Chapter I of the book Health Care Ethics is entitled “Understanding Ethics and How We Approach Ethical Decisions.” It comprises of three sub-parts. The part that should be summarized is “How We Approach Ethical Decisions.” In the following chapter, the authors discuss aspects that influence the making of moral decisions. In particular, the aim of the chapter is to find out the most important factors that affect ethical decision-making.
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Classic ethical theories
The principles of ethical decision-making often resemble something abstract and not concrete. Scientists have not developed particular methods for discipline. All approaches reflect the need to make choice and decisions that people face every day. It is important to be familiar with the concept of ethics before analyzing related theories. According to Panicola et al., “Ethics is about who we ought to become as persons (BEING) and how we ought to act in relation to others (DOING)” (23). Thus, the theories of ethical decision-making may be divided according to their focus on:
- Being. Such theories emphasize the importance of paying attention to the aspects of being. They investigate the nature of the person. Virtue theories belong to this group;
- Doing. This focus can be further subdivided. Thus, when the law, duties, principles, and rules of the action are of the primary interest, deontological theories prevail. In case the consequences of actions are of the central importance, one deals with consequentialist theories of ethical decision-making.
Authors emphasize the fact that one should not expect that theories give him or her a full understanding of how to make decisions. A person should make ethical decisions with the help of both heart and head.
The most significant aspects concerning virtue theories (VTs) are as follows:
- The origin. The roots of these ideas come from ancient philosophy. Aristotle and Plato developed their ideas about the proper behavior of individuals. These directions resemble modern virtue theories. Thus, Aristotle wrote about such virtues as justice, courage, temperance, love, dignity, and generosity. There are many virtues. Nevertheless, the most significant fact concerns whether the person is good or bad. The primary emphasis is on being;
- There are indispensable moral features. People may argue about their number and definition. Still, there are common virtues that cannot be neglected. They are essential for living a moral life and understanding morality. For instance, love is necessary for all people. There are different ways of comprehending and expressing love. It is impossible to prove that love is not vital for human beings;
- We do what we are. Persons’ identity is directly connected to his or her decisions. A virtuous person does good things while a vicious one does evil things;
- Definition. Virtue is what we do when nobody is watching. “Virtues are habits, character traits, feelings, and intuitions that comprise who we are and are necessary for being a good person and living a moral life” (Panicola et al. 27);
- Phrases that point to VTs: values, moral character, personal characteristics, and qualities, promoting the good for others and oneself, living a good and moral life.
- Origin. Deontological concepts commenced in Roman and Judaic legal traditions. Cicero, Philo of Alexandria, and Immanuel Kant — famous representatives of deontological theories (DTs);
- The emphasis on doing. “DTs focus mainly on our actions, what we choose to do as the means to an end. What we do matter much more in DTs that who we are becoming or what we hope the results will be (ends)” (Panicola et al. 28);
- There are the right actions. Deontological theorists believe that there are actions that are right by their nature as well as there are purely wrongdoings. One should conduct only good actions;
- The ends do not justify the means;
- The rightness of actions is defined in regulations. There are divine laws, civil laws, the law of nature, and autonomous law;
- Challenges. The problem arises when laws conflict with each other. Authors provide an example from health care ethics. There are three principles: do good for others (principle of beneficence), do not harm others (nonmaleficence), and respect the wishes of others (autonomy). Sometimes relatives’ choice of treatment can be harmful to the patient. The doctor realizes this fact. He should respect relatives’ desire. Nevertheless, at the same time, he understands that such a decision will contradict the principle of beneficence;
- The problem of choice. People may face difficulty in choosing a set of laws to follow;
- Phrases that point to DTs: rights, responsibilities, beliefs, obligations, convictions, principles, have to, always, never, right and wrong, absolute, and requirement.
- Origin. Consequentialist theories (CTs) are rather modern in comparison with two previous approaches. John Stuart Mill, Henry Sidgwick, and Jeremy Bentham are theorists of CTs. They consider outcomes to be the most significant factors in ethical decision-making;
- The ends always justify the means. According to these theories, the consequences are much more important than actions. Thus, particular rules, laws, or having virtues are necessary if they will lead to positive outcomes. Otherwise, there is no use in following the rules that do not bring something better;
- Right actions aim at good results. “Good” can be the absence of pain, happiness, or satisfaction. “…the morality of our actions within CTs is deduced from the cost-benefit analysis, in which we add up positive and negative consequences and choose the action with the best overall result for the good we seek” (Panicola et al. 30);
- The notion of “lesser evil.” It happens that one should choose between two negative consequences. CTs theorists believe that one should choose the way that leads to the lesser evil;
- Restrictions. The problems of CTs lie in the fact that a person can say that he or she is striving for a better life and violate rules for the accomplishment of the goal. Somebody’s desire to be happy may be harmful to others;
- Phrases connected with CTs: consequences, interests, results, outcomes, greater goods, and the exception because, balance, the lesser evil.
Ethical theories in personal decision-making
In this part of the chapter, the authors aim at deepening readers’ understanding of the concept. They present ten scenarios with three possible decisions. It is up to the reader to connect the decision with particular theories. The goals of this task include:
- To understand that all ethical theories are acceptable;
- To become familiarized with approaches;
- To comprehend that they cannot be used at the same time. There is always some loss due to the exclusion of particular aspects.
Panicola, Michael, David Belde, John Slosar and Mark Repenshek. Health Care Ethics: Theological Foundations, Contemporary Issues, and Controversial Cases. Winona: Anselm Academic, 2011. Print.