UNIT I.

THEORIES AND PRINCIPLES OF HEALTH ETHICS

I. Introduction

Ethics is concerned with the study of social morality and philosophical reflection on its
norms and practices. Moral issues are those which are essential, basic, or important, and deal
with important social values or norms, such as respect for life, freedom. and love; issues that
provoke the conscience or such feelings as guilt, shame, self- esteem, courage, or hope; issues to
which we respond with words like ought, should right, wrong, good, bad; and, issues that are
uncommonly complicated, frustrating, unresolvable, or difficult in some indefinable way
(Jameton, 1984, p. 4). Morality refers to traditions or belief about right and wrong conduct
(Beauchamp & Walters, 1999). Morality is a social and cultural institution with a history and code
of learnable rules. Morality exists before we are taught its rules-we learn about them as we grow
up (Beauchamp, 2001). Moral philosophy is the philosophical discussion of what is considered
good or bad, right or wrong, in terms of moral issues. Ethics, addresses the question, "What
should I do in this situation?" Ethics offers a formal process for applying moral philosophy. The
study of ethics gives us a groundwork for making logical and consistent decisions. These
decisions may be based upon morality or formal moral theory. In the end, though, ethics does not
tell us what we ought to do, we must decide on our own.

II. Objectives/Competencies

At the end of this unit, I am able to:

1. identify different ethical principles and moral issues;
2. apply the ethical-moral principles to the different medical and other health related
issues; and
3. make correct moral decisions on ethical issues.

III. Pre-Test

Arrange the words to form a meaningful sentence. Write your answer on the space provided
below.

PROMOTES BAD IT AN IS GOOD TENDS TO UNHAPPINESS IF ACTION

INSOFAR HAPPINESS AS IT PROMOTE AND

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________
IV. Lesson Proper

A. Ethical Theories

1. Deontology

Its name comes from the Greek word deon, meaning duty. Actions that obey these rules
are ethical, while actions that do not, are not. This ethical theory is most closely associated with
German philosopher, Immanuel Kant (The Ethics Centre, 2016).
His work on personhood is an example of deontology in practice. Kant believed the ability
to use reason was what defined a person.
From an ethical perspective, personhood creates a range of rights and obligations
because every person has inherent dignity – something that is fundamental to and is held in equal
measure by each and every person.
This dignity creates an ethical ‘line in the sand’ that prevents us from acting in certain
ways either toward other people or toward ourselves (because we have dignity as well). Most
importantly, Kant argues that we may never treat a person merely as a means to an end (never
just as a ‘resource’).
Kant’s ethics isn’t the only example of deontology. Any system involving a clear set of
rules is a form of deontology, which is why some people call it a “rule-based ethic”. The Ten
Commandments is an example, as is the Universal Declaration of Human Rights.
Most deontologists say there are two different kinds of ethical duties, perfect
duties and imperfect duties. A perfect duty is inflexible. “Do not kill innocent people” is an
example of a perfect duty. You can’t obey it a little bit – either you kill innocent people or you
don’t. There’s no middle-ground.
Imperfect duties do allow for some middle ground. “Learn about the world around you”
is an imperfect duty because we can all spend different amounts of time on education and each
be fulfilling our obligation. How much we commit to imperfect duties is up to us.
Our reason for doing the right thing (which Kant called a maxim) is also important. We
should do our duty for no other reason than because it’s the right thing to do.
Obeying the rules for self-interest, because it will lead to better consequences or even
because it makes us happy is not, for deontologists, an ethical reason for acting. We should be
motivated by our respect for the moral law itself.
Deontologists require us to follow universal rules we give to ourselves. These rules must
be in accordance with reason – in particular, they must be logically consistent and not give rise
to contradictions.
It is worth mentioning that deontology is often seen as being strongly opposed
to consequentialism. This is because in emphasising the intention to act in accordance with our
duties, deontology believes the consequences of our actions have no ethical relevance at all.
The appeal of deontology lies in its consistency. By applying ethical duties to all people
in all situations the theory is readily applied to most practical situations. By focussing on a
person’s intentions, it also places ethics entirely within our control – we can’t always control or
predict the outcomes of our actions, but we are in complete control of our intentions.

2. Teleology

Teleological ethics, (teleological from Greek telos, “end”; logos, “science”), theory
of morality that derives duty or moral obligation from what is good or desirable as an end to be
achieved. Also known as consequentialist ethics, it is opposed to deontological ethics (from the
Greek deon, “duty”), which holds that the basic standards for an action’s being morally right are
independent of the good or evil generated (Duignan, Encyclopaedia Britannica).
Modern ethics, especially since the 18th century German
deontological philosophy of Immanuel Kant, has been deeply divided between a form of
teleological ethics (utilitarianism) and deontological theories.
Teleological theories differ on the nature of the end that actions ought to
promote. Eudaemonist theories (Greek eudaimonia, “happiness”), which hold that ethics consists
in some function or activity appropriate to man as a human being, tend to emphasize the
cultivation of virtue or excellence in the agent as the end of all action. These could be the classical
virtues—courage, temperance, justice, and wisdom—that promoted the Greek ideal of man as
the “rational animal”; or the theological virtues—faith, hope, and love—that distinguished the
Christian ideal of man as a being created in the image of God.

3. Utilitarianism

The advocates of this ethical school of thought are Jeremy Bentham (1748-1832) and
John Stuart Mill (1806-1873).

Main Teaching:
a. The rightness and wrongness of actions is determined by the goodness and badness of their
consequences. There is only one principle, that is, the principle of utility. The utility or
usefulness of an action is determined by the extent to which it promotes happiness rather
than its reverse.

b. “An action is good insofar as it promotes happiness, and bad if it tends to promote
unhappiness,” according to John Stuart Mill. How are we to determine whether an action
tends to promote happiness or produce pain? The answer is its consequence or result rather
than the action itself.
c. No action seems to be intrinsically right or intrinsically wrong
d. The goodness of badness of an act does not depend upon the motive, intention or past action
of the doer.
e. CONSEQUENCES, EFFECTS, RESULTS and OUTCOMES are most important; they determine
the goodness or badness of the act. We ought to choose the action that produces the most
benefits (comfort) at the least cost of pain or unhappiness. Why, for example, take a diet and
exercise when you can be sexy without it or with minimum sacrifices by taking some pills or
undergo liposuction.

The Principle of Greatest Happiness

Bentham and Mill gave an alternative formulation of the utilitarian utility principle:

“An ACTION is GOOD insofar as it PRODUCES the GREATEST HAPPINESS for the GREATEST
NUMBER of PEOPLE;
BAD insofar as it PRODUCES more HARM than BENEFIT for the
GREATEST NUMBER of INDIVIDUAL.”

An example could be a person with a life support machine which is practically keeping
the patient alive (but virtually dead); at the same time making his family financially bankrupt,
jeopardizing the future of his family if the artificial life support system is continued. Is it
morally acceptable to stop the life support machine?
 Utilitarian ethics’ answer is: YOU SACRIFICE ONE for the SAKE of the MANY. The
death of one (taking the life support system) is the happiness of many. Similarly, if to kill a
man (corrupt, abusive or a liability to an organization) causes happiness to many, then, it is
justifiable.

Utilitarian Concept of Happiness and Moral Legitimacy

Happiness is intended pleasure and the absence of pain.

Unhappiness is the presence of pain; the deprivation of pleasure.

The proper ethical attitude is to calculate carefully the amount of pleasure and the
amount of pain that any act will bring. If there is balance in favor of pleasure, the act is
morally legitimate. If, otherwise, it is not a good one. The more intense the pleasure, the
better; the greater the number of people benefited, the better.
What is paramount is that, it is not one’s happiness but the happiness of all that should
be considered in making moral DECISIONS. Living in an imperfect and unjust society requires
self-sacrifice in such a way that the sacrifice of one’s happiness for the happiness of others is
the highest utilitarian value.

Critique on Utilitarianism

Value and Strength:

Realistic result is important in making a decision in life. For Utilitarianism, what
determines the goodness of the act is its effect or result, which is useful, beneficial to the
person, thus bringing happiness. The principle of happiness of the greatest number of people
as the final consideration in making a moral decision encourages a sense of heroism,
patriotism among individuals: others first before self.

Weaknesses:
a. It seems that the principle of utility justifies the imposition of discomfort or suffering on
a few (or some individuals) for the sake of the many.

Cases of death penalty or the use of some individuals for human experimentation
(made by the German Nazi during World War II) to test the effectiveness of certain drugs,
even if many subjects died.
Or a Neuropathologist who wants to acquire a better understanding of the nervous
system and or brain function, may justify the moral decision to experiment on the brain of
the person by saying that such a study would yield many opportunities for broadening our
knowledge of the human brain.
The principle of utility will legitimize this experiments or death penalty because of
the greater number of benefits for a greater number of individuals will result. Although, one
or two human subjects may have suffered (or in fact may have died) because of the
experimental study, the many millions who will be benefited would far outweigh their
suffering or death.
But this utilitarian principle is violating the highest moral principle, that is the right
to life of every individual, which can never be sacrificed by anyone.

b. Thus, utilitarianism lacks the principle of justice. It is not right to increase the happiness
of many at the expense of one human being especially if his right to life is at stake.
 It ignores the importance of motive or intention in making moral decision. It seems
that one who has evil motive of cheating someone is morally justifiable provided it has
beneficial and desirable consequences for as many people as possible. This means that a
society in which everybody acts from evil motives that nonetheless produce desirable results
is a good society.

In other words, the effect or consequence of an act is not the sole factor in analyzing
the morality of an act. No matter how the result is, or no matter how much the outcome
contributes to the happiness of others, it does not make the act automatically good. There
are evil acts that may produce good results, like killing a man for her wife to be liberated from
his being irresponsible and abusive. But this will not make the act of killing good no matter
how good the outcome would be for others.

V. Reflection

***Refer to google link***

VI. Post-test

***Refer to google link***

VII. References

Burkhardt, Margaret A. and Nathaniel, Alvita K. Ethics and Issues in Contemporary Nursing. 2 nd
Edition (2002). Thompson Learning Asia.

Rich, Karen and Butts, Janie. Nursing Ethics: Across the Curriculum and into the Practice. Jones
and Bartlett Publishers.

Tago, Bonifacio C. Jr., Bioethics

Sambajon, Jr., Marvin Julian L. Health Care Ethics: A College Textbook for Nursing, Medicine, and
Other Health-care Related Courses (2007). C & E Publishing, Inc.

https://ethics.org.au/ethics-explainer-deontology/

https://www.britannica.com/topic/teleological-ethics

https://ethics.org.au/ethics-explainer-
deontology/#:~:text=Deontology%20is%20a%20theory%20that,with%20German%20philoso
pher%2C%20Immanuel%20Kant.

https://pubmed.ncbi.nlm.nih.gov/15682160/
https://www.dentalcare.com/en-us/professional-education/ce-
courses/ce510/veracity#:~:text=Veracity%20is%20defined%20as%20being,and%20a%20he
alth%20care%20provider.&text=This%20allows%20patients%20to%20use,in%20their%20o
wn%20best%20interest.

https://plato.stanford.edu/entries/principle-
beneficence/#:~:text=The%20term%20beneficence%20connotes%20acts,kindness%2C%20g
enerosity%2C%20and%20charity.&text=Whereas%20beneficence%20refers%20to%20action
s,to%20act%20to%20benefit%20others.

https://www.medscape.com/viewarticle/811079_5

https://www.coursehero.com/file/8582543/920-notes/#:~:text=View%20full%20document-
,The%20Principle%20of%20Legitimate%20Cooperation%20When%20it%20is%20applied%2
0Whenever,committing%20a%20morally%20evil%20act.

http://www.arthurstreet.com/MEDICAL_ETHICS1995.htm

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5375653/#:~:text=%E2%80%9CSubsidiarit
y%20is%20the%20coordination%20of,%E2%80%9D%20(Benedict%20XVI%202008).

https://academic.oup.com/bja/article/108/suppl_1/i3/237272

http://www.beaumont.ie/media/OrdinaryandExtraordinaryTreatment1.pdf