Ethical Theories

1. Ethical Theories 7/2/2011 Miss Shurouq Qadous RN,MSN,MCH

2. A theory can provide individuals with guidance in moral thinking and reasoning and provide justification for moral actions. Ethical theories attempt to answer questions such as these : “ What ought I do or not do?”

3. Three types of ethical theories are widely used, and they can be differentiated by their emphasis on • Consequences • Principles and duties • Relationships

4. Consequence – based (teleological) theories “ telos” from the Greek meaning end or purpose. Look to the outcomes (consequences) of an action in judging whether that action is right or wrong. Utilitarianism One form of consequentialist theory, views a good act as one that brings the most good and the least harm for the greatest number of people. This is called the principle of utility. This approach is often used in making decisions about the funding and delivery of health care. Teleological theories focus on issues of fairness.

5. An example Antenatal screening test. By offering all women screening test to detect fetal anomalies the consequences are that women will be prepared for the birth of a handicapped child or choose to have the pregnancy terminated.

6. Advantages Disadvantages Certain difficult questions present themselves Does happiness refer to the average amount of happiness of all or the total happiness of a few? What is happiness? What constitutes the greatest good for the greatest number? Usually these determinations are quite subjective and can result in inconsistent decisions. The tenet that "the ends justifies the means" has been consistently rejected as a rational for justifying moral action • Easy to use in most situations • Built around individuals’ need for happiness • Fits well into a society that shuns rules • Truth telling is not a absolute requirement (e.g. if telling the truth will produce widespread unhappiness for a large number of people, then it would be ethically better than to tell a lie)

7. Principles – based (deontological) theories Involve logical and formal processes and emphasize individual rights, duties, and obligations. The morality of an action is determined not by its consequences but by whether it is done according to an impartial, objective principle. For example, following the rule “ Do not lie,” a nurse might believe he or she should tell the truth to a dying client, even though the physician has given instruction not to do so.

8. A follower of pure Deontology believes in the absoluteness of principles regardless of the consequences of the decision. Based on the belief that standards exist for the ethical choices and judgments.

9. These standards are fixed and do not change when the situation changes. e.g.: • People should always be treated as ends and never as means. Human life has value. • Always tell the truth. • DO NO HARM. • Deontology emphasizes moral obligation or commitment. According to deontological theory, honoring ethical obligations ensures good, even though actions may be difficult and consequences painful.

10. Advantages: • Useful in making ethical decisions in health care because it holds that an ethical judgment based on principles will be the same in a variety of given situations regardless of time, location, or individuals involved • Many consider deontology the only acceptable theory for ethical decision making in health care. • Deontological terminology and concepts are similar to the terms and concepts used by the legal system. • Difference: legal rights and duties are enforceable by law.

11. Disadvantages • What do you do when the basic principles conflict with each other? It may be difficult to resolve situations in which duties and obligations conflict, especially if consequences of following a rule end in harm to the patient. There are few followers of PURE deontology because most people will consider the consequences. • (e.g. keeping a brain-dead patient on a ventilator while recipients for a kidney transplant are found)

12. Relationships – based (caring) theories Stress courage, generosity, commitment, and the need to nurture and maintain relationships. Unlike the two preceding theories, which frame problems in terms of justice (fairness) and formal reasoning, caring theories judge actions according to a perspective of caring and responsibility. Principles – based theories stress individual rights, but caring theories promote the common good or the welfare of the group.

13. For example A frail, elderly client has made it clear that he does not want further surgery, but the family and surgeon insist. Three nurses have each decided that they will not help with preparations for surgery and they will work through proper channels to try to prevent it.

14. Using consequence – based reasoning, Nurse A thinks ‘’ Surgery will cause him more suffering ; he probably will not survive it anyway, and the family may even feel guilty later.’’ Using principles – based reasoning, Nurse B thinks ‘’ This violates the principle of autonomy. This man has a right to decide what happens to his body.’’ Using caring – based reasoning, Nurse C thinks “ My relationship to this client commits me to protecting him and meeting his needs, and I feel such compassion for him. I must try to help the family understand that he needs their support.’’