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• KNUST ETHICS LEVEL -200

• ETHICAL PRINCIPLES AND MORAL OBLIGATIONS

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• Introduction

• This course introduces students to ethical principles and moral obligations in professions. Topics to be discussed include the principle for justice, respect for autonomy, truth telling or veracity, beneficence, non-maleficence, confidentiality, honor and fidelity.

• Objective

• The course is to equip students to assess and apply ethical and moral principles to life and work.

• Lessons

• 1. Definition of Ethical Principles

• 2. Significance and Purpose of Ethical Principles

• 3. Moral Obligations

• 4. Principle for Justice

• 5. Respect for Autonomy

• 6. Truth Telling or Veracity

• Beneficence and Non-Maleficence

• 8. Confidentiality

• 9. Conflict of Interest

• 10. Honor and Fidelity

• Mode of teaching

• Oral and PowerPoint presentation

• Selected References

• Bobonich, C., (ed) (2017) The Cambridge Companion to Ancient Ethics. Cambridge: University Press.

• Curry, P. (2011) Ecological Ethics. Cambridge: Polity Press.

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• Dimmock, M. and Fisher, A., (2017) Ethics for A-Level. Open Book Publishers.

• Holmes, Robert L., (1998) Basic Moral Philosophy (2nd Edition). New York: Wadsworth Publishing Company.

• Hospers, J., (1990) An Introduction To Philosophical Analysis. London: Routledge.

• Lazar, S. and Frowe, H., (2018) The Oxford Handbook of Ethics of War: Oxford Handbooks Series. Oxford: University Press.

• Marchetti, G. and Marchetti, S., (2016) Facts and Values: The Ethics and

• Metaphysics of Normativity. New York: Routledge.

• Mizzoni , J., (2017) Ethics: The Basics, 2nd Edition. Wiley.

• Opoku, J. K. and Manu E. (2017) Ethics: An Introduction to Ethical Systems and Approaches.Saarbrucken: Lap Lambert.

• Opoku, J. K. and Manu E. (2017) Understanding Bioethics: Principles and Moral Obligations in Healthcare Practice. Kumasi: Graduate Standard.

• Sinha, J., (2006) A Manual of Ethics. Kolkata: New Central Book Agency Ltd.

• LECTURE

• DAY 1:

Definition of Ethical Principles;

Significance and purpose of Ethical Principles

Moral Obligations

• DEFINITIONS OF ETHICAL PRINCIPLES ETYMOLOGY

• Ethics comes from the Greek word ‘ethos.

• Which means behavior;

• something Customary or Conventional;

• A Code of Conduct set aside for a particular people;

• Ethics, brought to the religious perception is known as “Morals”

• To be ethical, in the sense of ethos is to:

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• Conform to what is typically done,

• Obey the Conventions and rules of one’s society and religion.

• To be ethical, in the sense of ethos is to:

• Conform to what is typically done,

• Obey the Conventions and rules of one’s society and religion.

• Despite the general conviction of the existence of good and evil actions, our daily experience attests to the fact that what human beings actually ‘do’ is quite another thing.

• This contradiction has its roots in humans’ natural inclination to be Self-Centred, overstressing the self to the detriment of the Common Good.

• In ethical language that is called greed and selfishness.

• The quest for ethics, therefore, is a question for Genuinely Rational human actions, characteristic of cultivated or ‘civilized’ life.

• Ethical Principles

Ethics is concerned with Human Will, Action, and Responsibly.

Evaluating what is Right and what is Wrong.

On what grounds can we say an action is Right or Wrong

• Ethical Principles

Criteria:

Absolutism: a belief in universal moral standards.

Relativism: a belief that No moral standard exists universally.

• Ethical Principles

• Free will vs Determinism

• Free Will: Freedom to choose between actions

• Determinism: everything in the universe obeys unchanging physical laws.

• Incompatible vs Compatible

• Ancient Time:

• Normative: Obeying Norms

– Ancient Time:

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– Normative: Obeying Norms

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– Deontologism (Gk. Deon- Obligation, duty): Actions are good or bad according to a clear set of rules.

– Categorical Imperative- A moral law that is unconditional or absolute for all agents, the validity or claim of which does not depend on any ulterior motive or end.

– - Rights Theory-There are things that we cannot do against individuals because they are holders of moral rights. A right defends an interest that should not be frustrated.

– Modern & Contemporary Time:

– Consequentialism: the consequences of one’s conduct are the ultimate basis for any judgment about rightness or wrongness of that conduct. Thus, morally right act is one that will produce a good outcome, or consequence.

– Utilitarianism: a moral action is one that maximizes utility, or happiness for the greatest number of people

– Pragmatism: rejects the idea that there is any universal principle or universal value. It holds for ethical principles being social constructs to be evaluated in terms of their usefulness.

– Ethical Egoism: that moral agent ought to act in their own self interest,

• Ethics is concerned with the Respect and Promotion of the interests of all in personal interactions.

• Its role is to ensure that nobody’s interests be harmed, but possibly enhanced.

• As a branch of philosophy, ethics retains its place as ‘knowledge for knowledge’s sake,’ but attempting to determine what should be done.

• Ethics is concerned with the respect and promotion of the interests of all in personal interactions.

• Significance and Purpose of Ethical Principles

For Order to prevail, for if there is no order the society can easily be in chaos.

To promote Peace so as to have a Harmonious and Conducive Environment;

• To make Justice and Fairness available for the weak and strong, thus promoting justice and fairness;

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To uphold the dignity of individuals;

For good governance;

To identify what is right and what is wrong so as to do the right things and avoid the wrong things;

• Helps to differentiate between the Moral person and Immoral person;

• Helps to reward the good and punish the bad

• Helps to differentiate between different groups of people (e.g. Christians marry one and Muslims marry more);

• We need ethical codes to be clear about ethical issues (what does the law say?)

• A training in ethics should help one to see the defects in his own conduct and other people’s conduct.

• to appreciate the high moral standards one has and what other people have,

• to make suggestions to oneself and others.

• MORAL OBLIGATIONS

• The distinction between the terms “Ethics” and “Morality” is not always clear.

• Even in some philosophical texts/works both are used Synonymously, while others seem to draw a clear distinction between them.

• For the sake of clarity, we assume a standard definition that:

• Morality means the customs, the special do’s and don’ts that are shared and widely accepted as a standard in a society or community of people.

• These are accepted as a Basis of Life that doesn’t have to be rationally questioned.

• Ethics on the other hand is the philosophical Reflection upon these rules and ways of living together, the customs and habits of individuals, groups or mankind as such.

• The discussion on moral and non-moral actions occupies a very important place in the phenomenon of ethics since ethics is the study of the rightness and wrongness of a particular action done by an individual.

• Being the science of morality, it is within the purview of ethics to give an exposition of moral actions as distinguished from non-moral actions.

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• A Code of Conduct set aside for a particular people;

• Ethics, brought to the religious perception is known as “Morals”

• LECTURE DAY 2

• PRINCIPLE FOR JUSTICE

• The term “justice” Latin ius, meaning “right”

• “To be just” – is to be in a right relationship with others or well disposed towards another

• This ‘rightness’ towards others helps also in developing one’s character

• Practicing justice entails practicing nearly all other virtues

• An outstanding form of it is honesty, because to tell the truth is to treat others with the respect owed to them

• All justice entails communication, relating with others, either between two persons, between one and several persons, or between two groups of persons.

• The bottom line of justice is the ‘Golden Rule”

• Justice and prudence are like the two sides of a coin.

• Justice leans on prudence and counts on it, just as prudence counts on a person’s sense of justice in order to be effective

• The principle of justice could be described as the moral obligation to act on the basis of fair adjudication between competing claims.

• As such it is linked to fairness, entitlement and equality.

• The principle of justice obliges us to equitably distribute benefits, risks, costs, and resources

• The following arguments (rules) are supported by the principle of justice:

• 1. To each person an equal share

• 2. To each person according to need

• 3. To each person according to effort

• 4. To each person according to contribution

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• 5. To each person according to merit

• FORMS OF JUSTICE

• An ancient tradition recognizes three basic forms of justice corresponding to three natural social relationships:

• COMMUTATIVE – Justice between equals

• DISTRIBUTIVE –Justice between an authority and its subject members

• LEGAL – Justice from subject to authority

• Some authors add social justice –intending to stress social responsibility

• COMMUTATIVE JUSTICE

• As a regulator between equals, it is concerned with safeguarding personal rights and the lawful protection against such offences as theft, bodily harm, family or property infringements

• Deceit in all forms violates commutative justice, e.g. Defective working conditions, skimping on the amount of hours agreed upon.

• Commutative justice requires prompt payment for services rendered, like salaries , rent, commuter fares, taxes, completion of deposits for goods taken and used.

• All efforts at evading any rightful dues through trickery, forgery, impersonation etc

• DISTRIBUTIVE JUSTICE

• It regulates the mutual relations between an institution and its members

• It ascends from down upwards, and descends from up downwards.

• descending distributive justice- an institution or organization ought to ensure that individual members share justly in the common good

• Usually, distributive justice does not demand an equality of people, because people differ in their capacities, abilities, and educational and professional skills.

• But it demands a fair distribution of social benefits and burdens

• SOCIAL JUSTICE

• It is the notion that everyone deserves equal economic, political, and social opportunities irrespective of race, gender, or religion.

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• RESPECT FOR AUTONOMY

• The word autonomy is derived from the Greek words ‘autos’ which means self and “nomos” meaning law or rule.

• Autonomy thus, literally means self-rule

• Respect for autonomy is a norm that obliges us to respect the decision (self-determination) of adults who have decisions-making capacity

• For example in the case of individual adults, an autonomous person is someone who is capable of making a rational and informed decision on their own behalf, but it doesn’t mean that they have the right to do whatever they want or disobey laws and regulations.

• A person of diminished autonomy is in some respects controlled or governed by others, or incapable of deliberating or acting on the basis of his or her desires and plans

• Prisoners and mentally retarded individuals, for example, often have diminished autonomy.

• Autonomy is a central value in medicine and medical ethics. Autonomous persons are often in the best position to determine what would be good and bad for them.

• Any notion of moral decision-making assumes that rational agents are involved in making informed and voluntary decisions.

• In health care decisions, our respect for the autonomy of the patient would, in common parlance, imply that the patient has the capacity to act intentionally, with understanding, and without controlling influences that would mitigate against a free and voluntary act.

• Three conditions must exist for autonomous action by those with capacity to choose:

• Intentionality

• Understanding

• Absence of controlling influences that determine their action

• The following moral rules or obligations are derived from the application of the principle of respect for autonomy:

• 1. Tell the truth

• 2. Respect the privacy of others

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• 3.Protect confidential information

• 4. Obtain consent for interventions with patients/ clients

• We have an obligation to respect the autonomy of other persons, which is to respect the decision made by other people concerning their own lives.

• The principle of respect for autonomy is often associated with allowing or enabling patients to make their own decisions about which health care interventions they will or will not receive.

• Considerations of respect for autonomy in health care contexts tend to focus on situations in which decisions need to be made about health care interventions

• TRUTH TELLING OR VERACITY

• Generally, veracity can be defined as conformity to facts and synonymous to accuracy (the fact of being true or correct).

• In Ethics, veracity is the principle of truth telling and it is grounded in respect for persons and the concept of autonomy (right and freedom to make personal choices)

• In order for a person to make fully rational choices, he/she must have the information to his or her decision

• TRUTH-TELLING

• Truth-Telling in medical ethics includes the right of Patients or their families to receive information about their diagnosis and illness.

• The physician on the other hand, must balance his or her obligation to tell the truth against the imperative of “do no harm”.

• The provision of truthful information to patients is one way to enable them make a correct decisions which benefit their overall health.

• Without knowledge of the truth, it will be uncertain whether patients can make informed decisions and would lead to failure of health professionals to respect them as autonomous individuals.

• Lying is held to be a breach of the autonomy of the person, and this contradicts concepts such as patient empowerment, shared decision-making and patient centered-care.

• Those who are well informed tend to collaborate with health professionals and seek to be treated.

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• This is based on the conviction that once the patient knows their diagnosis and prognosis, they can tolerate the treatment and the pain more positively.

• BENEFICENCE AND NON-MALEFICENCE

• BENEFICENCE

• The word beneficence comes from the Latin words ‘bene” –good and ‘FICERE” –Doing

• Hence beneficence means well-doing

• The ordinary meaning of this principle is that health care providers have a duty to be of a benefit to the patient, as well as to take positive steps to prevent and to remove harm from the patient;

• As a principle, it is at the very heart of health care implying that a suffering supplicant (the patient) can enter into a relationship with one whom society has licensed as competent to provide medical care, trusting that the physician’s chief objective is to help the patient.

• The principle of beneficence is a moral obligation to act for the benefit of others.

• There are two aspects of beneficence:

• 1. providing benefits – positive beneficence

• 2. balancing benefits and risks/harm – utility: benefits and drawbacks be balanced

• The principle of beneficence supports the following moral rules and obligations:

• 1. protect and defend the rights of others

• 2. prevent harm from occurring to others

• 3. remove conditions that will cause harm

• 4. help persons with disabilities

• 5. rescue persons in danger

• NON- MALEFICENCE

• From the Latin “Malus” – bad or evil and “non” – not

• Thus, non-maleficence means not doing what is bad or evil.

• The principle of non-maleficence states that: don’t inflict harm intentionally.

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• It maintains the duty not to harm or injure others, or impose risks of harm on them, at least without compelling justification for doing so

• It requires that we not intentionally create a harm or injury to the patient, either through acts of commission or omission.

• In common language, we consider it to be negligence if one imposes a careless or unreasonable risk of harm upon another,

• Providing a proper standard of care that avoids or minimizes the risk of harm is supported not only by our commonly held moral convictions, but by the laws of society as well.

• This principle affirms the need for medical competence.

• It is clear that medical mistakes may occur; however, this principle articulates a fundamental commitment on the part of health care professionals to protect their patients from harm.

LECTURE DAY 3

• 1. Confidentiality

• 2. Conflict of Interest

• 3. Honor and Fidelity

• 1. CONFIDENTIALITY

• Confidentiality will be defined as the protection of personal information.

• It simply means keeping a client’s information between you and the client, and not telling others including co-workers, friends, family, etc.

• Examples of maintaining confidentiality include:

Individual files are locked and secured

Support workers do not tell other people what is in a client’s file unless they have permission from the client

Information about clients is not told to people who do not need to know

Client’s medical details are not discussed without their consent

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Adult clients have the right to keep information about themselves confidential, which includes that information being kept from family and friends.

• The types of information that is considered confidential can include:

Name, date of birth, age, sex and address

Current contact details of family, guardian etc.

Bank details

Medical history or records

Personal care issues

Service records and file progress notes

Individual personal plans

Assessments or reports

Incoming or outgoing personal correspondence.

• Other information relating to ethic or racial origin, political opinions, religious or philosophical beliefs, health or sexual lifestyle should also be considered confidential.

• There is, however, no such thing as absolute confidentiality in the community services industry. Workers are required to keep note on all interactions with clients and often to keep statistics about who is seen and what issues are addressed.

• As a worker, there will be times when you could be faced with some personal difficulties regarding confidentiality.

• You need to give your client an assurance that what is said will be in confidence (that it will stay secret between you and the client) because, unless you are able to do that, the client is unlikely to be open with you.

• However, you also need to be aware of the limits to the confidentiality that you are offering.

• There are several instances where total confidentiality is either impossible, undesirable or illegal.

• These include:

Cases where the law requires disclosure of information which will be

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o If the health and/or welfare of a child or young person is at risk. You are required to contact Department of Social/Community Services and notify them of your concerns.

o If your client tells you he/she has committed a serious crime. You are required to notify your supervisor or police directly

o If a worker is subpoenaed to present information in a court of law

o When the client needs to be protected from harming themselves (e.g. If suicidal).

o Where others may need to be protected (if the client has threaten to harm others or will do so inadvertently)

o When working in conjunction with other professionals in caring for a client

o The requirement of professional supervision, training, workshops or seminars

• It is always good practice to tell clients at the beginning of your contact with them that whatever they tell you is confidential except in the above circumstances.

• If you are going to discuss a client and their situation in supervision, in training session or at a workshop, you can always change the name and any information that may identify the client.

• Importance of Confidentiality

• It helps to build and develop trust

• It allows for the free flow of information

• To protect the confidentiality and privacy of the client.

• 2. CONFLICT OF INTEREST

• A conflict of interest is a situation in which an individual has competing interests or loyalties.

• It involves a person who has two relationships that might compete with each other for the person’s loyalties.

• For instance, the person might have a loyalty to an employer and also a loyalty to a family business. Each of these businesses expects the person to have its best interest first. Thus, the conflict.

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• Again, a conflict of interest can exist when a person must answer to two different individuals or groups whose needs are at odd with each other. In this case, serving one individual or group will injure the other.

• In business and law, having a “fiduciary responsibility” to someone is known as having a “duty of loyalty.”

• Those of us who wish to be ethical people must consciously avoid situations where we benefit ourselves by being disloyal to others.

• Further Examples

• When a government official has a personal monetary interest in a matter up for vote, it is best for the official to abstain from voting to avoid the appearance of a conflict of interest.

• Lucy was found to have a conflict of interest and forbidden to act as judge in her favorite uncle’s trial.

• Honor and Fidelity

• According to the Oxford Dictionary, Honor [in singular] A person or thing that brings esteem. E.g. You are an honor to our profession.

• A title of respect used to address a circuit judge, a US mayor etc.

• A quality of knowing and doing what is morally right.

• Honor can be said to have both internal and external dimensions.

• The internal dimension is that sense of integrity and self esteem that says to us “this is what I won’t do, not because of any reward or punishment but because this is who I am.”

• The external component strangely contradicts the internal manifestation of honor-it is the social recognition of people of a certain character or with certain behaviors.

• Honor encourages virtues like courage, integrity, and solidarity, and gives a sense of living for something larger than oneself.

• Fidelity

• The principle of fidelity broadly requires that we act in ways that are loyal.

• This includes keeping our promises, doing what is expected of us, performing our duties and being trustworthy.

• Fidelity helps in the maintenance of trust, relationship building and confidentiality.

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• Fidelity in any profession means being faithful to the promises we make as professionals to provide competent, quality and honorable services.