Global Bioethics Institute New York City July 11, 2016

1. Introduction to Ethics Global Bioethics Institute New York City July 11, 2016

2. We have lawsWe have policyWe have social normsWe have family Why have ethics?

3. With ethics, we can debate law and policy on moral grounds. • We can seek to develop a coherent system of values. • We can critique current societal practices by advancing fundamental ethical principles. • We can develop a system of norms that are not covered in laws and regulations (i.e. environmental ethics)

4. What is ethics? • A system of theories, rules, principles and/or accepted cultural norms adopted in order to create social harmony. • To provide all people with a set of core values and principles for guiding behavior, for resolving disputes, and for establishing the foundations for laws and regulations.

5. ETHICS MORALITY LAW AND REGULATIONS SOCIAL BEHAVIOR

6. Ethics vs. Morality Morality is used to describe the rules and norms coming from social, cultural and professional institutions. Refers to some codes of conduct put forward by a society or, some other group, such as a religion [The Catholic Church considers IVF and destroying a human embryo immoral.] [The medical associations consider it immoral for doctors to make a profit on prescribing a drug.]

7. Ethics and Morality: Meaning of Terms The terms ethics and morality are often used interchangeably - indeed, they usually can mean the same thing, and in casual conversation there isn't a problem with switching between one and the other. However, there is a distinction between them in philosophy which will be maintained. While the terms “ethics” (how a person should behave) and “morality” (a personal view of cultural and individual values) may be separately defined, their meanings commonly overlap and it is reasonable to acknowledge their similarities and sometimes use them interchangeably. Strictly speaking, morality is used to refer to what we would call moral standards and moral conduct while ethics is used to refer to the formal study of those standards and conduct. For this reason, the study of ethics is also often called "moral philosophy."

8. Morals are culturally and religiously based distinctions of right/wrong. The sphere of morality does overlap the sphere of ethics which makes distinctions between the two difficult. Both terms denote a knowledge of right and wrong actions; the foundations of that knowledge are divergent. Ethics (beyond cultural relativism) is a foundation for morality.

9. The terms “ethics” and “morality” are often used interchangeably.

10. Ethics is the search for universal principles of right or wrong. It is a philosophical pursuit not based on a particular institution, nation or culture. What are the universal principles of good behavior; of right and wrong. Or what are the methods that one ought to use to determine right or wrong? For the benefit of society should people be experimented on without their informed consent?

11. Meta-ethics & Normative Ethics & Applied Ethics Metaethics: an attempt to step back from particular substantive debates within ethics to ask about the views, assumptions, and commitments that are shared by those who engage in the debate. Metaethicsis a branch of analytic philosophy that explores the meaning and nature of ethical terms, judgments, and arguments. It is not concerned with what the right action is, but what we mean by “right action” or “good”.

12. Metaethics: What does moral language mean? Do moral facts exist? If so, what are they like, and are they reducible to natural facts? How can we know whether moral judgments are true or false? Is there a connection between making a moral judgment and being motivated to abide by it? Are moral judgments objective or subjective, relative or absolute? Does it make sense to talk about moral progress?

13. Are moral standards culturally relative? Are there moral facts? If there are moral facts, what is their origin? How is it that they set an appropriate standard for our behavior? How might moral facts be related to other facts (about psychology, happiness, human conventions…)? And how do we learn about the moral facts, if there are any?

14. Applied ethics: Is abortion morally right? How should we treat animals? What political and economic systems are most moral? What are the moral responsibilities of businesses? How should doctors respond to complex and uncertain situations? When is lying acceptable? What kinds of sex are right or wrong? Is euthanasia acceptable. Business Ethics, Computer Ethics, Engineering Ethics, Medical ethics; ethics in science.

15. Normative Ethics Normative ethics is interested in determining the content of our moral behavior. Normative ethical theories seek to provide action-guides; procedures for answering the Practical Question ("What ought I to do?"). The moral theories of Aristotle, Kant, Mill and Bentham are examples of normative theories that seek to provide guidelines for determining a specific course of moral action.

16. Normative ethics: What moral principles should we use in order to decide how to treat animals, when lying is acceptable, and so on? Is morality decided by what produces the greatest good for the greatest number? Is it decided by a list of unbreakable rules? Is it decided by a list of character virtues? Is it decided by a hypothetical social contract drafted under ideal circumstances?

17. Value Assessment Whenever we address ethical issues we deal with: Values: how some things are given importance in comparison to other things: environmental amenities like clean air, clean water; how clean? Obligation: once you accept an ethical obligation what of many of any actions do you take?

18. 3. Science describes the way the world is (functions) then ethics deals with the way the world ought to be—not the physical world. We cannot dictate what the laws of nature ought to be. We can only dictate what autonomous agents ought to do. 4. Truth: we know that truth applies to scientific claims. Does truth apply to ethical claims? Is it true to say “Stealing is wrong” “Torture is unjust” ?

19. E. Applied Ethical principles. “The Principle of Informed Consent.” “The Principle of Distributive Justice.” “The precautionary principle.” “The principle that plagiarism is unethical.” What about “ghost writing” among medical scientists?

20. LAW & REGULATION ETHICS Capital Punishment Assisted Suicide

21. Ethical Theories Aristotle 350 BC Train/educate an individual to be a virtuous person. Humans have the capacity to acquire goodness of character; but the capacity has to be developed by practice—by doing virtuous acts. Habitual truth telling; eventually the child learns that truth telling is the right thing to do. Early moral acts develops a disposition

22. Virtue is a disposition (arising from practice and teaching). Once the disposition is developed, a person would choose the correct moral act. Aristotle believed in an enlightened conscience—he had no particular theory of right and wrong. He discussed the virtues of the “mean” avoiding excess and deficit in the virtues. Vanity is excess; humility is a deficit; self-respect is the mean; likewise rashness (excess), cowardice (deficit) and courage (mean).

23. Examples of Virtue Ethics Johnson and Johnson chose a NYC bioethicist to head a panel to help them decide which petitioners should be given a scarce unapproved experimental drug for a life threatening disease. They chose an elder statesman bioethicist known for his many public decisions in medical ethics—someone who has experience in the practice of ethical reasoning.

24. Each day physicians make ethical choices for sick patients. They are presumably trained to know how to act within the mean of extremes and to apply some basic principles of autonomy, beneficence, non-malfeasance, fairness, and justice. They cannot be guided by specific rules because the cases are all different. They are guided by their experience, their education and an enlightened conscience—virtue ethics.

25. Ethics of Immanuel Kant: 1724-1804 Immanuel Kant is a German ethicist—one of the most cited ethicist of our time. He wrote the Foundations of the Metaphysics of Morals. Always treat individuals (humans) as ends in themselves—with intrinsic value—not as a means for some other end. Examples of violating Kant’s principle: using a person in an experiment without his/her consent; torturing a person to get information.

26. According to Kant, there is only one thing that is good without qualification and that is a “good will.” The “good will” has good motives and good reasons. Those reasons for action are not personal, i.e. doing something because it makes you feel good, but because it is right. You act out of obligation and duty. One who follows moral law out of duty acts out of good will, rather than self-interest or intuition.

27. Universalizing the premise behind an action “I am never to act unless I am acting on a maxim that I can will to become a universal law.” Good Will Acts out of Duty –Universal Law Kant calls the premise behind the action a “maxim” 1) Can I conceive of a world where such a maxim operates? 2) Would I want to live in such a world where such a maxim operates?

28. All persons must be treated as having equal intrinsic value. A person must never be turned into a means for some other person’s end. Humans have reason (rationality) and therefore whose existence has intrinsic value. The person must be permittted to promote his/her free rational choices.

29. Utilitarianism Utilitarianism—sometimes called consequentialism-is the theory that judges the ethics of actions by the consequences of the action. Two English proponents: Jeremy Bentham (1748-1832) “The Principles of Morals & Legislation” 1789; John Stuart Mill (1806-1873); “Utilitarianism” 1861. Examine the consequences of one’s action—not the motive or one’s obligation.

30. Two determine the ethically correct choice of several possibilities, Utilitarianism would have us evaluate which outcome will yield the greatest good for the greatest number. To determine the morality of an act, determine the amount of good the act will produce and subtract the amount of evil it will also produce.

31. Mill’s Greatest Happiness Principle “Actions are right in proportion as they tend to promote happiness, wrong as they tend to produce the reverse of happiness. By happiness is intended pleasure and the absence of pain; by unhappiness , pain and the privation of pleasure.” Mill included mental as well as bodily pleasures.

32. Problems with applying Utilitarianism Suppose you have three choices of actions—A,B and C A  yields 100 units of good B yields 150 units of good. C yields 200 units of good. C is the ethically correct choice. But suppose we are not sure of the outcome—only probably sure. A yields 100 units of good at probability .7 B yields 150 units of good at probability .5 C yields 200 units of good at probability .4

33. Expectation Value Expectation Value = outcome x probability

34. Contemporary Issues in Bioethics 1. Crossing the Germline 25 years of a moral boundary between somatic and germ line therapy 2. Privacy of genetic information: should patients have to give consent to use their blood or tissue for future research. 3. Forensic DNA: Should police have as easy access to human DNA as they do fingerprints. Stem Cells: Should excess embryos be on the commercial market for stem cell use?

35. Competing Principles Autonomy/Privacy  vs  Social Good Cultural Norms (anti-eugenics)  vs  Reproductive Rights Respect for human life  vs Utilitarian Values