Sometimes, it is difficult to tell unambiguously whether a deed is right or wrong. Moral principles do not always find their place in legislation, and people should decide how to act in a challenging situation based on their feeling of rightness and wrongness, as well as common sense. In such circumstances, ethical theories come to the aid of decision-makers. This paper will discuss four such theories: consequential ethics, utilitarian ethics, deontological ethics, and nonconsequential ethics. Using the example of the case of State v. Cunningham, the author of this paper will analyze how these ethical paradigms apply to legal issues involving patient abuse. All four ethical theories confirm that the accused person’s actions were wrong and that the court reached the right verdict.
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Overview of the Case
The court case of State v. Cunningham was investigated in 1990, and the judges aimed to decide whether Dale Cunningham was guilty of patient abuse. The culprit owned and administered a residential health care facility in Iowa, which accommodated 30 to 37 mentally ill and elderly people (State v. Cunningham, 1992). The cause for the lawsuit was a series of annual inspections that identified several violations of regulations and led to the charge of wanton neglect of residents (State v. Cunningham, 1992).
Iowa Code section 726.7 (1989) explained wanton neglect as a situation “when the person knowingly acts in a manner likely to be injurious to the physical, mental, or moral welfare of a resident” (as cited in State v. Cunningham, 1992). Cunningham’s actions exactly corresponded to this definition since he knew that the conditions in his facility were inappropriate for patients, but he did nothing about it.
Cunningham’s violations were divided into five types, each of them being dangerous for residents. First, fire safety was not ensured since investigators found cigarette stubs and burns in patients’ rooms, paper, and wood near open flames, and exposed electrical wiring inaccessible areas (State v. Cunningham, 1992). Other types of violations were concerned with improper maintenance of the facility, failure to meet the dietary needs of residents, inadequate staff supervision, and improper dosages of medications (State v. Cunningham, 1992). Although Cunningham tried to appeal the court decision, none of his claims was satisfied, and the conviction was affirmed.
Analysis from the Perspective of Ethical Theories
The presented case involves a violation of regulations in a healthcare facility, which is called patient abuse. Patient abuse is defined as “the mistreatment or neglect of individuals in the health care setting” (Pozgar, 2016, p. 418). In-State v. Cunningham (1992), residents were subject to neglect by the administrator of the facility and the staff. From the perspective of various ethical theories, such treatment of individuals is regarded as wrongdoing.
The first ethical theory to be considered is consequential ethics. According to it, the consequences of action define whether this action is right or wrong (Pozgar, 2016). It implies that no act is evil per se; it becomes wrong when it has negative results. When applying this theory, decision-makers should ask themselves what the effects of their deeds would be, who would benefit from them, and how they should act to do less harm (Pozgar, 2016). It can also be assumed that consequential ethics may justify egoism if the consequences of one’s actions appear to be positive to one’s self.
If one regards the case of State v. Cunningham from the perspective of consequential ethics, one will find that the culprit’s actions were morally wrong. The results of Cunningham’s acts were negative for residents of his health care facility. The court discovered that, apart from the potential threats to the health of patients, Cunningham’s neglect led to real injuries of residents. For example, since the staff did not clean and irrigate a catheterized patient properly, the patient got a urinary tract infection (State v. Cunningham, 1992). Because of improper dosages of medications, another resident had a seizure (State v. Cunningham, 1992). The administrator’s actions did not benefit himself either because, eventually, he was fined a large sum of money for wanton neglect and was sentenced to jail. Hence, consequential ethics confirms the guilty verdict because Cunningham’s decision to do nothing to improve the conditions in his facility led to negative consequences.
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Utilitarian ethics can be considered a branch of consequential ethical theory. Just like consequentialism, it is concerned with the results of an action, but it emphasizes that the outcomes should contribute to overall utility (Pozgar, 2016). The principle of utilitarian ethics is “the greatest good for the most people” (Pozgar, 2016. p. 10). Therefore, a deed can be considered right if it is of benefit to a large number of individuals. Since Cunningham’s actions did not contribute to overall usefulness but, on the contrary, caused harm to his patients and posed a threat to their physical and mental well-being, they should be regarded as wrong from the perspective of utilitarian ethics.
Deontological ethics differs from the previous two theories in the attitude to consequences. Its originator, Immanuel Kant, believed that good deeds sometimes did not lead to the expected positive results (Pozgar, 2016). Nevertheless, one should always do the right things, like telling the truth and sticking to one’s word (Pozgar, 2016). According to this theory, doing the right thing is everyone’s duty, which is why deontological ethics is sometimes called duty-based ethics (Pozgar, 2016). The rightness of an act is defined by its compliance with a moral code, rules, or laws (Pozgar, 2016). Thus, if an action aligns with the existing regulations, it is considered right regardless of its consequences.
From the perspective of deontological ethics, Cunningham’s neglect of residents was wrong. As a health care facility administrator, he had to obey the laws regulating such establishments. For example, according to the Code of Federal Regulations (n.d.), residents of such facilities have the right to be free from neglect and mistreatment, have a well-balanced diet, and live in a safe physical environment. However, Cunningham did not make efforts to bring the premises in proper condition, which means that he did not act according to the law. Hence, even if his actions had led to positive consequences, he would have been guilty according to deontological ethics because he disregarded the established regulations.
The last theory to be considered is non-consequential ethics that contradicts the already mentioned paradigms. This theory argues that neither consequences nor rules define the moral value of an action (Pozgar, 2016). Instead, it says that the same action can be either right or wrong, depending on the circumstances (Pozgar, 2016). Pozgar (2016) explains this theory by the following situation: if a person survived a plane crash and had nothing to eat but the flesh of dead victims, cannibalism would be justified in this case. In other circumstances, it would be unacceptable to consume human flesh (Pozgar, 2016). Thus, there are no strict rules or consequences that would always be right or wrong.
When applying nonconsequential ethics to the case of State v. Cunningham, one will find that the judges were right in their verdict. There is no evidence that Cunningham had to behave the way he did. The only excuse he provided to the court was that it was not he who created those abominable conditions in the facility (State v. Cunningham, 1992). Therefore, it may be concluded that the circumstances did not hinder the administrator from executing his duties, which means that he was indeed guilty of violations of regulations.
The Interrelation of Law and Ethics
In this case, both law and ethics came to the same conclusion, namely, that wanton neglect of residents was Cunningham’s fault. The court’s decision was just because the culprit indeed violated laws and committed wrongdoings from an ethical point of view. The law and ethics are intertwined in this case in such a way that ethics explains what is wrong and what is right, and the law defines the punishment for wrongdoings. In law, consequences, rules, and the surrounding circumstances, which are the major principles of ethical theories, are combined to determine misdeeds and inflict punishment for them.
To sum up, the court’s finding was just, according to law and ethics. All four ethical theories confirm the guilty verdict brought by the judges. Consequential and utilitarian ethics support the court’s decision since Cunningham’s neglect of residents led to negative consequences that did not contribute to the overall usefulness. Deontological ethics also finds him guilty since he violated the regulations. Nonconsequential ethical theory regards his actions as wrong because there were no specific circumstances that could have justified the patient abuse in Cunningham’s health care facility.
Code of Federal Regulations. (n.d.). Web.
Pozgar, G. D. (2016). Legal and ethical issues for health professionals. Burlington, MA: Jones & Bartlett Publishers.
State v. Cunningham, 493 N.W.2d 884 (1992).