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  1. Chapter Two Theories and Principles Yuanyuan Dong 2007-9-4

  2. Moral Theory • Moral Philosophy include the sub-disciplines: • 1. normative ethics • Which is the study of moral standards, general principles, concepts, values, and theories. • 2. applied ethics • Which is the study of ethical dilemmas, choices, and standards in various occupations, professions, concrete (particular, not general) situations, and the application of moral theories and concepts in particular contexts. Such as “medical ethics” have mentioned above. • 3. meta-ethics • Which studies the nature and justification of moral standards, values, principles, and theories and the meaning of moral concepts and terms. Such as “is morality objective?” and “why should we obey moral obligations?”

  3. A Key concept: Commonsense Morality • “Commonsense morality” is a key concept of moral philosophy. Each person in society gets exposed to a commonsense morality. This morality consists of a wide variety of standards of conduct, duties, obligations, values and principles that come from disparate sources, such as parents, teachers, peers, religious leaders, professionals, literature, music, the media, and so forth. Ethicists call these standards a “commonsense morality” because they are the norms that most people learn and practice without any explicit theorizing or deeper analysis.

  4. Some of these commonsense morals include principles like “do unto others as you would have them do unto you”, “keep your promises”, “be fair”, “always do your best”, and so on. Some of these commonsense values include happiness, honesty, justice charity (or kind), courage, integrity , community, love, knowledge, and freedom.

  5. After using moral theories to change commonsense morality, we can then revise those theories so that they cohere with this new database. This process of revising commonsense morality in light of theory and vice versa can continue indefinitely, and is known as the method of wide reflective equilibrium. Most ethicists believe that this method provides the best way of justifying moral theories.

  6. Different Kinds of Moral Theories • Philosophers and theologians have defended a wide variety of moral theories, each with its own particular slant on morality: • Some theories emphasize individual rights and dignity; others emphasize the common good. • Some theories are secular; others are religious. • Some theories focus on obligations and duties; others focus on virtues and character. • Some theories establish moral ideals; others settle for practical principles. • Some theories assess consequences in judging actions; others assess motives. • Some theories are human-centered; others place human beings in a larger ecological framework.

  7. Different Theories • In here, beyond the textbook, I want to provide brief summaries of some of the most influential ones nowadays in the west. • 1. divine command theory • 2. utilitarianism • 3. natural rights theory • 4. natural law theories • 5. social contract theory • 6. virtue approaches theory • 7. the ethics of care • 8. the deep ecology theory

  8. Utilitarianism • Utilitarianism is often summed up as doing ‘the greatest good for the greatest number.’ • It is a consequentialist theory as it holds that the outcomes(that is ,the consequences) of an action are most morally important component of that action. • It is based on a single principle: the principle of utility. • It is founded by Jeremy Bentham(1748-1832) and John Stuart Mill(1806-73).

  9. What is utility? • Bentham and Mill thought that utility was pleasure or happiness. • Other utilitarians include values such as friendship, knowledge, health and beauty. • Still others believe that the concept of utility is best applied to the satisfaction of preferences rather than any instrinsic values.

  10. Which holds that we should act in such a way that we produce the greatest balance of good/bad consequences (or utility) for all people in the long run. There are two types of utilitarianism: act-utilitarianism and rule-utilitarianism.

  11. Act-utilitarianism holds that individual actions should maximize utility. • Rule-utilitarianism holds that actions should be based on a system of rules that maximize utility. (Do not lie.)

  12. The disadvantage of utilitarianism • Is it right to let one patient die in order to harvest their organs and perhaps save five lives? • The maximizing principles demands that not only should we donate blood and bone marrow as often as we can ,but also that we may well be morally obliged to donate one of our kidneys as well. • A small increase in pleasure for the majority will override a vast degree of pain for minority.

  13. German philosopher Immanuel Kant’s view • According to a view developed by Kant, one should always treat rational beings as having intrinsic value or worth, not as mere instruments or objects having only extrinsic value. • Kantianism also holds that moral standards should be universalize- able: moral principles are rules that would be followed by all rational beings with a good will. (A person with a good will is motivated by the desire to do her duty’s sake.) • For Kant, actions must be done for the right reasons in order to be worthy of moral praise.

  14. Kantianism implies that individuals should not be sacrificed for the common good, that we have moral duties that do not depend on the consequences of our actions, and that motives matter in assessing the morality of human conduct.

  15. Act only on that maxim through which you can at the same time will that it should become a universal law. (We should behave in such a way that we can imagine everyone an behave.) (steal, lie) • We should never treat people ‘simply as a means but always at the same time as an end’. (Treating individuals as an ‘end’ not just a ‘means’. All people are equal and deserve equal.)

  16. The disadvantage of Kantianism • It depends on freedom of will and rationality. • Moral rules are absolute-that is they can’ be broken. • The moral rules can seem quite abstract and unable to deal with the complexities of real-life ethical dilemmas. • Two duties may conflict, so what happens then?

  17. The natural rights theory • Like Kantianism, this theory emphasizes that importance of individual rights and freedoms. • According to this view, all people have natural rights to life, liberty, and property, and everyone in morally permitted to do anything they wish provided that their actions do not violate the rights of other people.

  18. Natural law theories • Which hold that morality is founded on human nature: if an action has a basis in our natural instincts, emotions, or social relations, then it is right; if an action goes against our natural instincts, emotions, or social relations, then it is wrong. • Natural law theories also maintain that we should strive to produce or achieve natural goods and eliminate or avoid natural evils. • Natural goods include life, health, and happiness.

  19. Social Contract Theory • Social contract theorists propose that morality consists of a set of rules that we agree are important to regulate society. In justifying moral rules, social contract theorists imagine people as existing in a state of nature prior to the formation of society. In order to live well, people must cooperate; and in order to cooperate, they need some rules for conduct. These rules are the rules of morality, politics, and the law.

  20. The Ethics of Care • A theory inspired by feminist approaches to morality, rejects traditional approaches to ethics on the grounds that they place too much emphasis on duties, rights, and justice. Such traditional theories are too abstract, legalistic, and uncaring, according to this view of feminist. • The ethics of care holds that our main task in life is to love and care for ourselves and other people. We should cultivate loving and caring relationships in our conduct instead of relying on abstract concepts and principles. • In some ways, the ethics of care provides a modern rendition of Jesus’ instruction to love your neighbor as you love yourself.

  21. The Deep Ecology Theory • Which approach to morality is unlike all the other approaches to ethics in that it is not human-centered. • Human-centered moral theories frame important questions about nature in terms of human interests, rights, obligations, and so on.

  22. The Deep Ecology Theory • Deep ecologists hold that human-centered ethics cannot adequately deal with moral issues involving other species, the land, ecosystems, the atmosphere, and oceans, since there are values in nature that are independent of human interests or rights. Thus, an ecosystem is worth preserving because it has intrinsic, moral value, not because we happen to value it for its economic or social uses. Animals have rights, according to this theory, because they also have intrinsic moral worth and not mere instruments for the promotion of human interests.

  23. From many philosophers’ views • Many philosophers who study applied ethics prefer to work with general, ethical principles rather than moral theories because one can use principles to support an ethical decision or a social policy without defending an entire moral theory. • Another reason for employing general principles is that they are easier to understand, to teach and learn than moral theories. • Finally, since principles are expressed in very general terms, they can be applied to a variety of cases and interpreted in different ways. This kind of flexibility allows one to apply principles to diverse cases without ignoring important details.

  24. Some of these basic moral principles are as follows: • Non-malignance: Do not harm yourself or other people. • Beneficence: Help yourself and other people. • Autonomy: Allow rational individuals to make free, informed choices. • Justice: Treat people fairly; treat equals equally; unequals unequally. • Utility: Maximize the ratio of benefits to harms for all people. • Fidelity: Keep your promises and agreements. • Honesty: Do not lie, defraud, deceive, or mislead. • Privacy: Respect personal privacy and confidentiality.

  25. The four Principles • Autonomy • Beneficence • Non-maleficence • Justice

  26. 1.Autonomy • The principle of respecting the decisions made by those capable of making decisions. • It refers to an ability: 1)to reason and think about one’s own choices 2)to decide how to act 3)to act on that decision ,all without hindrance from other people

  27. Autonomy is more than simply being free to do what one wants to do. (animals) • In respecting a person’s autonomy we recognize that they are entitled to make decisions that affect their own lifes.

  28. In health care respecting people's autonomy has many prima facie implications. • It requires us to consult people and obtain their agreement before we do things to them - hence the obligation to obtain informed consent from patients before we do things to try to help them. • Medical confidentiality is another implication of respecting people's autonomy.

  29. Respect for patients' autonomy prima facie requires us, therefore, not to deceive patients, for example, about their diagnosed illness unless they clearly wish to be deceived . • Telling the truth about terminal cancer?

  30. 2.Beneficence and non-maleficence • Beneficence is the principle of doing ‘good’ In the medical context, this generally means improving the welfare of patients. • Non-maleficence involves ‘not harming patients’, or ‘above all, do no harm’. • There is often confusion about where non-maleficence ends and beneficence begins.

  31. One way of looking at the two is to think of non-maleficence as a duty towards all people, whereas beneficence ,as we can’t help everyone, is a duty we choose to discharge on specific people. • Medical staff, by accepting a patient, have chosen to act beneficently towards that patient. • Similar to the principle of utility.

  32. 3.Justice • The principle refers to the allocation or distribution of resources amongst the population. • It demands the fair treatment of ‘equals’ within the health-care system. • What is fair and equal distribution?

  33. Equality-Each person receives an equal share of the resources available. • Need-Each person receives resources appropriate to how much that person needs. • Desert-Each person receives resources according to how much they deserve them (in terms of contribution, effort or merit.) • Desire-Each person gets what they want

  34. What should we do when these principles conflict? • These principles should be viewed as guidelines for conduct rather than hard and fast rules. • We should follow these principles in our conduct but exceptions can be made when they conflict with each other or with other standards. When two principles conflict we may decide to follow one principle instead of another.

  35. Moral Choices • We make choices very waking moment of our lives. Some of these choices are trivial or nor important; others are profound or important. Some choices are informed by personal preferences, tastes, or mere whimsy. Others are based on standards of conduct. • Standards of conduct can regulate our actions by providing guidance for many of the choices we face in living. • But, It is not easy to follow standards of conduct all of the time since they often conflict with each other or with our personal interests. • People often violate accepted ethical or moral standards for personal gain, but we usually label such actions as immoral and selfish and we disapprove of such conduct.

  36. People often must choose not between ethics (or morality) and self-interest but between different moral, ethical, legal, political, religious, or institutional obligations. In these circumstances, the key question is not “should I do the right thing?”, but “what is the right thing to do?” These problematic choices are known as ethical (or moral) dilemmas. Thus, an ethical dilemma is a situation in which a person can choose between at least two different actions, each of which seem to be well supported by some standard of conduct. These choices may be between the lesser of two evils or the greater or two goods. Sometimes these choices involve two different ethical standards.

  37. For example, when ask to give our opinion of someone’s cooking we may decide to be less than completely honest in order to avoid harming that person. • Since conflicts among various principles and standards can arise, we must frequently exercise our judgment in deciding how we should act. In order to exercise our judgment, we need to understand the particular features of a given situation. Thus, there is an important sense in which ethics are situational: although some general , ethical principles should guide our conduct, we need to base our decisions and actions on the facts and values inherent in particular situations.

  38. The Oath of Hippocrates • You do solemnly swear, each by whatever he or she holds most sacred .That you will be loyal to the Profession of Medicine and just and generous to its membersThat you will lead your lives and practice your art in uprightness and honor , That into whatsoever house you shall enter, it shall be for the good of the sick to the utmost of your power, your holding yourselves far aloof from wrong, from corruption, from the tempting of others to vice

  39. The Oath of Hippocrates (continued) • That you will exercise your art solely for the cure of your patients, and will give no drug, perform no operation, for a criminal purpose, even if solicited, far less suggest itThat whatsoever you shall see or hear of the lives of men or women which is not fitting to be spoken, you will keep inviolably secretThese things do you swear. Let each bow the head in sign of acquiescence And now, if you will be true to this, your oath, may prosperity and good repute be ever yours; the opposite, if you shall prove yourselves for sworn.

  40. Principles of medical ethics • Preamble • The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. As a member of this profession, a physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self. The following Principles adopted by the American Medical Association are not laws, but standards of conduct which define the essentials of honorable behavior for the physician.

  41. Ⅰ A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights. Ⅱ A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.

  42. Ⅲ A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient. Ⅳ A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law.

  43. Ⅴ A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated. Ⅵ A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.

  44. Ⅶ A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health. Ⅷ A physician shall, while caring for a patient, regard responsibility to the patient as paramount. Ⅸ A physician shall support access to medical care for all people. Adopted by the AMA's House of Delegates June 17, 2001.