Moral Theories & Ethical Principles

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Moral Theories and Ethical

PrinciplesBy

Christopher O. Agulanna

MA (Lagos), MAE (Linkoping), MA (Utrecht), PhD (Ibadan)

Department of Philosophy, University of Ibadan

Lecture delivered

At a 2 Day Course in

Medical Ethics

Organized by West African College of Physicians

2nd 3rd June, 2011


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What is ethics?

Ethics, otherwise known as moral

philosophy derives from the Greek word

ethikos, which means custom

Ethics is the branch of philosophy that

addresses questions about moralitythat is,

concepts such as good and evil, right and

wrong, virtue and vice, justice, etc.


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What is ethics?

Ethics is the systematic study of morality

The relationship between ethics and morality is

similar to that between logic and thinking or that

between theology and religion

In each of the cases, the latter is the basis of theformer


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Aim

Ethics aims to achieve two fundamental

objectives:

(i) to tell us how we ought to act in a given

situation, and

(ii) to provide us with strong reasons fordoing so


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Ethics and morality

Ethics and morality are closely related:

Morality refers to a set of duties that require

us to subordinate our natural instincts in order

to obey the moral law. A failure to fulfill our

duty brings with it a heavy sense of guilt.

Very often, morality is assumed to have a

religious basis an assumption that is not

always correct.


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Ethics and morality

Ever before we began studying ethics, we

already have a sense of morality, with what it

means to say of a thing that it is good or bad,

right or wrong, etc.

Ethics is the systematic study of the

fundamental principles underlying our

morality.


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Ethics and morality

Just as logic is the systematic study of the

fundamental principles of correct thinking,

and theology is the systematic study of the

fundamental tenets of religion, ethics is the

systematic reflection on our moral values or

beliefs


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Definition of ethics

Ethics has been defined in various:

It can be defined as the branch of philosophy which

deals with the morality of human actions

As the branch of philosophy which studies the

norms of human behaviour

The systematic study of the fundamental principles

of the moral law The normative science of human conduct


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Branches of ethics

Four major branches:

i. Normative ethics, also known as prescriptive ethics

- This branch of ethics actually judges morality.

Normative judgments are value judgments: theyindicate whether something is good or bad.

Example: To proclaim that abortion is right or

wrong; that advanced directive is good or bad;that euthanasia is morally good or bad, etc.


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Branches of ethics

ii. Meta-ethics: This is the branch of ethics that

concerns itself with the analysis or elucidation

of ethical concepts or ideas, e.g., what do the

terms good, bad, right, wrong, evil,

moral obligation, etc, signify? How may we

define a good action?

Meta-ethics is also known as analytic moral

philosophy


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Branches of ethics

iii. Applied ethics: The attempt to apply ethical theoryto real life situations. The discipline has many

specialized fields, such as Engineering Ethics,

bioethics and business ethics.

It involves the investigation of specific questions that

have elicited ethical controversies, such as end of life

issues, in vitro fertilization, environmental

degradation, world poverty, how to deal with

conflicts arising from our multi-cultural world, etc.


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Different senses

Ethics can be understood in two ways: First, it refers to well-founded standards of right and

wrong that prescribe what humans ought to do,

usually in terms of rights, obligations, benefits to

society, fairness, or specific virtues.

The word ethics is sometimes used to refer to the set

of rules, principles, or ways of thinking that guide, orclaim authority to guide, the actions of a particular

group; and sometimes it stands for the systematic

study of reasoning about how we ought to act.


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Ethical theories

Ethical theories and principles are the foundations ofethical analysis

It is to them we turn to obtain guidance when seeking

to make ethical decisions on any matter However, in order for an ethical theory to be useful, the

theory must be directed towards a common set of goals

Ethical principles are the common goals that each

theory tries to achieve in order to be successful. These

goals include beneficence, least harm, respect for

autonomy and justice.


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Ethical principles

A principle is a rule of a general nature

An ethical or moral principle (dictionary meaning) is:1. the principles of right and wrong that are accepted

by an individual or a social group;

2. the principle that conduct should be moral

Some moral principles are general, others particular


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Ethical principles

General moral/ethical principles make some general

statement about what is morally right or wrong, or

good or bad, or what we should or ought, or

shouldn't or ought not toExamples:

Thou shalt not kill.

You should not take what does not belong to youwithout permission of the owner.

If you make a promise, you ought to keep it.


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Moral judgments

Particular moral judgments

Not all moral judgments are general principles. Some

are about specifics.

Examples:

John was wrong in aiding Foluke to abort her baby.

Hitler was an evil person.


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The role of general moral principles in moral argument

General moral principles can serve as the major

premise of a moral argument.

For example,

Killing is wrong.

Capital punishment is killing.

Therefore, capital punishment is wrong.

The concern here is not whether the premises are true or

acceptable but to highlight the role of the general moral

principle in moral argumentation.


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What ethics is not

Ethics is not a manual with answers on how to act. It

is only a search for the right kind of morality.

Ethics is not a matter of following ones feelings It is not to be identified with religion

Being ethical is not the same as following the law

Again, being ethical is not the same as doing

"whatever society accepts"


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Ethics a recapitulation

What, then, is it?

It can mean any of the following:

A well-founded standards of right and wrong that

prescribe what humans ought to do, usually interms of rights, obligations, benefits to society,

fairness, or specific virtues. Ethics, for example,

refers to those standards that impose the

reasonable obligations to refrain from such vices as

rape, stealing, murder, assault, slander, and fraud.


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Ethical standards also include those that enjoin

virtues of honesty, compassion, and loyalty.

These include standards relating to rights, such

as the right to life, the right to freedom from

injury, and the right to privacy. Such standards

are adequate standards of ethics because they

are supported by consistent and well-foundedreasons.


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Secondly, ethics refers to the study anddevelopment of one's ethical standards. Here, we

should note that feelings, laws, and social norms

can deviate from what is ethical.

Hence, it is necessary that we constantly examine

our standards to ensure that they are reasonableand well-founded.


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Ethics - theory vs. praxis

In this wise, ethics involves the continuous effort

of studying our own moral beliefs and our

moral conduct, and striving to ensure that we,

and the institutions we help to shape, live up

to standards that are reasonable and solidly-

based.


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The role of theories

Like science, ethical discourse is guided by theories

and principles. Some theories, principles and

methods that guide the scientific inquiry are:positivism, pragmatism, empiricism,

instrumentalism, and probabilism. Others are the

theories of induction and deduction, etc.

The schema in the following slide shows the major

theories in ethics


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Ethical theories

Ethical Theories

Ethics of Conduct

What sort of actionsshould we erform?

Ethics of Character

What sort of people

should we be?

Consequentialism

The right action is the

one that produces the

most intrinsic good

Deontology

The good is defined

independently of the

right

AristoteleanismVirtue is a mean

between extremes of

action or passion

KantianismActions must satisfy

the categorical

imperative

For everyone

affected:

Utilitarianism

For the agent:

Ethical

Egoism


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Ethical theories

Should be clear

Internally consistent and coherent Complete and comprehensive

Simple

Generally support ordinary judgment


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Ethical theories

There are two fundamental types of ethical

theory:

i. Consequentialist or utilitarian theory

(teleology) Jeremy Bentham and John

Stuart Mill

ii. Deontological theory Immanuel Kant


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Consequentialist theories

Consequentialist theory is one sub class of

teleological moral theory

Consequentialism refers to moral theories that hold

that the consequences of a particular action form thebasis for any valid moral judgment about that action

(or create a structure or rule for judgment)

Says the moral value of an act, rule or policy is to be

found in the consequences, not in intentions or

motives


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From a consequentialist standpoint, a morally rightaction is one that produces a good outcome, or

consequence.

This view is often expressed in the maxim "The ends

justify the means.

The defining feature of consequentialist moral theories is

the weight given to the consequences in evaluating the

rightness and wrongness of actions.


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According to this theory, the consequences of anaction or rule generally outweigh other

considerations

Some questions that consequentialist theories address:

i. What sort of consequences count as good

consequences?

ii. Who is the primary beneficiary of moral action?

iii. How are consequences judged and who judges

them?


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Utilitarianism

Utilitarianism is the most influential consequentialist

theory

Formulated by Jeremy Bentham in the late 18th

century and John Stuart Mill in the 19th century The utilitarian ethical theory is founded on the ability

to predict the consequences of an action

To a utilitarian, the choice that yields the greatest

benefit to the most people is the choice that is

ethically correct.


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Utilitarianism

There is only one basic principle in ethics, that

of utility, the production of the greatest

possible balance of value over disvalue for all

persons affected The end justifies the means

Promote the greatest good for the greatest

number What is right is what is most useful


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Utilitarianism

Hedonistic utilitarians argue that the principle to

judge our moral thinking is utility, that is, the

maximisation of happiness, in the sense of pleasure,

and the minimisation of suffering, in the sense ofpain.

In any situation the morally right thing to do is the

action that promotes the greatest happiness for the

greatest number of people


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Two types of utilitarianism

i. Act utilitarianism considers the consequences of

each act, ie whitelie

A person performs the acts that benefit the most

people, regardless of personal feelings or the societalconstraints such as laws

ii. Rule utilitarianism - considers the general

consequences of these kinds of acts, ie the rule that

lying is generally bad for society. (Rules are

considered valid only if their consequences are

good overall)


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Utilitarianism: an illustration

In considering what is the right course of

action/treatment in any healthcare situation, doctors

tend initially to think about the consequences arisingfrom the different options. For example, in deciding

whether in particular circumstances a breach of the

duty of confidentiality is justified, the physician

thinks of the consequences the harms of breachingthe duty and the harms of not warning others of a

risk to their health.


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Criticism

A criticism of consequentialist theory is that it is so

concerned with the ways in which the ends or goals are

achieved it is so concerned with ends that it often

overlooks the moral importance ofmeans. The utilitarian theory requires that the consequences of

acts and policies be calculated.

In many situations one cannot predict consequences

with any certainty, making consequentialism

probabilistic we forecast the consequences to the best

of our ability.


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Criticism

A utilitarian is presumed to have the ability to

compare the various types of consequences against

each other on a similar scale. However, comparingmaterial gains such as money against intangible gains

such as happiness is impossible since their qualities

differ significantly


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Criticism

Utilitarianism has been charged with over-

demandingness - that it does not allow for the

existence of supererogation or heroes. For example,

we are obligated to constantly behave so that themost people benefit regardless of the danger

associated with an act. For instance, a utilitarian who

sacrifices her life to save a train full of people is

actually fulfilling an obligation to society rather thanperforming a selfless and laudable act.


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Criticism

Act utilitarianism is solely concerned with achieving

the maximum good. The theory implies that an

individual's rights may be infringed upon in order tobenefit a greater population. In other words, act

utilitarianism is not always concerned with justice,

beneficence or autonomy for an individual if

oppressing the individual leads to the solution thatbenefits a majority of people.


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Deontological Theory

Deontology (from Greek deon,

"obligation, duty) is an approach toethics that focuses on duty, rules and

the intentions of the person doing

the act, rather than third-partyconsequences of the act


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Deontology

Some features of an act other than its consequences

makes it right or wrong. May be based in

religious belief, natural law, common morality or

other system.honesty beneficence

fidelity nonmaleficence

gratitude autonomyjustice privacy


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Rules

Rules of thumb

Binding rules

Absolute rules (eg,

truth-telling)


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Duty/obligation

Deontological theory uses rule rather than

consequences to justify an action or policy

emphasis is on obligation or duty focuses on objectively obligatory rule

General rule - do unto others as you will have

them do unto you


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Kantian duty ethics

Kantianism is the most well known deontological

theory of ethics

Kant defended rules as do not lie, keep

promises, do not kill on what he claimed were

rational grounds

Rules should comply with the categorical

imperative


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Kantianism

The categorical imperative holds that:

Moral rules should be universalisable i.e. applied

to rational, moral members of the community

rather than to just some All persons should be treated never simply as

means but also always as ends in themselves

Members of the moral community should take ahand in making the laws as well as living by them


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Kantianism

Kants ethics is an ethics of respect for persons

One formulation of the CI that is crucially relevant in

dealing with issues in biomedical ethics is the onethat tells us:

Act in such a way that you always treat humanity,whether in your own person or in the person of any

other, never simply as a means, but always at the

same time as an end


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Preliminary Questions

What does it mean to treat an individual as an

end?

Is it always morally wrong for one person to

use another as a means?

Are there extenuating conditions to this rule?

explain what such conditions would look like


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Kantianism

Modern Kantians still stress the importance of

generally living by moral rules or laws. However,unlike Kant, many are not absolutist in their

application of moral rules or laws


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Importance of Kantian theory

Kants ethical ideas continue to have great impact in

ethical thinking till date. Mappes and De Grazia argue

that his ethical theory remains the underlying

framework of much argumentation in biomedica lethics today

For example, Kant s theory i s manifested

in the idea of a dut ies owed to a pat ientby the doctor the duty of care and the

duty not to harm


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Some difficulties

Although deontology contains many positive

attributes, it also contains its fair number of

flaws:

i. Provides no rationale or logical basis for

deciding an individual's duties

ii. Does not provide any guidance on how to

resolve conflicting duties or obligations

iii. Absolutism a big problem


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Communitarianism

Is a theoretical perspective that seeks to

lessen the focus on individual rights and

increase the focus on communal

responsibilities

Its central claim is the necessity of attending

to community alongside, if not prior to,

liberty, justice and equality


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Communitarianism

Communitarianism emerged in the 1980s as a response to

the limits of liberal theory and practice

Advocates the need to balance individual rights with

social responsibilities Says individuals do not exist in isolation, but are shaped

by the values and culture of communities

Says we should begin to redress the balance toward the

pole of community, or else our society will continue to

become normless, self-centred, and driven by special

interests and power seeking.


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Communitarianism

Communitarians believe that the value of

community is not sufficiently recognized in

liberal theories of justice, or in the public

culture of liberal societies

Says real emphasis should instead be on

common shared practices, cultural traditions,

and shared social understanding amongmembers of society


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Communitarian ethics

Grounds ethical thought in communal values,established social standards and traditions, and

considerations of the larger society. Communitarians

emphasize the influence of society on individuals and

contend that values are rooted in common historyand tradition

Believes that the good of individuals - their very

identity and capacity for moral agency - is bound up

with the communities they belong to


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Three principles

Communitarianism is based on three principles:

First, that any claim of truth be validated through co-

operative enquiry.

Second, that communities of co-operative inquiry,

which represent the spectrum of citizens, should

validate common values that become the basis of

mutual responsibilities of all community members. Third, that all citizens should have equal access and

participation in the power structure of society.


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A central premise

Is the recognition of societyas a web of intersecting

communities with differingmoral values and standards


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Community as a focal point

The key to resolving ethical questions and conflicts

lies in respect for local values that demonstrate

careful deliberation and local community

acceptance.

Holds that he system of moral rules of a particular

community is best understood in the context of thatcommunity's current historical view of social welfare

and related social interests.


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The common good as an ideal

Communitarianism downplays the values of

individuality, autonomy, and personal rights,

so prevalent in other ethical theories, in

favour of a focus on the virtues and actions

that support the interests of society as a

whole


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Role in health care

Communitarian thought contributes

immensely to ethical discussion in the health

care context.

This is particularly true with respect to issues

such as the best use of limited health care

resources, health care as a right, and the

concept of healthy communities versus anemphasis on individual health.


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Strength

Strengths of the communitarian perspective

include the emphasis on strong connections

between people, encouragement of

collaboration, diminished emphasis on self-

serving individualism, and sacrifice for the

greater good as a measure of character.


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Weakness

On the negative side, many would question

how realistic it is to achieve a common set of

global, or even local, values.

We should also be concerned with the

potential of the theory to erode individual

rights

As a theory, communitarianism provides no

systematic method for resolving ethical

conflicts


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Liberal individualism

Rights-based

What is a right?

i. A right is a claim that can be made on society on

moral or legal grounds

ii. Moral rights are claims justified by moral rules

iii. Positive rights require anothers action

iv. Negative rights require anothers forbearance


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Permissible murder?

A doctor kills a deteriorating and suffering

patient using an undetectable method. The

patients family is relieved of financial and

psychological stress, and the patient isrelieved of suffering.

Who benefits?

Who suffers?What is the balance?


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Permissible murder?

Same as the last case (euthanasia), except through an

unlikely chain of circumstance, the doctors act is

discovered. He goes to jail after a very painful trial.

Who benefits?Who suffers?

What is the balance?

Is the morality or ethical value of the actaltered by the outcome?


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Moral dilemma

You are a 1940s doctor in charge of a hospital in

which you are treating Jewish patients. Nazi

soldiers come and ask you if you have any

such patients. How do you respond if honesty is a rule of

thumb?

How do you respond if honesty is a bindingrule?

How do you respond if honesty is an absolute

rule?

Moral dilemma


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Moral dilemma

In 1973, the US Supreme Court made a landmark ruling inthe legal case Roe v. Wade, allowing that a woman may

procure abortion in the first trimester of pregnancy,

without the approval of the father, government, or any

other authority. In 1977, the Court ruled thatgovernment does not have to pay for abortions.

Explain the apparent paradox

What rights are involved in these decisions? How might your personal ethical theory impact your

approach to abortion?


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Emphasis on rights

Liberal theories emphasize the role of choice,

individual liberty, and freedom from government

interference in private matters

Rights refer to legal, social, or ethical principles of

freedom or entitlement - they are the fundamental

normative rules about what is allowed of people or

owed to people, according to some legal system,

social convention, or ethical theory.


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Ethics of care

Care ethics is a new ethical theory.

Believes that the development of morals is not

caused by learning moral principles. Instead,

people should learn norms and values in

specific contexts.

Views other people as of fundamental

importance and worthy of our respect.


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Ethics of care

By contacting other people, and by placing

yourself in their shoes, you learn what is good

or bad at a particular time.

The solution of moral problems must alwaysbe focused on maintaining the relationships

between people.

The connectedness of people is the key tomoral progress


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Four Principles

Earlier, we mentioned that in order for an ethical

theory to be useful, the theory must be directed

towards a common set of goals. Ethical principles are

the common goals that each theory tries to achievein order to be successful.

In what follows, we discuss four important ethical

principles: respect for autonomy, nonmaleficence,

beneficence, justice.


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Respect for autonomy

Respecting the decision-making capacities of

autonomous persons

Tell the truth

Respect others privacy

Protect confidential information

allow individuals to make reasoned informed

choices Obtain consent for interventions


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Nuremberg Code, Rule 1

Legal capacity to give consent

Free power of choice

Sufficient knowledge and comprehension

nature, duration, purpose

methods and means

inconveniences and hazards

long term effects

responsibility of experimenter to ensure

autonomy is respected


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Non maleficence:

Healthcare professional should avoid the

causation of harm to patient

do not kill

do not cause pain or suffering to others

do not incapacitate others

do not cause offense to others

do not deprive others of the goods of life


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Nuremberg Code

Rule 4:

The experiment should be so conducted as to avoid all

unnecessary physical and mental suffering and injury.

Rule 5: Experiment should not be conducted where there is an a

priori reason to believe that death or disabling injury will

occur...

Rule 5: Degree of risk should be minimal.


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Beneficence

Provide benefits and balance benefits against

risks and harm

protect and defend the rights of others

prevent harm to others

remove conditions that will cause others harm

help disabled persons

rescue persons in danger


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Hippocratic Oath

One basic principle in the Oath is:

do no harm


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Justice

Distribute benefits, risks, and costs fairly

to each an equal share

to each according to effort

to each according to need

to each according to contribution

to each according to merit

Applying the Four Principles


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Mrs Y is 56 years old and has a learning disability. She is

admitted to hospital with an ovarian cyst. The cyst is blocking

her ureter and if left untreated will result in renal failure.

Mrs Y would need an operation to remove the cyst.

Mrs Y has indicated quite clearly that she does not want a

needle inserted for the anaesthetic for the operation to

remove the cyst- she is uncomfortable in a hospital setting

and is frightened of needles.



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The clinician is concerned that if the cyst is not removed Mrs Y

will develop renal failure and require dialysis which wouldinvolve the regular use of needles and be very difficult to

carry out given her fear of needles and discomfort with

hospitals.

The anaesthetist is concerned that if Mrs Y does not comply

with the procedure then she would need to be physically

restrained.

Mrs Y's niece visits her in the care home every other month.

The niece is adamant that her aunt should receive treatment.

Question


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Question

Should the surgeon perform the operation despite

Mrs Ys objections?

How would you apply the Four Principles to this

case?

See The UK Ethics Network, The Ethox Centre, Department of Public Health and

Primary Health Care. The four principles approach. Available at:

http://www.ethics-network.org.uk/ethical-issues/ethical-frameworks/the-four-

principles-approach
http://www.ethics-network.org.uk/ethical-issues/ethical-frameworks/the-four-principles-approachhttp://www.ethics-network.org.uk/ethical-issues/ethical-frameworks/the-four-principles-approachhttp://www.ethics-network.org.uk/ethical-issues/ethical-frameworks/the-four-principles-approachhttp://www.ethics-network.org.uk/ethical-issues/ethical-frameworks/the-four-principles-approachhttp://www.ethics-network.org.uk/ethical-issues/ethical-frameworks/the-four-principles-approachhttp://www.ethics-network.org.uk/ethical-issues/ethical-frameworks/the-four-principles-approachhttp://www.ethics-network.org.uk/ethical-issues/ethical-frameworks/the-four-principles-approachhttp://www.ethics-network.org.uk/ethical-issues/ethical-frameworks/the-four-principles-approachhttp://www.ethics-network.org.uk/ethical-issues/ethical-frameworks/the-four-principles-approachhttp://www.ethics-network.org.uk/ethical-issues/ethical-frameworks/the-four-principles-approachhttp://www.ethics-network.org.uk/ethical-issues/ethical-frameworks/the-four-principles-approachhttp://www.ethics-network.org.uk/ethical-issues/ethical-frameworks/the-four-principles-approachhttp://www.ethics-network.org.uk/ethical-issues/ethical-frameworks/the-four-principles-approachhttp://www.ethics-network.org.uk/ethical-issues/ethical-frameworks/the-four-principles-approachhttp://www.ethics-network.org.uk/ethical-issues/ethical-frameworks/the-four-principles-approachhttp://www.ethics-network.org.uk/ethical-issues/ethical-frameworks/the-four-principles-approachhttp://www.ethics-network.org.uk/ethical-issues/ethical-frameworks/the-four-principles-approachhttp://www.ethics-network.org.uk/ethical-issues/ethical-frameworks/the-four-principles-approachhttp://www.ethics-network.org.uk/ethical-issues/ethical-frameworks/the-four-principles-approachhttp://www.ethics-network.org.uk/ethical-issues/ethical-frameworks/the-four-principles-approachhttp://www.ethics-network.org.uk/ethical-issues/ethical-frameworks/the-four-principles-approachhttp://www.ethics-network.org.uk/ethical-issues/ethical-frameworks/the-four-principles-approachhttp://www.ethics-network.org.uk/ethical-issues/ethical-frameworks/the-four-principles-approach


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Resources

Government of Canada, Context of an Ethical Framework,

Available on

http://www.pre.ethics.gc.ca/english/policystatement/context.

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Press, 2002

Medical Ethics Manual, World Medical Association, 2005

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now? New Review of Bioethics 2003;1(1):3-5
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Resources

Widdows H, Dickenson D, Hellsten S. Global bioethics NewReview of Bioethics 2003;1(1):101-116

McKneally M. What is an ethic? University of Toronto

Adebamowo CA. Ethical issues in cancer research. 2005

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Medical Education 2004; 4(21):1-6

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World Bioethics 2005; 5(1):1471-8847 (online)


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