Week 3 UTILITARIANISM, DEONTOLOGICAL, VIRTUE ETHICS

Question 1

A moral theory

Answer 1

• 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

Question 2

Virtues

Answer 2

Inner qualities and moral character that
guide one’s behavior towards goodness
* Examples: Courage, Honesty, Wisdom
* Philosophical Background: Aristotelian Virtue Ethics

Question 3

Duty

Answer 3

The responsibilities and obligations that one
owes to oneself and society
* Examples: Keeping Promises, Respecting Others
* Philosophical Background: Kantian Deontology

Question 4

Utility

Answer 4

The principle of maximizing overall
happiness and welfare
* Examples: Cost-Benefit Analysis, Effective Altruism
* Philosophical Background: Utilitarianism (Bentham, Mill)

Question 5

Principles

Answer 5

The basic truths and standards that
guide moral reasoning
* Examples: Justice, Fairness
* Philosophical Background: Principlism (Beauchamp and
Childress) or Contractarianism (Rawls)

Question 6

Virtue Ethics: Rightness of actions is
based on

Answer 6

whether an
action would accord
with the relevant
virtues

Question 7

Deontologism: Rightness of actions is
determined

Answer 7

partly or
entirely by their
intrinsic nature

Question 8

Consequentialism
* Rightness of actions
depends solely on

Answer 8

their consequences
or results

Question 9

Virtue ethicists set __________ _____________ as the highest
goal of humanity

Answer 9

“human flourishing”

Question 10

Aristotle defines virtue as a
habitus (a good habit) or a
disposition of the character to
aim at the good.

Answer 10

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.

Question 11

Aristotle recognized three main criteria for designing virtuous
actions:

Answer 11

• 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.

Question 12

Eudaimonia

Answer 12

• 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

Question 13

• Unlike many theories of obligation, virtue ethics asks us
  to do more than just observe minimal moral rules

Answer 13

it
insists that we aspire to moral excellence, that we
cultivate the virtues that will make us better persons

Question 14

Virtue ethics is goal-directed, not rule-guided.

Answer 14

• 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.

Question 15

Virtue ethics, seeking constant
improvement

Answer 15

• 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.

Question 16

(Modern) Virtue
Ethics

Answer 16

• 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)

Question 17

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.

Answer 17

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.

Question 18

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.

Answer 18

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.

Question 19

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.

Answer 19

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.

Question 20

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

Answer 20

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.

Question 21

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.

Answer 21

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.

Question 22

Virtue ethics Critiques

Answer 22

• 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.

Question 23

Deontology

Answer 23

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.

Question 24

Hypothetical (or conditional) ethical imperatives

Answer 24

• 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.

Question 25

Categorical ethical imperatives

Answer 25

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.

Question 26

Categorical and hypothetical
imperatives
Medicine

Answer 26

• 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.

Question 27

Categorical and hypothetical
imperatives
Health Research

Answer 27

• 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.

Question 28

Categorical and hypothetical
imperatives
Health Policy Making

Answer 28

• 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.

Question 29

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

Answer 29

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.

Question 30

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

Answer 30

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.

Question 31

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.

Answer 31

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.

Question 32

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

Answer 32

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.

Question 33

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.

Answer 33

. 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.

Question 34

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.

Answer 34

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.

Question 35

Deontology critiques

Answer 35

• 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

Question 36

Utilitarianism

Answer 36

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

Question 37

Consequentialism in a nutshell

Answer 37

• 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.

Question 38

Jeremy Bentham - utilitarianism

Answer 38

“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.

Question 39

Utility - synonymous/anonymous with

Answer 39

• 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

Question 40

John Stuart Mill - utilitarianism

Answer 40

“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.”

Question 41

• Act Utilitarianism

Answer 41

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)

Question 42

• Rule Utilitarianism

Answer 42

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)

Question 43

Utilitarianism critiques

Answer 43

• 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

Question 44

There are
so many
moral
theories,
which one
should I
choose? (Focus?)

Answer 44

Virtue Ethics
* Focuses on
character
Deontology
* Focuses on
duties
Utilitarianis
m
* Focuses on
consequences
of actions (&
maximising
utility)