2. GENERAL ETHICS
INTRODUCTION
Ethics tree:
1. General ethical theories —> fundamental
2. Ethical values
3. Specific ethical frameworks
4. Application of those models
Spectrum of statements:
- Measurement: 1 correct answer
- Judgement: best possible answer
- Taste: different answer possible —> what you think is the best
Definition ethics:
- “Any rational procedure by which we determine what individual human beings “ought” to do or what
it is “right” for them to do, or to try to bring about by voluntary action”
- Procedure must be rational —> for resolving ethical dilemma’s
Universalization:
- Ethics as distinct from casuistry
- Demands of rationality
o Ethical reasoning —> involves claims that transcend individual case
o Applicable in similar situations
- Often involve method/test to evaluate more specific rules/norms
Is-ought gap:
- Is —> factual/descriptive statements
o Patient missed 3 out of 5 appointments
- Ought —> ethical/judgmental/normative/prescriptive statements
o Patient missed a lot of appointments
Normative:
- Ethical theories must be normative
- Principles, values, norms, …
- Distinct from anthropology, history, psychology or sociology
TYPES OF ETHICAL REASONING
Ethical reasoning:
- Different ways of looking at problems —> inspiring + perspective
- Ethical intuition comes naturally —> comes with a cost
1
,Consequentialism:
- Looking at consequences of one’s action —> making ethical decisions based on this
- Actions should maximize good effects + avoid negative effects
- Advantages:
o Consequences —> easier to judge then intentions
o Impartial
- Primary moral principle: to choose the action that leads to the better outcome
- No distinction between doing and allowing
- Psychological impact is different —> morally irrelevant
- Potential criticism:
o How do we know the effects?
o Knowing what is right ≠ always the right thing to do
o Counterintuitive consequences
o What determines if it’s a good outcome?
Deontology:
- When examining moral issues —> discuss rules, principles, rights, values, norms, …
- The idea that how actions turn out is partly out of one's control —> broader perspective needed than
individual cases
- Following an ethically agreed upon rule
- Making exceptions is tempting but dangerous
Virtue ethics:
- Virtues: character traits which you can cultivate/perfect
- Action motivated by a virtuous character is qualitatively different
- What would a virtuous person do?
2
,3. MEDICAL ETHICS
HIPPOCRATIC TRADITION
Origin:
- Hippocrates —> Hippocratic oath
- Response to the socio-cultural situation
- Oath forbade harming and killing patients
Oath —> 3 characteristics of medicine:
- Goal medicine —> maintaining and restoring health
- To achieve that goal —> specific knowledge and skills to reduce suffering/combat illness
- Only acquired knowledge/skills should be used
Harm —> 4 types:
- Physical/psychological harm
- Harm to interests
- Harm as unfairness
- Harm as a violation of moral integrity
Criticism to Hippocratic tradition:
- Medical perspective dominates
o Ex. harm is determined by doctor —> patient = minor role
- Practitioner’s personality is central —> what if they have other interests (ex. money)
PHILOSOPHICAL-RELIGIOUS TRADITION
Fundamental principle:
- Death = enemy of medicine —> medicine must do everything to prevent death
- Life of every individual is valuable + all lives are equally valuable
ð Classical antiquity: not all human life was considered equally valuable
o Slaves, prisoners, women, …
o Abortion and suicide —> possible/physicians were involved
Sources:
- Christianity:
o “Every human life is sacred; it is given by god”
o Forbids the killing of another person or oneself
- Life sciences:
o Vitalism: aims to explain the uniqueness of life versus non-life
o Moral appreciation of life as something worthy of reverence and protection
3
, ENLIGHTENMENT TRADITION
Principle:
- Autonomy of the patient —> patient should be in control
- Currently: care is good if autonomy of patient is respected
Danger:
- Autonomy = only saving principle
- Tension between autonomy of patient and Hippocratic principles of physicians
CHANGE TO MODERN ETHICAL FRAMEWORK
ð 5 factors caused change in medicine + society and culture
1. Scientific research
o How research is conducted changes with time
o Belmont Report + Institutional Review Boards
2. Technological developments
o Natural function can be taken over
o Altering human life
3. Demographic changes
o Increase average life span
o Increase societal diversity
o People are longer unhealthy
4. Societal changes
o Welfare state
o Healthcare policy —> manageable healthcare system (financial)
o Demand <-> availability
5. Moral uncertainty
o What is meaningful for the patient?
o Different views, different cultures
o Resistance to medical power/tutelage/paternalism —> fueling growing interest in ethics
ð Within medical ethics little attention is paid to questions of meaning
4
INTRODUCTION
Ethics tree:
1. General ethical theories —> fundamental
2. Ethical values
3. Specific ethical frameworks
4. Application of those models
Spectrum of statements:
- Measurement: 1 correct answer
- Judgement: best possible answer
- Taste: different answer possible —> what you think is the best
Definition ethics:
- “Any rational procedure by which we determine what individual human beings “ought” to do or what
it is “right” for them to do, or to try to bring about by voluntary action”
- Procedure must be rational —> for resolving ethical dilemma’s
Universalization:
- Ethics as distinct from casuistry
- Demands of rationality
o Ethical reasoning —> involves claims that transcend individual case
o Applicable in similar situations
- Often involve method/test to evaluate more specific rules/norms
Is-ought gap:
- Is —> factual/descriptive statements
o Patient missed 3 out of 5 appointments
- Ought —> ethical/judgmental/normative/prescriptive statements
o Patient missed a lot of appointments
Normative:
- Ethical theories must be normative
- Principles, values, norms, …
- Distinct from anthropology, history, psychology or sociology
TYPES OF ETHICAL REASONING
Ethical reasoning:
- Different ways of looking at problems —> inspiring + perspective
- Ethical intuition comes naturally —> comes with a cost
1
,Consequentialism:
- Looking at consequences of one’s action —> making ethical decisions based on this
- Actions should maximize good effects + avoid negative effects
- Advantages:
o Consequences —> easier to judge then intentions
o Impartial
- Primary moral principle: to choose the action that leads to the better outcome
- No distinction between doing and allowing
- Psychological impact is different —> morally irrelevant
- Potential criticism:
o How do we know the effects?
o Knowing what is right ≠ always the right thing to do
o Counterintuitive consequences
o What determines if it’s a good outcome?
Deontology:
- When examining moral issues —> discuss rules, principles, rights, values, norms, …
- The idea that how actions turn out is partly out of one's control —> broader perspective needed than
individual cases
- Following an ethically agreed upon rule
- Making exceptions is tempting but dangerous
Virtue ethics:
- Virtues: character traits which you can cultivate/perfect
- Action motivated by a virtuous character is qualitatively different
- What would a virtuous person do?
2
,3. MEDICAL ETHICS
HIPPOCRATIC TRADITION
Origin:
- Hippocrates —> Hippocratic oath
- Response to the socio-cultural situation
- Oath forbade harming and killing patients
Oath —> 3 characteristics of medicine:
- Goal medicine —> maintaining and restoring health
- To achieve that goal —> specific knowledge and skills to reduce suffering/combat illness
- Only acquired knowledge/skills should be used
Harm —> 4 types:
- Physical/psychological harm
- Harm to interests
- Harm as unfairness
- Harm as a violation of moral integrity
Criticism to Hippocratic tradition:
- Medical perspective dominates
o Ex. harm is determined by doctor —> patient = minor role
- Practitioner’s personality is central —> what if they have other interests (ex. money)
PHILOSOPHICAL-RELIGIOUS TRADITION
Fundamental principle:
- Death = enemy of medicine —> medicine must do everything to prevent death
- Life of every individual is valuable + all lives are equally valuable
ð Classical antiquity: not all human life was considered equally valuable
o Slaves, prisoners, women, …
o Abortion and suicide —> possible/physicians were involved
Sources:
- Christianity:
o “Every human life is sacred; it is given by god”
o Forbids the killing of another person or oneself
- Life sciences:
o Vitalism: aims to explain the uniqueness of life versus non-life
o Moral appreciation of life as something worthy of reverence and protection
3
, ENLIGHTENMENT TRADITION
Principle:
- Autonomy of the patient —> patient should be in control
- Currently: care is good if autonomy of patient is respected
Danger:
- Autonomy = only saving principle
- Tension between autonomy of patient and Hippocratic principles of physicians
CHANGE TO MODERN ETHICAL FRAMEWORK
ð 5 factors caused change in medicine + society and culture
1. Scientific research
o How research is conducted changes with time
o Belmont Report + Institutional Review Boards
2. Technological developments
o Natural function can be taken over
o Altering human life
3. Demographic changes
o Increase average life span
o Increase societal diversity
o People are longer unhealthy
4. Societal changes
o Welfare state
o Healthcare policy —> manageable healthcare system (financial)
o Demand <-> availability
5. Moral uncertainty
o What is meaningful for the patient?
o Different views, different cultures
o Resistance to medical power/tutelage/paternalism —> fueling growing interest in ethics
ð Within medical ethics little attention is paid to questions of meaning
4
