Week 2

Question 1

How do individuals decide what is ethical?

Answer 1

Obedience
Imitation
Feeling or desire
Intuition
Habit

Question 2

What is the aim of ethical theories?

Answer 2

Aim to help us think clearly about ethical dilemmas
* Orientation for justified options
* Answers for Justified course of action

Question 3

Name 3 ethical theories

Answer 3

1. Consequentialism (Utilitarianism)
2. Deontology
3. Virtue Ethics

Question 4

What is Consequentialism?

Answer 4

An action is right if it promotes the best consequences
* The Internet Encyclopedia of Philosophy definition of consequentialism:
* Of all the things a person might do at any given moment, the morally
right action is the one with the best overall consequences.
* In bioethical terms, such an
approach is evident in discussions
of likely risks vs benefits.

Question 5

What does a consequentialist believe?

Answer 5

A consequentialist (one who believes in this theory) will find that the
best way to proceed in ethical dilemmas resides in the best outcome.
* whatever choices increase the Good, are the choices that it is morally right to
make (The Good in that sense is said to be prior to “the Right.”)
* In other words attention is focused on the end product as opposed to
what means is used to achieve that end. The ‘means’ to achieve this end may be viewed as ethical or
unethical….
* Depending on your moral code.

Question 6

What are the limitations of consequentialism?

Answer 6

1. Future consequences are difficult to predict
   * We cannot predict every outcome of an event
2. Measuring and comparing the ‘goodness’ of consequences
   is very difficult
   * what should be assessed in calculating good consequences?
3. Choosing different time periods may produce different
   consequences
   * eg. An intervention may offer good short-term results, but in the
   long-term it may lead to the development of other health
   conditions
4. It ignores things we regard as ethically relevant
   * For example, the intentions of the person doing the act;
   * the character of the person doing the act;
   * the fairness of the result

Question 7

What is utilitarianism?

Answer 7

A BRANCH OF CONSEQUENTIALISM
* Utilitarianism is an ethical theory that determines right from
wrong by focusing on outcomes
* Utilitarianism holds that the most ethical choice is the one
that will produce the best outcome for the MOST PEOPLE
* ‘consists of consequentialism together with the identification
of the best state of affairs in which there is most happiness,
most pleasure, or the maximum satisfaction of desire’.

Question 8

Explain Utilitarianism in Philosophy

Answer 8

Utilitarian concepts are said to derive from the work of Jeremy
Bentham and John Stuart Mill
* It is “the greatest good to the greatest number of people” which is
the measure of right and wrong.
* “Nature has placed mankind under the governance of two sovereign
masters, pain and pleasure”
* “actions are right in proportion as they tend to promote happiness,
wrong as they tend to produce the reverse of happiness” -

Question 9

What is Utility and Welfare maximisation?

Answer 9

Utilitarianism states that people should maximise human
welfare or well-being or health (principle of ‘utility’).
* It seems sensible to base ethics on producing happiness and
reducing unhappiness
* It seems sensible to base ethics on the consequences of what
we do, since we usually take decisions about what to do by
considering what results will be produced
* It seems easy to understand and to be based on common
sense

Question 10

What is the decision-making method?

Answer 10

Utilitarianism offers a relatively straightforward method for
deciding the morally right course of action
* To discover what we ought to do in any situation,
1. we first identify the various courses of action that we could
perform.
2. we determine all of the foreseeable benefits and harms that
would result from each course of action for everyone affected by
the action.
3. we choose the course of action that provides the greatest
benefits (for the majority) after the costs have been taken into
account.

Question 11

What are the principles of utility?

Answer 11

In act utilitarianism the principle of utility is directly used to guide
actions [assess and promote the consequences of specific actions]
* In rule utilitarianism, the principle of utility is used to formulate general
rules which in turn are used to guide actions [best rules to follow overall]

Question 12

Utilitarianism in healthcare?

Answer 12

The greatest amount of quality healthcare for the maximum number of
patients possible.
For a utilitarian, the ethically correct action will be that which
results in the maximum overall benefit.
* in making decisions about health care this theory requires
consideration of the benefit to be gained from the various
competing options in terms of the improvement in health for
an individual and also the number of individuals who could
benefit.

Question 13

What are the criticisms for utilitarianism?

Answer 13

Several criticisms of consequentialism apply for the utilitarian approach
* Because we cannot predict the future it is difficult to know with certainty
whether the consequences of our actions will be good or bad
* the utilitarian calculation requires that we assign values to the
benefits/harms resulting from our actions and compare with other
actions
* But it’s often difficult, if not impossible, to measure and compare
the values of certain benefits and costs.
* How do we go about assigning a value to life?
* And do we compare the value of money with, eg the value of life?
* Utilitarianism faces severe limitations accounting for values such as
justice and individual rights

Question 14

Ethical issues associated with costing healthcare?

Answer 14

Today utilitarians often describe benefits and harms in purely economic terms of
monetary benefits over monetary costs.
* Resource allocation (money, time, equipment, organs etc)
* Who will choose?
* The patient
* The doctors
* The government

Question 15

How is healthcare resource allocation determined?

Answer 15

Measure of QALYs - Quality-adjusted life year is a generic measure of disease
burden, including both the quality and the quantity of life lived
* Measure of DALYs - Disability-adjusted life year is a measure of disease burden,
expressed as the cumulative number of years lost due to ill-health/disability

Question 16

What is deontological ethics?

Answer 16

• Deontological ethics is often seen as the opposite of consequentialist
  ethics.
• Where the consequentialist is concerned with the outcome of the
  action, the deonotologist is concerned with the nature of the action
  itself
• the rule/law/reason for which an action was taken
• For the deontologist, some actions like murder are just inherently
  wrong, no matter the ultimate result.
• ‘Right’ has priority over the ‘Good’

Question 17

What is the key focus of deontology?

Answer 17

An action is right if it is in accordance with a moral rule or principle
* Some actions are morally forbidden
* Some actions are morally permissible

Question 18

Deontology in terms of duties and rights?

Answer 18

Deontology is a duty-based scheme of ethics
* Approaches framed around what people must do or must not do
[duties]
* others on what must be done or must not be done to people
[individual rights]
* In medical ethics this translates to duties/requirements/obligations that
should be followed and fulfilled without exception

Question 19

What is a moral rule?

Answer 19

A moral rule is one that
* is laid on us;
* is required by reason;
* would be chosen by all rational beings

Question 20

What two imperatives does deontology consist of?

Answer 20

Hypothetical imperative: do this in order to achieve that
Categorical imperative: do this! [unconditional command]

Question 21

What are parameters of an ethical act?

Answer 21

1. Self
   – Are you ready to accept the same act on yourself?
2. Universalisability
   – If you can universalise an act and still it is right, then it is ethical.
3. Means
   – Any person should not be used as the means but always at the
   same time as an end; (people are equal and deserve equal
   respect)

Question 22

What are deontology’s strengths?

Answer 22

1. simple to apply; requires that people follow the rules and do
   their duty.
2. tends to fit well with our natural intuition about what is or isn’t
   ethical.
3. Unlike consequentialism, deontology doesn’t require weighing
   the costs and benefits of possible consequences. This avoids
   subjectivity and uncertainty

Question 23

What does a rule-based ethical theory mean in medical practice?

Answer 23

-It would mean that the doctor attends to each patient with the same
set of rules
-Rules which are set before the consultation and are not permitted to
be broken
-the moral acts of the doctors are to be judged in terms of their
conformity to rules, duties or obligations.

Question 24

What are the challenges with rule-based medical ethics?

Answer 24

• Each patient is a unique person with individual
  health needs
• one set of rules will inevitably not suit every patient or not apply to
  any situation
• Having a set of pre-set rules allows no much room for manoeuvre in
  varying situations
• Also, if rules or duties conflict, it may not be clear what one should
  do

Question 25

Criticisms of rule-based ethics?

Answer 25

1. Moral rules can seem quite abstract and unable to deal with the
   complexity of real ethical dilemmas
2. room for disagreement about what the rules require (for example,
   whether the rule against killing another human being would prohibit
   abortion or capital punishment)
3. rigidly following deontology leads to disregarding the possible
   consequences of our actions when determining what is right and what
   is wrong
   It can produce results that many people find unacceptable

Question 26

Ethical theories summarised

Answer 26

Consequentialist/Utilitarian; Outcome-focused
Deontological; Duty-based

Question 27

Who is Michael Stocker?

Answer 27

-Contemporary ethicist, rejects both
Utilitarianism and Deontology
-He maintains that these views take the focus away from the
person and transfer the light of importance to principles,
rules and obligations.

Question 28

What is virtue ethics?

Answer 28

Virtue; character trait/skill/way of living;
taking a certain person’s behaviour as an indicator of their character;
it is from their actions that we can suppose they have certain virtues.

Question 29

Where does virtue ethics come from?

Answer 29

Virtue ethics is often traced back in ancient Greek
philosophy (Socrates, Aristotle)
* In East it is linked with the writings of Mencius and
Confucius

Question 30

What counts as virtue?

Answer 30

• Socrates; How should a man live in order to achieve eudaimonia?
  (happiness/flourishing)
• Aristotle: a genuinely virtuous person is one who achieves true
  happiness and satisfaction
• Rosalind Hursthouse and Philippa Foot: virtue is what promotes
  human flourishing

Question 31

Aristotle’s view on virtue

Answer 31

the right act is one that a virtuous person would do in the
circumstances

Question 32

What are the 4 virtues?

Answer 32

1.Prudence
2. Justice
3. Fortitude
4. Temperance

Question 33

What is prudence?

Answer 33

is right reason applied to action

Question 34

What are the three steps of prudence?

Answer 34

1. take counsel
2. judge
3. command

Question 35

What is gnome?

Answer 35

to wit or judge when departure from the common rules is called upon

Question 36

What is justice?

Answer 36

Giving each patient what is due to them
* Being fair to your patients; the notion that patients in similar
positions should be treated in a similar manner.
*Equality is at the heart of justice, but, as Aristotle noted, justice is more than
mere equality -people can be treated unjustly even if they are treated
equally.
*He argued that it was important to treat equals equally (what health
economists call horizontal equity) and to treat non-equals unequally in
proportion to the morally relevant inequalities (vertical equity

Question 37

What is fortitude?

Answer 37

-moral courage which enables one to act reasonably and
appropriately
-ability to cope, make sound decisions with firmness and strength
* in the face of difficulties or under pressure
* in particular when a patient is in danger of death

Question 38

What is temperance?

Answer 38

All decisions made are well measured and moderated and free
from any self-interest
➢Decisions taken by doctors and healthcare professionals may
involve putting the best interests of patients’ and the clinical team
before one’s own

Question 39

Summary of the 4 virtues

Answer 39

Question 40

What is the distinctive focus of Virtue Ethics?

Answer 40

Virtue ethics is agent – based
* Considering Character
* Concerned with a person’s motivation for action (ethical behaviour), and not with
the rightness or consequences of the action itself [An act can be beneficial, but
the motivations for the act can still not be morally good]
* A virtuous person does right acts for the right motives
* For example, if one performs a compassionate act, it is because one has a
compassionate character in order to act in a compassionate way.
* For the virtuous person, it is intrinsically good to be compassionate, at the
right time - in the right way - toward the right people, and the person’s
actions reflect this belief.
* The Golden Mean - Whatever is moderate is right
Cowardice - Courage - Recklessness

Question 41

What are the criticisms for virtue ethics?

Answer 41

• Much of our behaviour is not the result of our characters, our character traits,
  and our virtues, but rather is controlled by the situation in which behaviour
  occurs
• virtue theory may be too individualistic; The focus should be on what acts
  contribute to the good of all (or the benefit of the whole)
• Unhelpful in resolving moral conflicts; even virtuous individuals often are
  unsure how to act in particular situations

Question 42

Explain virtue ethics in medicine?

Answer 42

The character of the virtuous doctor;
➢we are what we repeatedly do.
Excellence, then, is not an act but a
habit (Aristotle) - A settled
disposition (Thomas Aquinas)
➢ virtue is a good habit
➢ doctor becomes naturally
orientated to do what is right -good -
ethical –legal
➢ simply for the good in itself
➢ the medical good of his/her patient
not out of fear

Question 43

What is the virtues of doctors?

Answer 43

*Good character alone does not ensure that the right decision is made.
* Virtues must be linked to the obligations the physician owes his patient.
* commitment to the good of the patient over one’s own self-interest
* Pellegrino (2006) wrote that the medical virtues
“focus primarily on those traits necessary to do the work of medicine well.
The good that medicine seeks … is ultimately the preservation, promotion and
restoration of health”

Question 44

The virtues of doctors summarised

Answer 44