Week 3 UTILITARIANISM, DEONTOLOGICAL, VIRTUE ETHICS Flashcards
A moral theory
- is a discourse constituted by a structured set of normative,
coherent, and in principle justifiable assertions. - explains why an action is right or wrong or why a person or a
person’s character is good or bad. - It provides grounds on which to establish what is deemed
right/wrong, and the reasons why. - Using (and, to a lesser extend, assessing) moral theories is a
normal, pervasive feature of the moral life
Virtues
Inner qualities and moral character that
guide one’s behavior towards goodness
* Examples: Courage, Honesty, Wisdom
* Philosophical Background: Aristotelian Virtue Ethics
Duty
The responsibilities and obligations that one
owes to oneself and society
* Examples: Keeping Promises, Respecting Others
* Philosophical Background: Kantian Deontology
Utility
The principle of maximizing overall
happiness and welfare
* Examples: Cost-Benefit Analysis, Effective Altruism
* Philosophical Background: Utilitarianism (Bentham, Mill)
Principles
The basic truths and standards that
guide moral reasoning
* Examples: Justice, Fairness
* Philosophical Background: Principlism (Beauchamp and
Childress) or Contractarianism (Rawls)
Virtue Ethics: Rightness of actions is
based on
whether an
action would accord
with the relevant
virtues
Deontologism: Rightness of actions is
determined
partly or
entirely by their
intrinsic nature
Consequentialism
* Rightness of actions
depends solely on
their consequences
or results
Virtue ethicists set __________ _____________ as the highest
goal of humanity
“human flourishing”
Aristotle defines virtue as a
habitus (a good habit) or a
disposition of the character to
aim at the good.
Virtues are both the traits that
make us good persons and the
dispositions that enable us to
live good lives. The good life is
the virtuous life.
Aristotle recognized three main criteria for designing virtuous
actions:
- the model of the wise person (the phronimos),
- the measure of the golden mean (the mesotes), and
- the faculty of the right (practical) reason (the orthos logos).
- The agent determines by herself (and not based on a moral code)
which action is right or good, deliberating through a complex
process of confrontation between the reasons in favor and against
the various options.
Eudaimonia
- Virtue ethics is teleological since it maintains that
human beings pursue a “telos” (a purpose):
eudaimonia, or the “good life” - Eudaimonia refers to happiness, prosperity or bliss
- Unlike many theories of obligation, virtue ethics asks us
to do more than just observe minimal moral rules
it
insists that we aspire to moral excellence, that we
cultivate the virtues that will make us better persons
Virtue ethics is goal-directed, not rule-guided.
- Possessing the right virtues means having the proper
motivations that naturally accompany those virtues. - The moral virtues— benevolence, honesty, loyalty,
compassion, fairness, and the like— are ideals that we
must ever strive to attain - It is not enough to do right; we must do right for the
right motivating reasons. - If we save a drowning friend, we should do so out of genuine
feelings of compassion, kindness, or loyalty— not because of
the prodding of moral rules or social expectations.
Virtue ethics, seeking constant
improvement
- Being virtuous is not only a matter of acquiring virtues,
it is also attained through the practice of virtues
(repetition, acting consistently in a virtuous way). - The acquisition of virtues should be done voluntarily.
- Hence, eudaimonia is not achieved through
instrumental rationality, but through the form of
rationality that Aristotle calls “practical”. - The virtue par excellence of practical reason, proper to
ethics and politics, is prudence.
(Modern) Virtue
Ethics
- The emphasis on character has
become the mark of a “renaissance”
of virtue ethics in recent times, often
appealing to the role of feelings as
an integral part of the person. - Alasdair MacIntyre (1981) has
recalled the need for the
reintroduction of the notion of an
intrinsic end (telos) as the basis for
recognizing the values at stake in
each practice. - For example: Medicine is a practice
led by the goal/ value of caring (not
just a technique), which implies
some socially recognized
requirements (scientific competence,
fairness, concentration on the good
ofthepatient,confidentiality)
Virtue ethics: Terminally ill patient
A physician treating a terminally ill patient must balance the virtues of honesty, empathy, and respect
for the patient’s autonomy. Instead of simply following rules or protocols (like “always tell the truth” or
“do not harm”), the virtuous physician considers how to communicate the terminal diagnosis with
compassion. They think carefully about the patient’s emotional state, what level of detail the patient
may wish to hear, and the right moment to offer support or discuss palliative care options.
This approach goes beyond simply following guidelines or performing technical procedures; it
recognizes that the practice of medicine is rooted in virtues like benevolence (acting in the patient’s
best interest), practical wisdom (knowing how and when to act), and trustworthiness (maintaining
patient confidentiality and being reliable in care).
Virtue ethics in this context provides a moral framework that ensures the physician’s actions are not
just technically correct but also aligned with the broader goal of caring for the patient holistically,
attending to their physical, emotional, and ethical needs.
This application aligns with MacIntyre’s notion of practices having intrinsic ends, where medicine’s end
is not merely curing disease but caring for the whole person with moral excellence.
Virtue Ethics: Pain Management
* A physician is treating a patient with chronic pain, a
condition that has persisted despite numerous
interventions. The patient expresses significant
distress, and conventional pain medications have led
to minimal relief. The physician must decide on the
next steps, weighing the use of stronger opioids
against potential long-term consequences, such as
dependency and side effects. Practical wisdom is
essential for determining the right balance between
managing the patient’s pain effectively and avoiding
the risk of addiction or harm from medication overuse.
* In addition, the physician must display empathy to
fully understand the patient’s experience of pain and
suffering. This connection ensures that the patient
feels heard and cared for, even as the physician
navigates the complexities of the medical decisions
involved. By combining practical wisdom and
empathy, the physician can create a treatment plan
that addresses the patient’s physical and emotional
needs while considering the broader risks and benefits
of the chosen therapy.
Golden
Mean
for Practical
Wisdom
Deficiency (rigidity):
The physician might
rigidly adhere to
standard protocols
without considering the
patient’s unique
circumstances, leading
to inadequate pain
management.
Excess
(recklessness): The
physician could
prescribe high doses of
opioids without regard
for the risks of
addiction, leading to
potential harm.
Golden Mean: The
physician carefully
balances the patient’s
pain relief with the
consideration of longterm consequences,
making a flexible,
reasoned decision that
promotes both
immediate comfort and
future well-being.
Golden
Mean
for
Empathy
Deficiency
(detachment): The
physician might be
emotionally distant,
failing to understand
the patient’s pain and
emotional suffering.
Excess (overidentification): The
physician could
become overly
involved, leading to
impaired judgment due
to emotional
entanglement.
Golden Mean: The
physician listens
empathetically to the
patient’s concerns,
understanding their
pain, but maintains
professional distance to
make objective medical
decisions.
In this case, balancing practical wisdom and empathy
through the Golden Mean helps the physician formulate a
treatment plan that is both medically sound and
emotionally attuned to the patient’s experience.
Virtue ethics: Breaking Bad News
* A physician must deliver the diagnosis of
terminal cancer to a patient who had been
hopeful about their treatment. The physician
knows that full disclosure is necessary for the
patient to make informed decisions about their
care and quality of life. However, delivering
such news requires a balance of honesty,
ensuring that the patient understands their
condition without diminishing hope or causing
unnecessary emotional harm.
* In parallel, the physician must approach the
situation with compassion, considering how this
life-altering information will affect the patient
emotionally and mentally. Compassion guides
the physician in choosing how to present the
diagnosis gently, supporting the patient
through the difficult process of acceptance
while encouraging a focus on the quality of life
and available support.
Golden Mean for Honesty
Deficiency
(deception): The
physician might
withhold critical
information, preventing
the patient from fully
understanding their
prognosis.
Excess (bluntness):
The physician might
deliver the diagnosis
harshly, overwhelming
the patient and
creating unnecessary
distress.
Golden Mean: The
physician
communicates the
truth clearly and
transparently but does
so in a sensitive,
thoughtful manner that
respects the patient’s
emotional state
Golden
Mean for
Compass
ion
Deficiency
(callousness): The
physician might
disregard the patient’s
emotional reaction,
appearing uncaring in
the face of their
suffering.
Excess (overinvolvement): The
physician might
become overly
emotionally invested,
making it difficult to
maintain the
professional objectivity
needed to guide the
patient.
Golden Mean: The
physician expresses
sincere care and
support while
maintaining enough
emotional distance to
continue providing
effective and objective
medical care
The physician balances the Golden Mean of honesty and
compassion by delivering the truth about the diagnosis
while providing emotional support, ensuring that the
patient is informed yet feels cared for during this difficult
moment.
Virtue ethics: Resource Allocation
* In the case of organ transplantation, a
healthcare team is responsible for deciding
which patients receive a limited number of
available organs. They must follow medical
criteria to ensure a fair and equitable process.
The virtue of justice requires that the team apply
impartial and consistent standards, ensuring
that no one receives an unfair advantage and
that the allocation process serves the common
good, focusing on factors such as medical
urgency and likelihood of success.
* At the same time, the team must honor the
virtue of fidelity by maintaining loyalty and
dedication to the patients under their care. This
means keeping patients informed about their
status on the waiting list, providing emotional
support, and ensuring that their individual needs
are considered, even within the constraints of a
broader system of fairness
Golden
Mean
for
Justice
Deficiency
(favoritism): The
team might allow
personal biases or
external pressures to
influence their
decisions, favoring
certain patients
unfairly.
Excess (strict
egalitarianism): The
team might treat all
patients the same,
ignoring relevant
individual differences
such as medical
urgency or suitability
for the organ.
Golden Mean: The
team applies fair,
consistent standards
for organ allocation,
but remains sensitive
to the individual needs
of each patient when
considering special
circumstances.
Golden
Mean
for
Fidelity
Deficiency (neglect):
The team might
disregard their duty to
inform and support
patients awaiting
transplantation, leading
to feelings of
abandonment or
confusion.
Excess (partiality):
The team might
prioritize one patient’s
case based on personal
connections or
emotional ties,
compromising the
fairness of the process.
Golden Mean: The
team maintains loyalty
to each patient by
providing transparent
information and
emotional support
while adhering to fair
allocation criteria.
By striking the Golden Mean between justice and fidelity,
the medical team ensures fair allocation of resources, such
as organs for transplant, while continuing to honor
commitments to the patients under their care.
Virtue ethics: Medical Errors * A surgeon realizes after a procedure that a
mistake was made, which could result in
complications for the patient. The surgeon faces a
difficult choice: admit the error and risk legal
consequences, or conceal it and hope it goes
unnoticed. The virtue of courage is essential here,
as the surgeon must confront the fear of
professional and legal repercussions and disclose
the mistake to the patient and their family. This
requires bravery in the face of potential negative
outcomes.
* Simultaneously, the virtue of integrity guides the
surgeon to act with honesty and transparency.
Integrity demands that the surgeon take
responsibility for the error, be truthful about what
happened, and work diligently to correct the issue.
This also includes learning from the mistake to
improve future practice. Together, courage and
integrity ensure that the surgeon addresses the
mistake ethically and constructively.
Golden
Mean
for
Courage
Deficiency
(cowardice): The
surgeon might avoid
admitting the error,
compromising patient
safety and undermining
trust.
Excess
(recklessness): The
surgeon might disclose
the error without
considering the best
approach to mitigate
harm or provide
solutions.
Golden Mean: The
surgeon bravely admits
the mistake and
addresses it
responsibly, ensuring
that the patient’s care
is prioritized and trust
is maintained.
Golden
Mean
for
Integrity
Deficiency
(dishonesty): The
surgeon might fail to
disclose the error fully,
evading responsibility
and creating further
risks for the patient.
Excess
(overzealousness):
The surgeon might take
on too much blame or
become overly selfcritical, affecting their
ability to continue
practicing effectively. Golden Mean: The
surgeon takes
appropriate
responsibility for the
error, acts
transparently, and
works toward
correcting the issue
while maintaining a
balanced sense of
accountability and self reflection
In this situation, the physician must balance courage and
integrity by responsibly acknowledging the mistake and
acting to correct it, while maintaining professional
composure and learning from the experience.
Virtue ethics Critiques
- Virtue ethics is fundamentally personal and hardly
collective or political. - Present difficulties of being promoted as an interesting
ethic for policymakers. - In public ethics, what is needed is to determine some
rules which can be shared by people with different
moral outlooks: the state in a complex society functions
as a neutral territory for rather homogeneous
communities, but cannot permit the values of one of
these to override the others.
Deontology
The core of morality consists of following a rational and
universally applicable moral rule and doing so solely out
of a sense of duty
* According to Kant, deontology is “[…]
the necessity of doing something out
of respect for the law”
* While virtue ethics pertained to
being, deontology pertains to doing.
Hypothetical (or conditional) ethical imperatives
- a hypothetical imperative is a command to do something if we want to achieve particular
aims, as in “If you want good pay, work hard.” - the moral law, then, rests on absolute directives that do not depend on the contingencies of
desire or utility.
Categorical ethical imperatives
unconditional, because they represent things that are
desirable in themselves.
* An imperative is a command to do something; it is categorical if it applies without exception
and without regard for particular needs or purposes.
* A categorical imperative says, “Do this—regardless.
Categorical and hypothetical
imperatives
Medicine
- Hypothetical Imperative Example:
- A physician advises a patient, “If you want to lower your blood pressure, you should
follow a low-sodium diet.” - This is a hypothetical imperative because the command is conditional: it applies
only if the patient wants to achieve a specific goal, such as lowering blood pressure. If
the patient does not care about their blood pressure, the imperative doesn’t apply. - Categorical Imperative Example:
- A physician is faced with a decision of whether to disclose a serious medical error to
the patient. According to Kant’s categorical imperative, the physician must disclose
the error, regardless of potential consequences for their reputation or career. - The categorical imperative here is that truth-telling and respect for patient
autonomy are moral obligations in themselves. The physician must act truthfully, not
because it will lead to a good outcome (such as maintaining trust), but because telling
the truth is a moral duty.
Categorical and hypothetical
imperatives
Health Research
- Hypothetical Imperative Example:
- A researcher advises a colleague, “If you want to publish quickly, use this data analysis
method.” - This is a hypothetical imperative because the action (choosing a specific method)
depends on the goal of quick publication. The action is conditional upon the researcher’s
desire to publish swiftly, and this imperative wouldn’t apply if quick publication wasn’t a
goal. - Categorical Imperative Example:
- In conducting research on human subjects, a researcher is obligated to obtain informed
consent from participants. According to Kant’s categorical imperative, this must be
done regardless of the potential benefit to science or how much time it takes. - This is a categorical imperative because respecting the autonomy and dignity of
research participants is an unconditional duty. The obligation to obtain consent does not
depend on the researcher’s goals or the potential for scientific advancement; it is a moral
requirement in itself.
Categorical and hypothetical
imperatives
Health Policy Making
- Hypothetical Imperative Example:
- A health policy maker might state, “If we want to reduce healthcare costs, we should limit
access to certain expensive treatments.” - This is a hypothetical imperative because the policy action (limiting access) is based on the
conditional goal of reducing healthcare costs. If the policy makers had different goals (such as
improving access to care regardless of cost), this imperative would not apply. - Categorical Imperative Example:
- A health policy maker must ensure that policies provide equitable access to basic healthcare
for all citizens. According to the categorical imperative, the policy maker is morally required
to protect the right to healthcare for everyone, regardless of budgetary constraints or political
pressure. - This is a categorical imperative because it reflects an unconditional moral duty to ensure
fairness and equal access to essential healthcare services. The policy maker’s actions should
not depend on external factors like financial goals; ensuring equity is a moral requirement in
itself.
1st
Formulation
Universalizability
“Act in such a
way that the
maxim of your
will can always
be considered as
a principle of
universal
legislation.
Truth-telling in Medicine
* A physician is asked by a terminally ill patient about their prognosis
According to
the first formulation, the physician must act according to a maxim that could be
universally applied. The maxim here is, “One must always tell the truth to patients
about their condition.” If the physician considers lying to the patient to spare their
feelings, they must ask whether it would be acceptable for everyone to follow this
principle. If universal lying were permitted, trust between doctors and patients
would break down. Therefore, the physician is morally required to tell the truth,
even if it is difficult.
1st
Formulation
Universalizability
“Act in such a
way that the
maxim of your
will can always
be considered as
a principle of
universal
legislation.
Informed Consent in Clinical Research
* A researcher considers bypassing informed consent to speed up their clinical trial
The maxim would be, “One may bypass informed consent if it benefits the
research.” However, according to Kant’s first formulation, if this maxim were
universalized, all researchers could bypass informed consent, undermining the
autonomy of participants and trust in research. Since this would lead to unethical
outcomes if universally applied, the researcher is morally obligated to obtain
informed consent from every participant, regardless of how much it slows the
process.
1st
Formulation
Universalizability
“Act in such a
way that the
maxim of your
will can always
be considered as
a principle of
universal
legislation.
Using Unverified Treatments During a Health Crisis
* During a rapidly spreading pandemic, a researcher proposes using an untested
drug to treat critically ill patients.
The maxim would be, “It is acceptable to use
unverified treatments during emergencies to save lives.” If this were universalized,
it could lead to widespread use of unsafe or ineffective treatments, eroding public
trust in medicine. Therefore, the researcher must adhere to ethical standards of
testing and approval, even during a crisis. This ensures that treatments are safe
and effective before being widely administered, following a principle that can be
universally applied without harmful consequences.
2nd
Formulation
Universalizability
“Act so that you
treat humanity,
whether in your
own person or in
that of any other,
always also as an
end and never as
a means only.
Respecting Patient Autonomy in Treatment Decisions
* A physician considers overriding a patient’s wishes in order to perform a life-saving
surgery that the patient has refused
According to the second formulation, the
patient must be treated as an end in themselves, meaning their autonomy and
dignity must be respected. Even though the physician believes the surgery would
save the patient’s life, treating the patient as a mere means to achieve a good
outcome (survival) would violate their autonomy. The physician must respect the
patient’s decision, ensuring they are treated as an autonomous individual, not just
as a tool for achieving a medical goal.
2nd
Formulation
Universalizability
“Act so that you
treat humanity,
whether in your
own person or in
that of any other,
always also as an
end and never as
a means only.
Patient Privacy in Health Policy
* A health policy maker is designing a system to share patient data for research
purposes.
. According to the second formulation, patients’ data cannot be used
solely as a means for scientific discovery; the privacy and dignity of each patient
must be protected. Patients must be treated as ends in themselves, meaning their
data can only be used in ways that respect their autonomy and confidentiality. The
policy maker must ensure that patients give informed consent for the use of their
data and that robust safeguards are in place to protect their privacy.
2nd
Formulation
Universalizability
“Act so that you
treat humanity,
whether in your
own person or in
that of any other,
always also as an
end and never as
a means only.
Testing Vaccines on Vulnerable Populations
* A pharmaceutical company considers conducting vaccine trials in a developing
country where regulatory standards are more lenient and participants are less
likely to question the risks.
According to the second formulation, the company
must not treat participants as mere means to the end of faster, cheaper trials.
Exploiting vulnerable populations for the sake of research efficiency reduces them
to tools for achieving scientific gains. The company must ensure that participants
are treated as ends in themselves, meaning they are given full information,
adequate protection, and the opportunity to give informed consent. The trials
should be held to the same ethical standards as those in wealthier countries,
respecting the dignity and autonomy of all participants.
Deontology critiques
- Understanding morality as a law issued by practical
reason alone leaves the world of emotions and feelings
out of the picture and sees persons as isolated from
each other. - There also exist the issue of conflicting obligations:
- i.e., deontologist seek to keep their hands clean by respecting
certain formal principles rather than by promoting some end,
but that can lead to counter-intuitive decisions. - (Like we saw with lying
Utilitarianism
It is an ethical theory that stems from consequentialism, according to which
the morality of an action (or inaction) is determined on the basis of the
consequences it generates
- The leading consequentialist theory is utilitarianism, the view that right
actions are those that result in the most beneficial balance of good over bad
consequences for everyone involved. - Without promoting a conception of the “good life” (as Aristotle does),
utilitarianism gives a certain orientation to consequentialism, which is—as its
name suggests—that of utility. - Maximize the nonmoral good (the utility) of everyone affected, regardless
of the contrary urgings of moral rules or unbending moral principles. - Modern or “classical” utilitarianism was systematized by Western thinkers
Jeremy Bentham (1748–1832) and John Stuart Mill (1806–1873). - … believe that the purpose of morality is to make life
better by increasing the amount of good things (such as
pleasure and happiness) in the world and decreasing the
amount of bad things (such as pain and unhappiness). - … reject moral codes or systems that consist of commands
or taboos that are based on customs, traditions, or orders
given by leaders or supernatural beings. - … think instead that what makes a morality be true or
justifiable is its positive contribution to human (and
perhaps non-human) beings
Consequentialism in a nutshell
- In a consequentialist framework, moral
assessment is - an assessment of instrumental or extrinsic value.
- Extrinsic assessment because (unlike in
Deontology), moral principles are: - only of value if they maximize positive consequences,
or minimize negative ones, either directly or
indirectly - Consequentialist moral theories insist that the rightness
of actions depends solely on their consequences or
results. - The key question is what or how much good the actions
produce. - Often referred as the theory of the greatest good for the
greatest number. - The good can either be utility or happiness.
Jeremy Bentham - utilitarianism
“Everybody to count for one,
nobody for more than one”
* So, it doesn’t matter how
many followers you have
on Instagram or TikTok,
your value to Bentham is 1
like anybody else.
Utility - synonymous/anonymous with
- synonymous with:
- benefit, advantage, pleasure, good or happiness
- antonymous with:
- mischief, pain, evil or misfortune
- Utility refers to the pleasure and pain that give moral
meaning to our experiences - Interestingly, the content of the terms pleasure, utility and
well-being may change according to utilitarians
John Stuart Mill - utilitarianism
“It is quite compatible with the principle of
utility to recognize the fact, that some kinds
of pleasure are more desirable and more
valuable than others. It would be absurd that
while, in estimating all other things, quality is
considered as well as quantity, the estimation
of pleasures should be supposed to depend
on quantity alone.”
- Act Utilitarianism
Perform that act that will yield the greatest
amount of utility
* Put another way, the right act is determined solely by the
consequences of the act in itself, although considered
probabilistically and within the accessible span of time.
Act utilitarians
focus on the
effects of
individual
actions
(killing a specific
person)
- Rule Utilitarianism
Perform that act that is sanctioned by the
set of rules that, if everyone were to obey them, would yield
the greatest amount of utility
* Put another way, the right act is the one required by the rule that
has the most beneficial consequences when observed systematically
Rule
utilitarians
focus on the
effects of
certain types
of actions (such
as killing or
stealing in
general)
Utilitarianism critiques
- John Rawls (1971):
perspectives personal
characteristics are cancelled
from the moral outlook * If equity is not a consideration,
then the individuals seem to
count only as bearers of welfare
and not as endowed with a
value in themselves - Bernard Williams (1973):
utilitarian thinking threatens
individual integrity * Since utilitarianism requires
that our most personal
motivations and feelings be
superseded by an impersonal
and abstract priority of the
highest quantity of welfare
considered in a complete
separation from the individuals
There are
so many
moral
theories,
which one
should I
choose? (Focus?)
Virtue Ethics
* Focuses on
character
Deontology
* Focuses on
duties
Utilitarianis
m
* Focuses on
consequences
of actions (&
maximising
utility)
