What is ethics?
Philosophy dealing with moral dimension of life
What if right and wrong
What are values?
Concepts or ideals that give meaning to an individual’s life, providing a framework for decisions and actions e.g. religious beliefs, family relationships, prejudices
What are morals?
Standards of right and wrong associated with individuals, groups and society in general
What is a dilemma?
Choice has to be made between different courses of action
Having to choose between 2 or more principles that often conflict
Responsibility for any decision reached is a personal one
What are the 6 normative theories of ethics?
- Consequentialist theories
- Deontological theories
- Four principles approach (Beachamp and Childress)
- Virtue ethics
- Context based ethics- causitry
- Doctrine of double effect
What is the consequentialist theory?
Utilitarianism
Look at the consequences of actions when trying to work out what should be done
Maximise good consequences and minimises bad consequences for the greatest number of individuals
What are the two branches of consequentialist theories?
- Act utilitarianism- We should choose the action that will create the greatest new “good consequence” - greatest good for greatest number of people
- Rule utilitarianism- Follow a rule of action that maximises good consequences and minimises bad consequences. It depends on the correctness of the rules that allows it to achieve the greatest good.
Healthy and unloved individuals should be killed and have their organs harvested on behalf of those individuals who are loved and would otherwise die.
Explain this in terms of act utilitarianism
Act utilitarianism might lead me to decide to adopt this policy, because I’d be looking at the consequences of actions alone.
Killing healthy and unloved individuals and harvesting their organs may increase the number of organs available and decrease the numbers of people dying because there are no available organs.
If I kill healthy and unloved individuals, no-one else would sense their loss…but in saving the lives of loved individuals, I might be lessening the pain and suffering of that individual and also the pain and suffering of the people who love them. Overall, I’d be creating the greatest good.
Healthy and unloved individuals should be killed and have their organs harvested on behalf of those individuals who are loved and would otherwise die.
Explain this in terms of rule utilitarianism
Rule utilitarianism says I need to follow rule of action that generally maximises pleasure and minimises pain as consequences.
Going around killing healthy, unloved individuals might lead to a society in which people feel afraid and less secure (if they know they might be killed for their organs and that they are being targeted just because they are healthy and unloved).
Even though I might save the lives of some individuals, in the long-run, the negative consequences of doing this might outweigh any benefits. So I might look to other (less extreme) policies.
What are the problems with utilitarianism?
- Cannot always predict the consequences with certainty
- You are only looking at consequences and not if achieving these goals are morally right or wrong
- Who are these best consequences for?
- How do you assess consequences? e.g. pain, overall health, happiness
- Over what time frame?
What are the good and bad consequences of giving someone an injection to relieve pain?
Bad consequences: cause patient anxiety and distress because they don’t like having injections
Good consequences: relieve pain, improve functionality and quality of life, might be able to come off medication in long term if pain improves or is relieved completely
Might decide on balance that good consequences (especially in long-term) outweigh bad consequences
What is the deontological theory?
Duty based ethics
- Choose a course of action based on what is the right thing to do/is your duty regardless of the consequences
- Your duties are determines by principles and rules
- Believe in moral rules e.g. it is wrong to kill innocent people, it is right to keep promises
What is Immanuel Kant’s theory of categorical imperative?
There are some moral laws that all rational beings have to obey simply because they are rational beings
Commands you must follow, regardless of your desires
Applies to all rational beings in any universe (universalisability principle)
Moral obligations are derived from pure reason
In order to determine what’s right, you need to use reason
- Must be universalisable i.e. act in such a way that you would be willing for it to become a general law - everyone else should do the same in the same situation
- Must respect human beings i.e. should always be treated as valuable and should not just be used in order to achieve something else
What are the four principles in Beauchamp and Childress approach?
- Non-maleficence
- Beneficence
- Autonomy
- Justice
What is non-maleficience?
- Avoids harm
- Covers acts and omissions
- Sometimes harm is inevitable e.g. subject patient to a painful procedure because it prolongs life
What is beneficence?
- Promote well-being of others
- E.g. acting without consent in order to benefit patient or prevent harm to others
- Benefits vs risks
What is autonomy?
- Self-determination
- Individual’s action ought to be result of his or her own choices
- Respect for decision-making abilities
What are the issues with the four principles?
- What principles apply in the case?
- Interpreting principles
- Weighing different principles, especially where principles conflict
- How much weight do you give each principle?
- What principles do you prioritise?
- How do we tell if cases like or unlike?
E.g. if we are in charge of allocating lungs for transplant, do we act justly by making smokers lower priority than smokers i.e. are these unlike cases because by smoking, someone puts themselves at higher risk of getting lung disease, so should they be ‘lower down the list’ when deciding who gets a lung transplant? Or should the only relevant criterion be clinical need, in which case non-smokers and smokers would be like cases
What are virtue ethics?
Rather than looking at consequences, rules and duties… what would a virtuous (good and proper person) do in this situation?
Focuses on who does the act rather than the act
How do virtue ethics relate to pharmacy?
Pharmacist’s virtues- wisdom, compassion, fairness, diligence, conscientious, discernment (ability to judge well)
Standard 8- open and honest when things go wrong. Say sorry, and provide an explanation and put things right.
Trustworthiness of a HCP
What is context-based ethics? (Casuistry)
Case-based reasoning. Focuses on practical decision making rather than rules and theories
Identify ethical features of a case and make comparison with other similar cases/prior experience
Identify key factors
What is the doctrine of double effect?
Permits actions with a double effect, both good and bad
Under certain conditions
Sometimes it is difficult to do good to patients without causing them harm
What are the conditions for permitting the doctrine of double effect?
- The act itself must not be morally evil
- The good effect does not result from the evil effect
- Only the good effect is intended
- There is a proportionate reason for causing the harm
What are the limitations of the doctrine double effect?
- If we know there is going to be good and bad effects, we have to take the moral responsibility for both effects. You cannot argue that we only intended the effect that suits us
- Some acts are objectively right or wrong, the intention of the person who does them is irrelevant
- e.g. in death - is a quicker or slower death better? People may disagree
