Truth Telling Flashcards
what is the railroad problem?
how is it relevant to medical practice?
should you divert the track to kill one person instead of 5…
puts into perspective the difficult choices that need to be made when treating patients
what is Utilitarianism?
Whether action is right or wrong depends on its outcome, not the act itself
A good act is one that maximises happiness for the most people possible whilst minimize suffering
in the context of the railroad problem, what would a Utilitarian do?
Utilitarian would say you should divert the train
Utilitarian would say we should tell the truth if it will lead to a good outcome
We should lie if it would lead to a better outcome than the truth
compare ‘Act’ Utilitarian vs ‘rule’ Utilitarian?
Act: each act evaluated separately – do the thing that in that particular circumstance would lead to the most happiness
Rule: extrapolate act such that you could be satisfied that if people generally behaved in this way, it would lead to the maximal happiness in comparison to doing something else. E.g. even though doing something in a situation would lead to maximal happiness you may still not choose to do it as it would cause suffering if it were to be done for all cases.
what are the advantages of utilitarianism?
Seems pretty intuitive - marries up with how some of us think about morality
Is considered as a form of distributive justice - distribution of welfare / wellbeing is done in a way to ensure maximal happiness for the most people and can therefore deal with the good of societies, not just individuals.
Flexible - considers the particulars of a situation (consequences), not just rigid rules.
(Although, with rule utilitarianism you do end up with a list of rules however these are designed to achieve optimal welfare)
what are the disadvantages of utilitarianism?
Consequences can be pretty difficult to predict
If you predict a good outcome, but get a bad one a pure utilitarian would say the act was morally wrong!
Consequences can also be far-reaching (affect things very far down the line), or impossible to measure
How do you weigh up benefits / detriments?
People have no intrinsic value in this system
People are a means to an end - one individual would be expendable in the interests of many (trolley problem)
Example: If you have a young person, wouldn’t it create more happiness if you euthanise and harvest all his organs to give to 15 other people who require them. Rule utilitarianism was created to combat this (if you killed all young people it would be a major detriment to society)
In this system, one person might feasibly be considered as more valuable than another, depending on their ability to lead to more happiness e.g. a billionaire who employs a lot of people is more valuable than someone who is unemployed.
what are Deontological Ethics?
Based on the idea that we are rational beings, capable of reason, therefore we can decide what our moral duties are and from that decide what actions are right and what actions are wrong
Principle: Actions are inherently right or wrong - it is not about the outcome of those actions – e.g. lying is wrong, even if it helps someone (complete opposite of utilitarianism)
From our reasoning we can generate a list of rules which apply universally, regardless of the situation, and which will allow us to always be ‘in the right’. E.g. lying and killing are universally wrong no matter the situation.
in the context of the railroad problem, what would a deontologist do?
For the rail road track a pure deontologist would not switch the track - won’t take an action that will kill one person
what are the advantages of deontology?
Reflects how at least some people in the population perceive morality
Gives human beings more worth
People are not expendable. They are not ‘a means to an end’ - e.g they should not be sacrificed for the happiness of others
It places value on intention 🡪 Offers certainty
don’t have to worry about the probability of certain outcomes just on the action itself
decision making is massively simplified - in a way the decision is already made, if you live by a rigid moral code
what are the disadvantages of deontology?
- Too rigid
there are always going to be cases that don’t fit – (e.g. if a murder came to you asking where your friend is to kill him a pure deontologist would tell the truth as lying is immoral)
… so you end up with huge lists of exceptions - allows acts that cause immense suffering in the defence of a principle
classically, the ‘railroad track’
But also, small things - “did he suffer, doc?” (if they died in pain you would have to tell the truth to the relative causing unnecessary pain) - duties often conflict – one rule conflicts with another e.g. do you lie or steal (both immoral and no emphasis is placed on the consequence)
- how rational are we really? Are we all rational?
what are the Four Principles specifically for medical ethics (form of ethical pluralism)?
it is a form of ethical pluralism
beneficence
non-maleficience
autonomy
justice
what is a disadvantage of Four Principles specifically for medical ethics?
difficult to determine which principle takes priority over others.
explain the myth of objectivity?
None of us are really objective (unbiased) - We all arrive at each decision we make with a pre-existing set of values
Evidence suggests pre-existing values is one of the most important factors influencing people’s decision-making
Often when we say ‘objective’ or ‘rational’ what we mean is ‘without emotion’ - The Greeks disagreed
Aristotle - emotion is the guide of reason
Many cultures across the globe have associated emotions with insight and wisdom, as have modern philosophers
Emotional flags when something doesn’t seem morally right - unpick it to find the root (however emotions can sometimes cloud judgement)
Believing you are objective makes it harder to see that you are wrong and accepting making a mistake.
explain Aristotle’s model of ethics?
it was called virtue ethics
Principle: when you decide on a good moral character and when you want to make a decision you ask yourself what would this good moral character do in this situation and that is what you do. You should keep in mind phronesis, that you have obtained through past experiences, and when making a decision. E.g. I am in a similar situation when I did this something bad happened etc. This decision making will eventually become integrated into you and you won’t have to think as hard.
Essentially this model of ethics is to do with deciding on a moral character (cultivating right values) and they will become part of you – Phronesis (practical wisdom) and integrating your experiences should continually build this person.
Often based around a mentor or role-model
what are advantages of Virtue Ethics?
Phronesis (wisdom in practical actions) does seem to describe pretty accurately many people’s experience of the decision-making process:
- Acknowledges the complexity of decision-making, and the influence of our previous experiences
Most people do report that they have role-models that they emulate
Developmental model - it doesn’t expect us to be perfect, but acknowledges the imperative to improve
what are the disadvantages of Virtue Ethics?
- What is virtue, or who is virtuous?
are you just picking a role model whose values you already share? - nebulous (vague/ unclear) - doesn’t help with decision-making
imagining what an ‘ideal’ doctor would do is difficult – how good’s your imagination? - Self-centred - the Health care professional is central in this model - so where is the patient?
Virtues are exercised in the interests of the patient
However, the patient is still denied agency (decision made on their behalf) - Virtuous character takes years to develop - what about now when we need help?
- Encourages perfectionism - continual comparison to a fictional ‘perfect’ doctor – setting yourself up for failure
- Role-model based - so it can perpetuate ‘problem’ norms and values – e.g. just copying elders means nothing in society changes/develops
what criteria needs to be met in order for us to build successful society?
what happens when ethics are removed from a successful system?
The ethics have been removed from this system so everything else falls apart.
It was unethical not only how patients were treated but staff as well.
Because of no collaboration staff were really overstretched and there was really low moral 🡪 all leading to bad patient care (unsuccessful system)
