From Ethical Theory to From Ethical Theory to PracticePractice

Robert Scott Stewart, Ph.D.Robert Scott Stewart, Ph.D.Professor of PhilosophyProfessor of Philosophy

Chair, Philosophy & Religious StudiesChair, Philosophy & Religious StudiesCape Breton UniversityCape Breton University

Different Levels of Ethical Different Levels of Ethical InquiryInquiry

Meta-Ethics: Defining the meaning of moral Meta-Ethics: Defining the meaning of moral concepts. E.g., Are ethical claims relative or concepts. E.g., Are ethical claims relative or universal? What does the term ‘good’ mean? What universal? What does the term ‘good’ mean? What role does reason play in ethical judgments?role does reason play in ethical judgments?

Normative Ethics: What principles ought to guide us Normative Ethics: What principles ought to guide us making ethical decisions? making ethical decisions?

Practical Ethics: An examination of particular issues Practical Ethics: An examination of particular issues in ethics. E.g., Is euthanasia defensible? Are clinical in ethics. E.g., Is euthanasia defensible? Are clinical drug trials involving children acceptable? Should we drug trials involving children acceptable? Should we allow genetically modified foods on the market?allow genetically modified foods on the market?

Methods for ethicsMethods for ethics

Name the issue(s)Name the issue(s) Collect and analyze the facts (all stakeholders Collect and analyze the facts (all stakeholders

+ law and administrative policies)+ law and administrative policies) Ethical analysis of the issue(s) given the factsEthical analysis of the issue(s) given the facts Suggestion of alternativesSuggestion of alternatives Implementation and follow-up (Handbook for Implementation and follow-up (Handbook for

Bioethics Committee Members) Bioethics Committee Members)

Ethical Theories: UtilitarianismEthical Theories: Utilitarianism

The greatest happiness principle: The greatest happiness principle: ““Actions are right in proportion as they tend to Actions are right in proportion as they tend to

promote happiness; wrong as they tend to promote happiness; wrong as they tend to produce the reverse of happiness.” produce the reverse of happiness.” --John Stuart Mill (1806-1873) John Stuart Mill (1806-1873)

A “consequentialist” theory of value. Actions A “consequentialist” theory of value. Actions aren’t right or wrong in themselves: it always aren’t right or wrong in themselves: it always depends on the context and the (expected) depends on the context and the (expected) consequences.consequences.

Utilitarianism: ProsUtilitarianism: Pros

Straightforward: provides one principle as the Straightforward: provides one principle as the moral test of all actions (monistic theory of moral test of all actions (monistic theory of value).value).

Intuitive appeal: we all seek happinessIntuitive appeal: we all seek happiness Has particular appeal with respect to ‘public’ Has particular appeal with respect to ‘public’

morality or law. I.e., Social programs ought to morality or law. I.e., Social programs ought to aim for the biggest bang for the buck – high aim for the biggest bang for the buck – high satisfaction, low cost (cost-benefit analysis: satisfaction, low cost (cost-benefit analysis: efficency).efficency).

Utilitarianism: ConsUtilitarianism: Cons

How do we measure happiness (or pleasure)? How do we measure happiness (or pleasure)? Is my happiness (or unhappiness) comparable Is my happiness (or unhappiness) comparable to yours?to yours?

Possibly inconsistent with individual rights. Possibly inconsistent with individual rights. E.g., in cases where trampling of my rights E.g., in cases where trampling of my rights would produce overall utility.would produce overall utility.

Possibly inconsistent with other things of Possibly inconsistent with other things of value like loyalty and friendship.value like loyalty and friendship.

DeontologyDeontology

Kant and the first version of the categorical Kant and the first version of the categorical imperative.imperative.

““Act as if the maxim of your action were to Act as if the maxim of your action were to become through your will a universal law of become through your will a universal law of nature.” nature.”

Immanuel Kant (1724-1804)Immanuel Kant (1724-1804) A secular version of the golden rule: “Do onto others as A secular version of the golden rule: “Do onto others as

you would have them do onto you.”you would have them do onto you.” I.e., universalize your actionsI.e., universalize your actions

DeontologyDeontology

Kant’s second formulation of the categorical Kant’s second formulation of the categorical imperative.imperative.

““Always treat humanity, whether in your own Always treat humanity, whether in your own person or that of another, never simply as a person or that of another, never simply as a means but always at the same time an end.” means but always at the same time an end.”

Kant (1724-1804)Kant (1724-1804) Persons vs. things or mere objectsPersons vs. things or mere objects Dignity and autonomyDignity and autonomy

Deontology: ProsDeontology: Pros

Straightforward: provides one principle (with Straightforward: provides one principle (with two formulations) as the moral test of all two formulations) as the moral test of all actions (monistic theory of value).actions (monistic theory of value).

Intuitive appeal: humans do typically feel Intuitive appeal: humans do typically feel special and hence deserving of respect by not special and hence deserving of respect by not being used and by being allowed to make being used and by being allowed to make decisions over their own lives. decisions over their own lives.

Good ground for individual rights.Good ground for individual rights.

Deontology: ConsDeontology: Cons

Too restrictive and context independent. Too restrictive and context independent. Is it Is it alwaysalways wrong to lie? Are there no wrong to lie? Are there no

exceptions?exceptions? Should we never assess the morality of our Should we never assess the morality of our

actions by their consequences?actions by their consequences? Offers no clear path when we have conflicting Offers no clear path when we have conflicting

obligations.obligations.

The impact of Utilitarianism and The impact of Utilitarianism and KantKant

Despite their problems, utilitarianism and Despite their problems, utilitarianism and Kantian deontology provided the two main Kantian deontology provided the two main ethical theories in use until the late 20’th ethical theories in use until the late 20’th century (and are still tremendously influential century (and are still tremendously influential today). today).

Alternatives:, (1) care rather than justice, (2) Alternatives:, (1) care rather than justice, (2) virtue ethics, (3) case studies (casuistry), (4) virtue ethics, (3) case studies (casuistry), (4) pluralism.pluralism.

Theories of Care and FeminismTheories of Care and Feminism Carol Gilligan (Harvard), Carol Gilligan (Harvard), In a Different Voice, In a Different Voice, 19821982 Attacked Kohlberg’s theory of moral development as biased Attacked Kohlberg’s theory of moral development as biased

toward a male perspective who prefer abstractness and toward a male perspective who prefer abstractness and universals over the concrete and relationships .universals over the concrete and relationships .

While males prefer abstract principles (like utilitarianism and While males prefer abstract principles (like utilitarianism and Kantian deontology), females show a preference for Kantian deontology), females show a preference for relationships with specific people.relationships with specific people.

Led to much feminist thought including the “ethics of care.”Led to much feminist thought including the “ethics of care.” Feminism and care have been particularly influential in Feminism and care have been particularly influential in

biomedical ethics since at the core of health care are special biomedical ethics since at the core of health care are special kinds of relationships b/w health care workers and patients.kinds of relationships b/w health care workers and patients.

Virtue EthicsVirtue Ethics

Whereas utilitarianism and deontology emphasize Whereas utilitarianism and deontology emphasize whether a particular action is right or good, virtue whether a particular action is right or good, virtue ethics emphasizes ethics emphasizes the personthe person making the judgments making the judgments or doing the actions. I.e., a virtuous person will make or doing the actions. I.e., a virtuous person will make virtuous decisions and act virtuously.virtuous decisions and act virtuously.

Has its roots in Aristotle (384-322 BCE): stress on Has its roots in Aristotle (384-322 BCE): stress on moral education, moderation, and relationships. moral education, moderation, and relationships. Virtue in Greek is Virtue in Greek is aretearete, which literally means , which literally means “excellence.” “excellence.”

CasesCases

Don’t worry so much about theory. Look at Don’t worry so much about theory. Look at actual cases and formulate principles on the actual cases and formulate principles on the basis of these.basis of these.

But is this possible with no guidance from But is this possible with no guidance from principles at all?principles at all?

PluralismPluralism

W.D. Ross (1877-1971) complained that W.D. Ross (1877-1971) complained that utilitarianism and Kantian deontology erred in utilitarianism and Kantian deontology erred in claiming that there was only one ethical principle (the claiming that there was only one ethical principle (the greatest happiness principle or the categorical greatest happiness principle or the categorical imperative). This was the main reason why neither imperative). This was the main reason why neither had been able to secure complete acceptance. had been able to secure complete acceptance.

Utilitarianism too forward lookingUtilitarianism too forward looking Deontology too backward lookingDeontology too backward looking A need for plurality of ethical principles which would A need for plurality of ethical principles which would

incorporate elements of the two main theories. incorporate elements of the two main theories.

PrincipalismPrincipalism

An increasing interest in An increasing interest in appliedapplied ethics ethics through the 1980’s and 90’s.through the 1980’s and 90’s.

Recognition (by some) that ethical theory as it Recognition (by some) that ethical theory as it stood not adequate to the task of applied stood not adequate to the task of applied ethics.ethics.

Tom Beauchamp (Georgetown) and James Tom Beauchamp (Georgetown) and James Childress (Virginia), Childress (Virginia), Principles of Biomedical Principles of Biomedical EthicsEthics (1979, 5’th ed., 2001) (1979, 5’th ed., 2001)

Four PrinciplesFour Principles

AutonomyAutonomy NonmaleficenceNonmaleficence BeneficenceBeneficence JusticeJustice

Application and use various contexts: e.g., Application and use various contexts: e.g., codes of ethics and research ethics.codes of ethics and research ethics.

Tri-Council Policy StatementTri-Council Policy Statement

Respect for Human DignityRespect for Human Dignity Respect for Free and Informed ConsentRespect for Free and Informed Consent Respect for Vulnerable PersonsRespect for Vulnerable Persons Respect for Privacy and ConfidentialityRespect for Privacy and Confidentiality Respect for Justice and InclusivenessRespect for Justice and Inclusiveness Balancing Harms and BenefitsBalancing Harms and Benefits Minimizing HarmMinimizing Harm Maximizing BenefitMaximizing Benefit

CNA Code of Ethics for Registered CNA Code of Ethics for Registered NursesNurses

Safe, Competent, and Ethical CareSafe, Competent, and Ethical Care Health and Well BeingHealth and Well Being ChoiceChoice DignityDignity ConfidentialityConfidentiality JusticeJustice AccountabilityAccountability Quality Practice EnvironmentsQuality Practice Environments

Concluding RemarksConcluding Remarks

No single paradigm for ethics: principalism is No single paradigm for ethics: principalism is one attempt to incorporate various strands into one attempt to incorporate various strands into one comprehensive systemone comprehensive system

Not meant to be algorithmicNot meant to be algorithmic Hardest decisions are ones where principles Hardest decisions are ones where principles

clash and we have obligations pointing in clash and we have obligations pointing in different directions.different directions.

Sound judgment and humility requiredSound judgment and humility required