agent must be able to make
his own choices.
Does this approach work?
Sometimes? Never? What do you think?
Ethical approaches linked to Healthcare 2
• Jeremy Bentham (1748-1832) & John
Stuart Mill (1806-1873)
• ‘Utilitarianism’ or ‘consequentialism’
• Bentham created “felicific calculus”
(happiness sums) to calculate what
would produce maximum pleasure and
minimum pain for the most people.
• Mill amended the approach to the
‘greatest good’ rather that the ‘greatest
pleasure’
• Motives not important; the outcome is
what is matters
• A bad means justifies a good end
The stuffed body of Bentham is kept
in University College London,
where he is occasionally allowed to
take part in college council votes!
If a utilitarian were to decide upon an action, they would
possibly do a happiness sum to help them decide (bear in
mind they will usually carry out an act that gives the
greatest happiness to the greatest amount of people).
Presume the greatest happiness is +2, and the greatest
unhappiness is -2.
Given the above, if a utilitarian was sent to kill Hiltler,
would he do it, and if so, why?
If Kant (a deontologist) was sent to kill Hitler,
would he do it?
• A utilitarian or consequentialist would probably decide
that according to his sums, millions of people would be
moderately or very happy if Hitler died, and only a few
would be unhappy (including Hitler himself).
Consequently, he would kill Hilter, as in this case, a bad
means (i.e. murder) justifies a good end (happiness of the
population and possibly saving of countless lives).
– Demonstrates the greatest good for the greatest amount of
people
• However, Kant (a deontologist) would not kill Hilter as
killing is wrong, and a bad means (killing) does not
justify a good end.
• You can see from this case that applying a different
approach to the same question can come up with very
different conclusions
4 Principles approach (Beachamp & Childress 2001)
•Autonomy
•Nonmaleficence
•Beneficence
•Justice
“Our four clusters of principles do not constitute a general moral
theory. They provide only a framework for identifying and
reflecting on moral problems”
Beauchamp and Childress 2001, page 15
In considering the above principles, you may also think about
how the utilitarians and deontologists would look at each of
them
Respect for Autonomy (1)
Personal autonomy is, as a minimum, self
rule that is free from both controlling
influences and from limitations such as
inadequate understanding that prevent
meaningful choice.
Two essential elements are
(1) liberty - no controlling influences
(2) agency - capacity for intentional action
Respect for Autonomy (2)
Has both positive and negative
obligations
Negative - Autonomous actions should not be
subjected to controlling constraints by others
Positive - Respectful treatment in disclosing
information and fostering autonomous
decision making
Non-maleficence
An obligation to do no harm - Primum non
nocere.
One ought not to inflict evil or harm
One ought to prevent evil or harm
One ought to remove evil or harm
One ought to do or promote good
Frankema 1973
Non-maleficence
Doctrine of Double Effect
Allows an “evil” to occur as long as it is not intended.
•The (good) act to be done considered it itself and apart from
its consequences must not be intrinsically wrong
•Given both a good and an evil effect of an act the evil must
not be intended but simply tolerated or permitted
•The good must be desirable enough to offset permitting the
evil
•The evil effect must not be the means of bringing the good
effect
Doctrine of double effect
• e.g. a terminally ill patient is in unbearable pain. She is on
20 mg diamorphine per hour. A dose of 21mg will control
her pain BUT will also result in her death.
• Doctrine of double effect will allow you to give the fatal
dose as your intention is to relieve the pain, not to kill the
patient.
This stems from the case of Dr Bodkin Adams who was
accused of murder in 1957 (he had given a dying patient a
fatal dose of opiates in order to control her pain). Courts
findings were that he was“…entitled to do all that was
proper and necessary to relieve pain and suffering even if
the measures he took might incidentally shorten life by
hours or even longer.”
(www.BMA.org accessed 2005)
• If you intended to kill the patient (even with
the good motive of relieving the pain), how
would British law view your act?
• Intentionally killing, even if the patient has
requested it, and even if it is in their best
interests is still murder (in British law)
Beneficence
A requirement to contribute to
the welfare of others
Two principles
•Positive beneficence - doing good
•Utility - balancing benefits and
drawbacks
Justice (1)
•Distributive justice (e.g. share equally)
•Retributive justice (e.g. ‘punish’ those who have
‘done wrong’)
Formal Principle of Justice (after Aristotle)
“Equals must be treated equally, and
unequal must be treated unequally”
Justice (2)
•To each person an equal share
•To each person according to need
•To each person according to effort
•To each person according to contribution
•To each person according to merit
•To each person according to free market exchanges.
What do you think about these different types of justice? Are some people
more or less ‘deserving’ of healthcare? What are the implications of this?
e.g. 2 people need a liver transplant. One is a businessman who has paid
huge amounts of tax, and has liver failure due to excessive alcohol
consumption. He has already had one transplant. The other is a disabled
teenager who is does not work, and is unlikely to be able to do so; she
has cancer of the liver. Who should receive the liver?
Challenges to the Principle Based
Approach
•Too simplistic
•Too complicated (!)
•Overvalues autonomy
•Takes no account of other cultures
•Doesn’t actually tell you what to do.
How do we solve our moral dilemmas?
We analyze them,
reflect on them,
weigh up the options
justify them
There is no magic formula!