3. ETHICAL SCHOOLS OF THOUGHT (PART 2)

• 3.1 Kant’s Ethics (Immanuel Kant) - sometimes called deontologism for its

emphasis on duty or obligation - others regard it as a form of intuitionism

precisely because of its claim that morality is exclusively within the human personality; what is morally right or wrong is solely a matter of intent, motive and will

3.1.1 Act done in accord with duty and act done from a sense of duty (Kant/Popkin/Stroll)• The essence of morality is to be found in

the motive from which an act is done, that is, the rightness and wrongness of an action is determined by the motive from which it is being carried out, regardless of the consequences which doing so or not doing so will produce

a.) Act done in accord with duty ex. A doctor who performs his/her medical

functions merely out of the desire to do so or out of fear of being accused of negligence, hence such acts are nonmoral

b.) Act done from a sense of duty ex. A doctor who recognizes that there is a

special obligation to their patients because of their relationships with them

3.1.2 Categorical imperative• Kant’s categorical imperative mandates an

action without any conditions whatsoever, and without regard to the consequences that such an action may yield

• It is a command or maxim that enjoins a person to do such and such an act without qualification; it thus lays down a universal rule which, if followed, will ensure that the person is acting from a sense of duty

3.1.3 Formulations of the categorical imperative

1. Act only on that maxim which you can at the same time will to become a universal law (Paton 1948)

2. Always act so as to treat humanity, either yourself or others, as an end and never as only a means

- all cases in which one acts inhumanly against another man are ways in which others are treated as only a means are morally wrong

3.1.4 Two types of duties1. Perfect - is one which we must always observe, irrespective

of time and place ----- that I should not harm or inflict injury upon others is a perfect duty

2. Imperfect - is one which we must observe only on some

occassions ----- that I should show love and compassion occassionally to others, based on my own choice , is an imperfect duty

3.1.5 Autonomous, self- regulating will• Autonomy means governing, regulating,

restraining oneself, including one’s own choices or courses of action, in accord with moral principles which are one’s own and which are binding on everyone

* specifically for Kant, respecting autonomy is bound to his notion that every person has worth and dignity, precisely because persons are ends in themselves and are capable of making their own moral decisions

3.1.6 In the medical context• In dealing with issues in medical practice and

research, Kant’s ethical principles are of far-reaching importance

1. First, for Kant it is always wrong to lie, no matter what the consequences may be (medical investigators/researchers should not lie to their patients)

2. Second, we must always treat people (including ourselves) as ends and not only as means

3. The third application is that an action is right and legitimate insofar as it satisfies the categorical imperative ---- good results never make an action morally right ---- the welfare of the great majority of people at large may not justify the harm, deception or injustice done or imposed upon an individual just because he is poor, a criminal or a handicapped person

4. Fourthly, Kant’s distinction between perfect and imperfect duties suggests that some rights should be recognized ----- in a doctor-patient relationship, for example, the physician has an imperfect duty to accept one as a patient- that is, how he discharges his duty is his own decision, his own prerogative, his own right

3.1.7 Difficulties• Despite its being a fruitful source of principles

and ideas for working out moral dilemmas of medical experimentation and practice

1. Kant’s principles have no clear way of resolving issues of conflicting duties

2. The categorical imperative fails to establish duties in cases involving maxims that cannot be willed to become a universal law of subjective reasons

3.Kant’s ethics presents a third problem in connection with the notion that we have a duty to treat others as rational beings or persons – this problem is a serious one with regard to the moral issue of abortion

* is a fetus that is developing in its mother’s womb– be it deformed or not, considered a person?

* is an infant born with serious physical deformities a rational being?

Despite its shortcomings, however, Kant’s ethics captures

many of our intuitive perceptions about lying, treating others with dignity, and acting benevolently, it also determines our duties in particular situations (that is, the categorical imperative)

3.2 Ross’s Ethics(William David Ross)

• Though influenced by rule utilitarianism, Ross has rejected precept that an action is validated as right by its consequences• The outcomes of an act -- however

beneficial and pleasant they may be for many individuals -- may not determine its rightness

3.2.1 Rules and moral principles• Ross has recognized that there are

exceptions for every rule, and in some situations the latter must be set aside

* absolute rules are often insensitive to the consequences of an act; at times, not only are they in conflict with one another but they are also inflexible that they become irrelevant to ever-changing situations

• For Ross, rightness and goodness are the only two moral properties

* neither can be explained or replaced by other properties, when it is said that an act is right, rightness is the moral property of that act – but it is not identical with the act per se, a right act can originate from a morally bad motive

3.2.2 Actual duty and prima facie duty

• Actual duty – is one’s real duty in a given situation --- it is the action one ought to choose from among any other actions• Prima facie duty – is one that directs or

commands what ought to perform when other relevant factors are not taken into account

• To determine the greater balance of prima facie rightness or wrongness between two conflicting duties, according to Ross, we have to rely on our moral intuitions as the ultimate guide in particular cases

• What to do in such a situation according to Ross are the following:

1. Learn and discern the facts in the case 2. Consider the possible consequences of

our actions 3. Reflect on our prima facie duties 4. Decide on the best course of action

under the circumstances

• SEVEN TYPES OF PRIMA FACIE DUTIES 1. Duty of fidelity 2. Duty of reparation 3. Duty of gratitude 4. Duty of justice 5. Duty of beneficence 6. Duty of self-improvement 7. Duty of nonmaleficence

• Duty of fidelity - we should be faithful to our duties, obligations,

vows, or pledges; this likewise refers to one’s loyalty to a worthy cause, telling the truth as the situation demands it, keeping actual and implicit promises, and not representing fiction as truth

** treachery, deception, hypocrisy, trickery, double-dealing, insincerity, betrayal, lying, duplicity, cunning or craftiness are infractions against the duty of fidelity

• Duty of reparation - a duty to make amends for injury that we have

inflicted on others * an act of making amends, righting the wrongs

we have done to others * asking for the person’s forgiveness is

insufficient, good must be done to that person to atone for the wrongdoing

- also known as the duty of compensation

• Duty of gratitude - a duty to appreciate and recognize the services others

have done for us, which may be either a favor, kindness, good fortune, a great help, or saving one’s life

• Duty of justice - stresses the proper distribution of social benefits and

burdens **not only should we enjoy social benefits with others,

but we should also equally share with them the burdens of social living

• Duty of beneficence - enjoins us not only to bring about what is

good for others but also to help them better their conditions with respect to virtue, intelligence, or comfort

- requires the provision of benefits and balancing of benefits and harm for all people concerned in a given circumstance

• Duty of self-improvement - a duty to improve and develop oneself with respect

to virtue, intelligence, and happiness - should go hand-in-hand with other duties, for

unless one performs or carries out one’s duty to oneself, the fulfillment of one’s other duties would be less effective

** having done one’s duty of self-improvement---morally, intellectually and physically--- one would be in a better position to fulfill his duties to others

• Duty of nonmaleficence - duty to avoid inflicting evil, injury or harm upon

others as we would avoid doing so to ouselves----- we ought to prevent evil or harm, which encompasses pain, suffering, disability and death

** a physician who assumes the treatment and care of a patient, yet lacks the qualifications of his profession, and does not possesses the skill, care, and diligence required for treating such a patient, would actually be exposing this patient to danger

3.2.3 In the medical context• It encourages us to show discernment and

sensitivity with regard to the unique aspects of varying situations before making a decision• It urges us to be judicious, prudent, and

flexible in the light of the facts at hand then explore the possibilities of our decisions --- our moral guide should be not what is useful, but what is right

• The list of prima facie duties may serve as moral guidelines for health care professionals, including researchers--- such a list prompts health personnel responsible for patient care to reflect on these duties and to choose the one that best applies to a particular situation

** not only must we consider the possible consequences of our moral decisions, ( a utilitarian precept), but we must also consider the duties ( the Kantian principle) that would justify our moral actions or judgments

3.2.4 Difficulties• Contrary to what Ross seems to suggest, it is

practically impossible for all individuals to be able to discern the same moral principles and prima facie duties• One’s perception of what is right and wrong,

as well as of one’s duties, is the by-product of one’s education, training and experience

• Ross --- after giving a twofold principle by which to resolve conflicting prima facie duties --- does not tell us how to determine which duty, between two prima facie duties in conflict , is more stringent than the other; and which duty, among a cornucopia of prima facie duties has the greatest balance of rightness over wrongness

** ultimately, we rely upon our own intuition, our own subjective perception of what and how things ought to be

3.3 Rawls’s Theory of Justice (John Rawls)

3.3.1Theory of justice – 3 aspectsa.)every individual is inviolable---the larger sum of

advantages which is supposedly to be enjoyed by the many should not outweigh the sacrifices or inconveniences to be imposed on a few

**one may not exploit or oppress one individual or a particular group of citizens in the name of modernism and industrial progress

b.) an erroneous theory is tolerable in the absence of a good one

- as much as possible, when given two erroneous laws, one should choose the better and the less erroneous one

- an act of injustice, for instance, can be tolerated if and only if it is necessary to avoid an even greater act of injustice

c.) individual liberties should be restricted in order to maintain equality of opportunity

- liberties of equal citizenship are of paramount importance in a just society

- individual rights are not subject to political bargaining or compromise

- restrictions of individual liberties serve as safeguards against abuses and misuses of one’s freedom against others

3.3.2 Principles of justicea.) Equal access to the basic human rights and principles --- this

principle defines and secures equal liberties of citizenship - our basic rights and liberties include the right to vote and to

be eligible for public office, freedom of speech and peaceable assembly.......

b.) Fair equality of opportunity and the equal distribution of socio-economic inequalities

- as much as the availability of resources will allow, everyone should be given an opportunity for self-development or to receive medical treatment

3.3.3 Justice in human relations Aware of the need for principles that bind and guide individuals

in making decisions, Rawls cites four types of duties: a.) fairness in our dealings with others b.) fidelity c.) respect for persons d.) beneficence e.) natural duties – the duty of justice, the duty of helping

others in need or in jeopardy, the duty not to harm or injure others, and the duty to keep our promises

3.3.4 In the medical context • Rawls recommends the legitimacy of paternalism which

others should act or decide in our behalf whenever we are unable to make decision by and for ourselves --- for instance, should we become mentally incompetent

• Rawls justifies the allocation of social resources for the training of medical personnel by the benefits that it will yield to society in general---- likewise, he sanctions the voluntary consent of an individual to become a research subject, by virtue of his basic right to decide on what risks he is willing to take with his own life

• Rawls also introduced the concept of an order of priority, with regard to equal access to health care, within the context of the principles of equal opportunity and equal distribution of socio-medical resources

** between two patients, for example, one of whom is poor and needs immediate medical treatment , and the other who is rich and wants to undergo immediate cosmetic surgery, the former should be given first priority

3.3.5 Difficulties• In Rawls account of a hypothetical community under the

veil of ignorance, he does not permit the people in the original position to know their goals, plans, interests, and purposes, but only their self-respect, wealth and rationality

• Despite his objection against utilitarianism, Rawls’s concept of justice (“liberties of individuals should be restricted, provided that such restrictions are for the benefit of everyone”) refers to the utility principle or principle of the greatest number

3.4 Natural Law Ethics(St. Thomas Aquinas)

• So called precisely because there exists a natural moral law which is manifested by the natural light of human reason, demanding the preservation of the natural order and forbidding its violation

• In Aquinas’s view, the source of the moral law is reason itself

- reason directs us towards the good as the goal of our action, and that good is discoverable within our nature

3.4.1 Voice of right reason or voice of conscience

• The moral law is the dictate of the voice of reason – “the good must be done, and evil, avoided”• How are we to determine whether we

are acting rightly or wrongly? - if we follow the voice of reason we are

acting rightly, we are acting wrongly if we act against it

• “Thus, whenever I am faced with a particular act, the voice of reason serves as my natural guide in making moral decision. Similarly, I know I am doing the right thing if and when I follow the voice of my conscience; otherwise , I feel a sense of guilt, self-reproach, or remorse. This explains why some Thomists say we cannot run away from our conscience, as Judas Iscariot allegedly tried when he betrayed Jesus”

3.4.2 Man’s threefold natural inclination

1. Self-preservation – urges us to care for our health, not to kill ouselves or put ourselves in danger

2. Just dealings with others – reason by nature leads us to treat others with the same dignity and respect that we accord ourselves

3. Propagation of our species – we are naturally inclined to perpetuate our species which is viewed as a natural good

3.4.3 Three determinants of moral action

• The object - that which the will intends directly and

primarily is the object of the moral act; it may be either a thing (for example, money), or an action ( such as surgical operation)

** the very act of operating on a patient for a particular disease --- say, a tumor or cyst --- is directly and primarily intended by the physician

• The circumstances - there are conditions which, when superadded to the

nature of the moral act, will affect its morality, they are called the circumstances

- “will affect its morality” means that a given circumstance or a set of circumstances will either mitigate or aggravate the goodness or badness of a particular act; an act whose object is morally good may further be judged as good because of some circumstance; likewise, an act whose object is morally wrong may further be judged as wrong because of some circumstance

• The seven circumstances cited by St. Thomas

1.Who ? - this circumstance has something to do with

the special quality, prestige, rank or excellence of the person involved in the moral act.

** it is morally bad to rape a woman but even worse to rape one’s own daughter, the worst is to rape one’s own granddaughter

2. What? - this circumstance refers to the quantity

or quality of the moral object ** the very act of surgical operation on a

sick person who needs it is good in itself but to perform the act as excellently as a skilled surgeon is capable of heightens the goodness of the said action

3. Where? - this circumstance denotes the place where the

act occurs ** it makes a big difference for example, when a

doctor extends medical assistance to someone brought to the emergency room for stab wounds, and when a doctor selflessly goes out of his way to take the the wounded victim to his clinic or to a nearby hospital --- the former is a perfunctory role, while the latter is the act of a “Good Samaritan”

4. By what means? - this refers to the means used in carrying out the act ** to take advantage of one’s weakness is bad

enough, but to deceive and seduce someone in order to take advantage of that person makes matters much worse

** to extend medical help to an indigent patient is good, but to give him/her the money needed for his/her medication makes the goodness of the act much greater

5. Why? - the end or purpose is considered as a

circumstance affecting the goodness or badness of the action

- if the act itself is bad and is still carried out with a bad purpose, the said act becomes much worse

** to seduce a destitute girl is in itself bad; but to do so with the intention of making her one’s querida or number two makes the act of seduction doubly evil, so to speak.

6. How? - this circumstance indicates the manner in which

the action is done. ** when facing death through starvation for

example, the famished or starving individual may take surplus goods from another in order to avoid death

** in the case of unjust aggression, it is legitimate to kill the aggressor who unjustly attacks and attempts to kill another person

7. When? - this circumstance refers to the time element

involved in the performance of the action, not only with regard to quantity but to quality as well

** to commit rape under the cover of darkness is even worse than when it is done in broad daylight

** to abuse one’s patient under sedation is much worse than mere seduction

• The end or purpose - here we take end in the sense of end or purpose of the

doer or agent - it also affects the goodness or badness of an action or

decision in a number of imporant ways - the end or purpose may be taken either as a circumstance

or as the end of the agent, for it is an integral part of every moral act in either sense

- a good act with a moral motive makes the moral action bad,likewise, we may not employ an evil means in order to attain a good end

3.4.4 The double effect principle• The principle applies to a situation in which a

good effect and an evil effect will result from a good cause

- we may have a good action which will yield two effects, a good one and an evil one, how are we to solve this question?

--- according to the principle, under certain conditions, some evil effect--- voluntary in cause --- may be permitted to occur

3.4.5 The principle of totality• An individual has the right to cut off, mutilate or remove

any defective or worn out non-functioning part of his body; to dispose of his organs or to destroy their capacity to function “only insofar as the general well-being of the whole body requires it

** a gangrenous leg or arm or any other organ that is beyond being cured and threatens the whole organism may be mutilated to save the person’s life --- healthy organs, however, may not be cut off, as this would weaken a person’s health

3.4.6 Other moral principles• Other moral principles of natural law ethics 1. The principle of stewardship – declares

that human life comes from God, and no individual is the master of his/her own body

- humans are only mere stewards or caretakers , with the responsibility of protecting and cultivating spiritual and bodily functions

2. The principle of the inviolability of life - states that life is God’s and has been

loaned to us, hence it is inviolable and sacred

- it is only God who has complete control and dominion over life, our duty is to take care of it until God takes it back from us

3. The principle of sexuality and procreation – underscores a two fold purpose of sexual union

a.) the procreation and nurturing of children b.) the expression of loving union and companionship ** both purposes must be achieved only within the

conjugal bond ** human procreation requires responsible

collaboration on the part of the spouses with the fruitful love of God