Chapter 1

Introduction to
Ethics
 Learning Objectives

• Explain what ethics is, its importance, and its

application to ethical dilemmas.
• Describe the concepts of morality, codes of
conduct, and moral judgments.
• Understand relevant ethical theories and
principles.
• Describe virtue ethics and values and how they
more clearly describe one’s moral character.
 Learning Objectives, cont’d

• Understand how religious ethics can affect one’s

moral character.
• Explain the concept of situational ethics and how
changes in circumstances can alter one’s
behavior.
• Understand the importance of reasoning in the
decision-making process.
 What Is Ethics?

• Ethics is the branch of philosophy that seeks to

understand the nature, purposes, justification,
and founding principles of (Sound human
behavior) moral rules and the systems they
comprises).
– Deals with values relating to human conduct.
– Focuses on the rightness and wrongness of
actions, as well as the goodness and badness
of motives and ends.
 Scope of Ethics
• Microethics
– Individual’s view of right and wrong. Based on one's
personal life teachings, traditions, and experiences.

• Macroethics
– Global view of right and wrong.
• Solving ethical dilemmas involves consideration of
ethical issues from both the micro and macro
perspectives.
 Bioethics

Addresses difficult issues related human and life. Such as:

1. Nature of life
2. Nature of death
3. What sort of life worth living
4. What constitute a murder
5. How we should treat vulnerable people
6. Responsibilities toward other human beings

It is about making better decisions when faced with

diverse and difficult situations.
 Ethics from Various Perspectives

• Ethics used in different but related ways

– Philosophical ethics
• Inquiry about ways of life and rules of
conduct
– General pattern or way of life
• Religious ethics
– Set of rules or “moral conduct”
• Professional codes for ethical behavior
 Why Study Ethics?

• To make sound judgments, good decisions, and

right/better choices.
• Understand the goodness and badness of
motives and ends.
 What Is Morality?

• Morality describes a class of rules held by

society to govern the conduct of its individual
members.
• Implies quality of being in accord with standards
of right and good conduct.
 Morals

• Ideas about what is right and wrong

• Guides to behavior that rational persons put
forward for governing their behavior
 Code of Conduct

• Generally prescribes standards of conduct,

states principles expressing responsibilities,
and defines the rules expressing duties of
professionals to whom they apply.
• Most members of a profession subscribe to a
certain values and moral standards written
into a formal document called a code of
ethics.
 Codes of Ethics Provide for
• Standards – guides to human conduct by stating
desirable traits to be exhibited and undesirable ones.
E.g. honesty, respect, integrity.

• Principles – describe responsibilities that do not specify

what the required conduct should be. Professionals
needs to make judjmets on what is desirable in a
particular situation based on accepted principles.

• Rules of expected conduct – no allowance for individual

judgment.
 UAE NMC code of conduct
Standard

Principle

Conduct: i.e. All children in pediatric ward has to receive the

same treatment
UAE NMC code of conduct
Irish NMC code of conduct
 Moral Judgments

• Judgments concerned with what an individual or

group believes to be right or proper behavior in a
given situation.

• Involves assessment of another person’s moral

character.
– Based on how he or she conforms to moral
convictions established by the individual
and/or group.
 Morality Legislated

• Law is distinguished from morality in that

– Law has explicit rules, penalties.
– Laws are created to set boundaries for
societal behavior.
– Laws are enforced to ensure that expected
behavior happens.
 Moral Dilemmas

• Moral dilemmas arise when values, rights,

duties, and loyalties conflict

• Caregiver must not only examine what he or she

considers the right thing to do, but
– What are the alternatives
– What are the patient’s known wishes
Ethics, too, are nothing but reverence for life. This
is what gives me the fundamental principle of
morality, namely, that good consists in maintaining,
promoting, and enhancing life, and that destroying,
injuring, and limiting life are evil.
-Albert Schweitzer
 Theories of Ethics

• Ethical theories attempt to introduce order into

the way people think about life and action.
–They are the foundations of ethical analysis
and provide guidance in the decision-making
process.
 Metaethics

• Metaethics is the study of the origin and

meaning of ethical concepts.
• Metaethics seeks to understand ethical terms
and theories and their application.
• It involves exploring the connection between
values, reasons for action, and human
motivation.
 Normative Ethics
• Normative ethics is prescriptive in that it
attempts to determine what moral standards
should be followed so that human behavior and
conduct may be morally right.
– Primarily concerned with establishing
standards or norms for conduct and is
commonly associated with investigating how
one ought to act.
– Involves the critical study of major moral
precepts, such as what things are right, what
things are good, and what things are genuine.
 Normative Ethics
One of the central questions for modern normative
ethics is:
• Whether human actions are to be judged right or
wrong solely according to their consequences

• This perspective assume that: the determination

of a universal moral principle for all humanity is
a formidable task and most likely not feasible
due to the diversity of the people and their
cultures.
 Descriptive Ethics

• Descriptive ethics, also known as comparative

ethics, is the study of what people believe to be
right and wrong, and why they believe it.
– Describes how people act.
– Whereas normative ethics prescribes how
people ought to act.
 Applied Ethics

• Applied ethics is the philosophical search (within

western philosophy) for right and wrong within
controversial scenarios.”
– The application of normative theories to
practical moral problems, such as abortion,
euthanasia, and assisted suicide.
 Consequential Ethics

• Consequential theory of ethics emphasizes that

the morally right action is whatever action leads
to the maximum balance of good over evil.

• Rightness or wrongness of an action is based on

the consequences or effects of the action.
• Also the value of the action derives solely from
the value of its consequences
• The morally right act or failure to act is one that
produce a good outcome.
 Case discussion

Book : page 8.
No good deeds goes unpunished
 Utilitarian Ethics
• Moral worth of an action is determined solely by
its contribution to overall usefulness.
– Philosophy that advocates greatest good for
greatest number
– Obligation to do whatever will achieve the
greatest good for the greatest number
– It is thus a form of the consequential ethics
– The utilitarian commonly holds that the proper
course of an action is one that maximize
utility.
 Case discussion

Book : page 10.

Maximizing happiness and reducing suffering
 Deontological Ethics
• Deontology ethics is commonly attributed to the
German philosopher Immanuel Kant.
• Often referred to as duty-based ethics. It
focuses on ones duties to others and others
rights.
• It involves ethical analysis according to a moral
code or rules, religious or secular or maybe
professional.
• Deon is derived from the Greek word meaning
“duty.”
 Deontological Ethics
• Theory differs from consequentialism in that
consequences are not the determinant of what is
right; therefore, doing the right thing may not
always lead to an increase in what is good.
• Duty based approaches are heavy on
obligations, in the sense that person who follows
this ethical paradigm believes that the highest
virtue comes from doing what you are supposed
to do, either because you have to (following the
law)or because you agreed to (following the
policy).
 Case discussion

Book : page 11.

Duty compromise patient care
 Nonconsequential Ethics

• The nonconsequential ethical theory denies that

the consequences of an action are the only
criteria for determining the morality of an action.
– Rightness or wrongness of an action is based
on properties intrinsic to the action, not on its
consequences.
 Case discussion

Book : page 12.

Bad outcomes, good intentions
 Ethical Relativism

• Morality is relative to the norms of one's culture.

• Actions can be considered right or wrong
depending on the accepted norms of the society
in which they are practiced.
– For example, slavery may be considered an
acceptable practice in one society and
unacceptable in another.
 Ethical Relativism

• Professional care givers has to be aware of

cultural religious and legal issues that can affect
the boundaries of what is acceptable and what is
unacceptable practice.
 Principles of Ethics

Ethical principles are universal rules of conduct,

derived from ethical theories that provide a
practical basis for identifying what kinds of actions,
intentions, and motives are valued.
 Principles of Ethics – I

• Autonomy
– Auto is a Greek word means “self”, or
“individual”
– Recognizing the right of a person to make
one’s own decisions about what is best for
him/herself.
– This is not an absolute principle, the
autonomous action of one person must not
infringe upon the rights of others.
 Principles of Ethics – I
• Autonomy..cont..
– In healthcare patients has the rights to refuse to
receive care even if it is beneficial to saving his or her
life.
– Autonomous decision making can be affected by ones
disabilities, mental status, maturity, or incapacity to
make decisions.
– The principle of autonomy can be carried out through
an advanced directive, or through a person in certain
cases where autonomy can not be practiced: e.g. one
wrote on chest-NO CPR, would you resuscitate in an
emergency.
 Principles of Ethics – I
• Autonomy..cont..
– What happen when the autonomy principle conflicts
with the another ethical principles. E.g. when a
patients refuse blood transfusion considered
necessary to save his or her life, whereas the
caregivers principal obligation is to do no harm.
– An example on autonomy is the Jehovah witness
patients. See: book-page 16- “life or death: the right
to choose”.
 Case discussion

Book : page 15.

Spouse’s Grief leads to withholding the truth.
 Principles of Ethics – 2

• Beneficence
– Principle of doing good
– Demonstrating kindness
– Showing compassion
– Helping others
– Paternalism
• Making decisions for others
 A Case of Paternalism

The family physician does not fully inform Mr.

Smith as to the seriousness of his illness and
how the consequences of the various alternative
treatments might affect his life style.

Discuss the legal and ethical issues.

 Ethical and Legal Issues

• Legal issues
– Informed consent

• Ethical issues
– Autonomy
– Paternalism
 Principles of Ethics – 3

• Nonmaleficence
– Avoid causing harm.
– Not concerned with improving others’ well-
being but with avoiding the infliction of harm.
 Principles Ethics – 4

• Justice
– Obligation to be fair in distribution of benefits
and risks

– Distributive Justice
• Requires all individuals be treated equally

– Justice and government spending

 Age and Justice

Should an 89-year-old patient get a heart

transplant because he or she is higher on the
waiting list to receive a heart transplant than a
10-year-old girl?
 Age and Justice, cont’d

Should a pregnant 39-year-old single parent get a

heart transplant because he or she is higher on the
waiting list to receive a heart transplant than a
10-year-old boy?
 Which Disaster Patients
Get Treated First?
• Room #1: Severely injured patients not expected
to live.

• Room #2: Severely injured patients most likely to

live if treated.

• Room #3: Injured patients will live but will suffer

varying degrees of disability if not treated
promptly.
 Emergency Care

Two patients in critical condition, who gets

treated first?

• First patient who walks through door

• Younger patient
• Patient most likely to survive
• Patient who can pay for services
• Patient with most serious condition
 Scarce Resources

• What happens when resources are scarce and

only one of two patients can be treated?

• What should be the determining factors

– Age
– Position in life
– Patient wishes
 Virtue Ethics and Values
• Virtue ethics
– Focuses on the inherent character of a person
rather than on the specific actions he or she
performs.

• A virtue (I‫لفضيله‬II‫ او ا‬I‫لعفه‬II‫ )ا‬describes a positive trait

of moral excellence and that which has
beneficial quality.
– Virtues are those characteristics that
differentiate good people from bad people
 Virtue Ethics and Values
– Virtues are habits. Once acquired, they
become characteristic of a person.
– Examples of virtues are Courage, honesty,

• A morally virtuous person is one who does the

good and right by habit. Not merely based on a
set of roles of conduct.
 Moral Value
• Is the relative worth placed on some virtuous
behavior.

• Values change as needs change.

• What has value to one person may not have

value to another.
 Values

• Values represent a standard of conduct.

– Used for judging goodness or badness of an

action.
– Values are rooted in the customs and habits
of a culture
– Values are the standards by which we
measure the goodness in our lives.
 Intrinsic and Instrumental Values

• Intrinsic Value
– Something that has value in and of itself (e.g.
happiness)

• Instrumental Value
– Something that helps to give value to
something else
• For example, money is valuable for what it
can buy
Values may change as the needs change, i.e. if
one’s basic needs for food or water or clothing or
housing were not met, one’s values may change
such as friendship which may be sacrificed if
ones basic needs can be better met
List of Values:
1. Courage
2. Wisdom
3. Temperance (self control/restrains)
4. Commitment
5. Compassion (deep awarness and compassion with others
suffering)
6. Detachment
7. Conscientious (integrity)
8. Discernment (the ability to judge well/no bias)
9. Fairness
10. Fidelity (faithfulness or obligation to others)
11. Freedom
12. Honesty
13. Kindness
14. Respect
15. Hopefullness
16. Tolerance
17. Forgivness
 Pillars of Moral Strength – I
Virtues and Values
• Courage
– The mental or moral strength to persevere
and withstand danger

Courage is the greatest of all virtues, because if

you haven’t courage, you may not have an
opportunity to use any of the others.
-Samuel Johnson
 What Is Courage?

• Courage is the mental or moral strength to

persevere and withstand danger. “Courage is
the ladder on which all the other virtues mount.”
• Courage involves balancing fear, self-
confidence, and values. Without courage, we
are unable to take the risks necessary to
achieve the things most valued.
 The Courageous Person

A courageous person has good judgment and a

clear sense of his or her strengths, correctly
evaluates danger, and perseveres until a decision
is made and the right goal that is being sought has
been achieved.
 Pillars of Moral Strength – II
Virtues and Values
• Wisdom
– The judicious application of knowledge
• Temperance
– Orderliness and moderation
• Commitment
– Agreement or pledge to do something
 Pillars of Moral Strength – III
Virtues and Values
• Compassion
– Sympathy for another’s suffering
– Detachment
• Conscientiousness
– One who has moral integrity and a strict
regard for doing what is considered the right
thing to do
• Discernment
– Ability to make a good decision without
personal biases
 Pillars of Moral Strength – IV
Virtues and Values
• Fairness
– Ability to make judgments free from
discrimination
• Fidelity
– Being true to our commitments and
obligations to others
 Pillars of Moral Strength – V
Virtues and Values
• Freedom
– Free to make choices for oneself within the
boundaries of law
• Honesty/Trustworthiness/Truth Telling
– Confidence a person will act with right
motives
• Integrity
– Steadfast adherence to strict moral or ethical
code and a commitment not to compromise
this code
 Pillars of Moral Strength – VI
Virtues and Values
• Kindness
– Considerate and sympathetic to another’s
needs
• Respect
– Show special regard to someone or
something
• Hopefulness
– Looking forward to something with the
confidence of success
 Pillars of Moral Strength – VII
Virtues and Values
Tolerance
– Positive tolerance
• Implies that a person accepts differences in
others
• Tolerant people are generally free of
prejudice and discrimination
– Negative tolerance
• Implies that one will reluctantly put up with
another’s beliefs
• In other words, simply tolerating the views
of others
 Cooperation and Teamwork

Cooperation is the process of working with others.

In the health care setting, caregivers must work
together to improve patient outcomes.
 Forgiveness

• The willingness to pardon someone who has

wronged you in some way.
• A form of mercy.
• Forgiveness is to forgive and let loose the bonds
of blame.
 Religious Ethics

• Religion provides a moral code for appropriate

behavior.

– Prospect of divine justice helps us tolerate the

injustices in life.
– Need to better understand cultural diversity
and the importance of religion in the healing
process.
 Spirituality

In the religious sense implies that there is purpose

and meaning to life; spirituality generally refers to
faith in a higher being.
 Varying Religious Beliefs – I

• Judaism

• Hinduism

• Buddhism

– Falun Gong
 Varying Religious Beliefs – II

• Zen

• Taoism

• Christianity

• Islam
 Religious Beliefs and Duty Conflict

• Religious beliefs and codes of conduct

sometimes conflict with the ethical duty of
caregivers to save lives.
– For example, Jehovah’s Witnesses, believe
that it is a sin to accept a blood transfusion.
– Important for hospitals to work out such
issues in advance with legislative bodies and
the judicial system.
 Secular Ethics

• Secular ethics is based on codes developed by

societies that have relied on customs to
formulate their codes.

– Example, Code of Hammurabi

 Atheism

• Rejection of belief in God.

• Claims the existence of God cannot be
scientifically proven.
• Belief that ethics is the product of culture and
politics.
 Evidence that God Exists

• Various religious faiths believe there is

overwhelming evidence that there is reason to
believe that God does exist and that the
evidence.
– Historical documents
– Archeological finds
– The vastness of space and time
– Clearly supports and confirms the existence
of God
 Situational Ethics

• Refers to a particular view of ethics, in which

absolute standards are considered less
important than the requirements of a particular
situation.

• Importance of a particular value may vary as

one’s situation changes.
 Situational Ethics — II
• Moral character can be compromised when
faced with difficult choices.

• Good people behave differently in different

situations.
 Situational Ethics — III
• Good people sometimes do bad things.

• One’s moral character can sometimes change

as circumstances change.

– Thus the term situational ethics.

 Situational Ethics — IV
Values Can Change
• People make value judgments and choices
among alternatives.
• Values one so dearly proclaims may change as
needs change.
• Motivating power of a person's actions are
necessity for survival.
• Values give purpose to each life. They describe
one’s moral character.
 Situational Ethics — V

• If one’s basic needs for food, water, clothing,

and housing have not been met, one’s values
may change in such a way that a friendship, for
example, might be sacrificed if one’s basic
needs can be better met as a result of the
sacrifice.
 The Creation of Ignorance:
Situational Ethics
How Common I the Creation of Ignorance?
It’s pretty common. I mean in terms of sowing
doubt, certainly global warming denialists who
for years have managed to say, “well the case is
not proven. We need more research.” And
what’s interesting is that a lot of the people
working on that were also the people working on
Big Tobacco.
- Interview with Robert Proctor, Professor, Stanford
University Discover 2008
 The Creation of Ignorance:
Discussion
1. Why do people who do bad things in one job
repeat their pattern of doing bad in another?
What is their motive?
2. Why do people watch bad things happen and
then deny they are happening? Explain.
3. What is often referred to as being the “root of
all evil”? How does it apply in this case.
 Sustaining Life: Situational Ethics

• A decision not to use extraordinary means to

sustain the life of an unknown 84-year-old “may”
result in a different decision if the 84-year-old is
one’s mother.
 Differing Values

• If Mom’s estate is being squandered at the end

of life – a family member financially well-off may
want to hold on to Mom despite the financial
drain on her estate. Another family member
financially struggling to survive may more readily
see the futility of expensive medical care and
find it easier to let go.
 Case: High in the Andes

• Those who survived the plane crash high in the

Andes Mountains were faced with some difficult
survival decisions. Their need to survive
illustrates to what lengths one may go in certain
situations in order to survive.
 High in the Andes, cont’d

• How might you change as circumstances

change?
• Describe how your consultative advice might
change based on the patient’s needs, beliefs,
and family influences.
 Reasoning and Decision Making

• Reason includes the capacity for logical

inference and the ability to conduct inquiry, solve
problems, evaluate, criticize, and deliberate
about how we should act and to reach an
understanding of other people, the world, and
ourselves.
 Reasoning and Decision Making — II

• Partial reasoning involves bias for or against a

person based on one’s relationship with that
person.
• Circular reasoning describes a person who has
already made up his or her mind on a particular
issue and sees no need for deliberation.
 Health Care Dilemmas

• Ethical decision making is the process of

determining the right thing to do in the event of a
moral dilemma.
– Alternative choices
– Limited resources
– Differing values among patients, family
members, and caregivers.
– Coming to an agreement often requires
sacrificing one’s personal wishes and
following the road where there is consensus.
 Health Care Dilemmas — II

• Consensus building requires:

– Parties to a dilemma must reason together.
– Identification of alternative choices.
– Willingness to listen, learn, and make an
informed decision.
 The Moral Compass

• Hartford Police Chief questions the city’s “moral

compass”.
– A week after bystanders and drivers
maneuvered around the motionless body of
78-year-old victim of a hit-and-run crash.
 Lack of a Moral Compass:
Discussion
1. What moral principles might the sheriff have
been referring to when he questioned the city’s
lack of a moral compass? Explain.

2. Discuss your thoughts as to why society in

general is losing its moral compass.
 Summary Thoughts – I

• Be careful of your thoughts, for your thoughts

inspire your words.
• Be careful of your words, for your words precede
your actions.
• Be careful of your actions, for your actions
become your habits.
 Summary Thoughts – II

• Be careful of your habits, for your habits build

your character.
• Be careful of your character, for your character
decides your destiny.
Although you cannot control the amount of time
you have in this lifetime, you can control your
behavior by adopting the virtues and values that
will define who you are and what you will
become and how you will be remembered or
forgotten.
 REVIEW QUESTIONS

• What is ethics?
• Why should one study ethics?
• What is morality?
• Describe the ethical theories presented in this
chapter.
 REVIEW QUESTIONS cont’d
• What is ethical relativism? What is the relevance
of this concept to individuals of various cultures
living in the same society?
• Describe the various ethical principles reviewed
and how they might be helpful in resolving
health care ethical dilemmas.
• Describe virtue ethics and values. How do
virtues and values differ?
• Discuss why “courage” could be considered as
the greatest of all virtues.
 REVIEW QUESTIONS cont’d
• Discuss how religion can affect one’s character.
• Describe the principle of justice and how it can
affect the decision-making process.
• Explain how you would allocate scarce
resources in the provision of health care?
• What is “situational ethics”? Why do people
behave differently in different situations?