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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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Consequentialist theories
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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Consequentialist theories
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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Applying the Four Principles
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.
Applying the Four Principles
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Applying the Four Principles
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-approach7/27/2019 Moral Theories & Ethical Principles
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