Ths is for Students

1. Ethical TheoriesEthical Theories
PIR BUXPIR BUX
25-08-201425-08-2014

2. ObjectivesObjectives
 Discuss ethical principles in health care in the
light of ethical theories.
 2. Discuss the ethical dilemmas face by nurses
and client.
 3. Discuss the strategies to resolve ethical
dilemma in daily nursing practice.
 4. List steps of ethical decision-making

3. ETHICSETHICS
ACTION
INTENTION UTILITY

4. Philosophy BasisPhilosophy Basis
 Two plus two make four, regardless ofTwo plus two make four, regardless of
time, circumstances, feelings, belieftime, circumstances, feelings, belief
involved in the circumstancesinvolved in the circumstances
 Killing Euthanasia AbortionKilling Euthanasia Abortion
 Killing during warKilling during war
 Reasonable argumentsReasonable arguments
 Ethical rules are less clear, difficult orEthical rules are less clear, difficult or
impossible to proveimpossible to prove

5. SoSo
 Ethics is a systematic approach toEthics is a systematic approach to
understanding, analyzing, andunderstanding, analyzing, and
distinguishing matters of right and wrong,distinguishing matters of right and wrong,
good or bad, admirable or adorable asgood or bad, admirable or adorable as
they exist along the continuumthey exist along the continuum

6. WhyWhy
 Scientific and technological advancesScientific and technological advances
 Economic realitiesEconomic realities
 Pluralistic worldviewsPluralistic worldviews
 Global communicationGlobal communication
 Develop an appreciation on personalDevelop an appreciation on personal
philosophiesphilosophies
 Personal opinions, unexamined beliefs,Personal opinions, unexamined beliefs,
intuition or scientific reasoningintuition or scientific reasoning

7. ReasoningReasoning
 It involves using abstract thought processIt involves using abstract thought process
to solve problems and formulate plans.to solve problems and formulate plans.
(Angeles, 1992)(Angeles, 1992)
 Ethical Theory: it Helps to provideEthical Theory: it Helps to provide
guidance in moral thinking and reasoningguidance in moral thinking and reasoning
and justification for moral actions.and justification for moral actions.
 Helps to discern common place moralityHelps to discern common place morality
and strengthen moral judgments in theand strengthen moral judgments in the
face of moral dilemmas (Mappes 2001)face of moral dilemmas (Mappes 2001)

8. PhilosophyPhilosophy
 It is intense and critical examination ofIt is intense and critical examination of
beliefs and assumptions.beliefs and assumptions.
 Natural and necessary to humanityNatural and necessary to humanity
 Gives coherence to the whole realm ofGives coherence to the whole realm of
thought and experiencethought and experience
 Offers principles for deciding what actionsOffers principles for deciding what actions
and qualities are most worth whileand qualities are most worth while
 May show inconsistency in meaning andMay show inconsistency in meaning and
context (Kneller, 1971)context (Kneller, 1971)

9. PhilosophyPhilosophy
 It gives shape to what would otherwise beIt gives shape to what would otherwise be
a random chaos other thoughts, beliefs,a random chaos other thoughts, beliefs,
assumptions, values and superstitions.assumptions, values and superstitions.
 Examines questions that deal with theExamines questions that deal with the
most important aspect of lifemost important aspect of life
 How can one find path that leads to end ofHow can one find path that leads to end of
suffering? Buddasuffering? Budda
 What is remedy for social disorderWhat is remedy for social disorder
 How should one liveHow should one live

10. Theory of ethicsTheory of ethics
 Moral philosophy is the branch ofMoral philosophy is the branch of
philosophy that examines beliefs andphilosophy that examines beliefs and
assumptions about the nature of certainassumptions about the nature of certain
human valueshuman values
 Practical applicationPractical application
 Philosophy reveals an integrated vision inPhilosophy reveals an integrated vision in
which elements, like pieces of puzzle,which elements, like pieces of puzzle,
have a logical fithave a logical fit

11. NaturalismNaturalism
 Moral judgment that regards ethics asMoral judgment that regards ethics as
dependent on human nature anddependent on human nature and
psychologypsychology
 Attributes differences in moral codes toAttributes differences in moral codes to
social conditionssocial conditions
 All peoples have similar psychologicalAll peoples have similar psychological
tendency (Raphael, 1994)tendency (Raphael, 1994)
 Universality or near universality in moralUniversality or near universality in moral
judgmentjudgment
 Feelings about particular action inFeelings about particular action in
particular situationsparticular situations

12. NaturalismNaturalism
 to make similar ethical decisions, valueto make similar ethical decisions, value
differences among cultures,differences among cultures,
 Does not explain selfish, cruel choicesDoes not explain selfish, cruel choices
 Experience pleasure and avoid painExperience pleasure and avoid pain
 To be happy is to get pleasure and avoidTo be happy is to get pleasure and avoid
painpain
 A natural tendency to sympathizesA natural tendency to sympathizes
 Helping people in needHelping people in need

13. SympathySympathy
 A motivating factor, is the sharing, inA motivating factor, is the sharing, in
imagination of others’ feelings.imagination of others’ feelings.
 Involves as pleasure, the tendency toInvolves as pleasure, the tendency to
warm towards others who has pleasedwarm towards others who has pleased
another, painanother, pain
 The tendency to feel hostile toward oneThe tendency to feel hostile toward one
who has caused pain to anotherwho has caused pain to another
 It is a natural tendency and a basis forIt is a natural tendency and a basis for
moral reasoningmoral reasoning

14. UTILITARIANISMUTILITARIANISM
 Jeremy Bentham (1748-1832)Jeremy Bentham (1748-1832)
 Consequential: teleologicalConsequential: teleological
 Telos Greek word meaning “end”Telos Greek word meaning “end”
 Action related to good or badAction related to good or bad
consequences, result derived from itconsequences, result derived from it
 Naturalism: right action with greatest utilityNaturalism: right action with greatest utility
 Utility or usefulnessUtility or usefulness
 Actions are right when they increaseActions are right when they increase
happiness, and diminish miseryhappiness, and diminish misery
 wrong, when they have opposite effectwrong, when they have opposite effect

15.  Principle of utilityPrinciple of utility
 Humans are sentient beingHumans are sentient being
 Good bad sensation (Epicurus)Good bad sensation (Epicurus)
 Hedonistic point of viewHedonistic point of view
 Six criteriaSix criteria
 Intensity, duration, certaintyIntensity, duration, certainty
 Propinquity: nearness in place or timePropinquity: nearness in place or time
 Fecundity : chances of it being followed byFecundity : chances of it being followed by
sensation of same kindsensation of same kind
 Purity: chances of it not being followed byPurity: chances of it not being followed by
sensation of same kindsensation of same kind

16. RebirthRebirth
 ““end justifies means”end justifies means” ( John S Mill)( John S Mill)
 ““ action is conduct not agent’s ownaction is conduct not agent’s own
happiness”happiness”
 Object of happiness is multiplicationObject of happiness is multiplication
 It is beyond physical pleasureIt is beyond physical pleasure
 It could be gift, profit, benefit so on…..It could be gift, profit, benefit so on…..
 A type of action which augmentA type of action which augment HappinessHappiness
of community as a wholeof community as a whole
 Life of moderation, courage, justiceLife of moderation, courage, justice
 Cultivating friendshipCultivating friendship

17. RATIONALISM:RATIONALISM:
 feelings and perceptions seems similar,feelings and perceptions seems similar,
are not actually or may not be sameare not actually or may not be same
 Absolute truths that are not dependent onAbsolute truths that are not dependent on
human naturehuman nature
 ethical value have an independent origin,ethical value have an independent origin,
 in the universe or from of Godin the universe or from of God
 Known through reasoning processKnown through reasoning process
 Truth about the world that is necessaryTruth about the world that is necessary
and universe, are superior than theand universe, are superior than the
information, we receive from our sensesinformation, we receive from our senses

18.  Misfortune, feel bad for self or one, but notMisfortune, feel bad for self or one, but not
for allfor all
 Ethics variations being free of humanEthics variations being free of human
nature or matter of reasoningnature or matter of reasoning
 ““Help others” maxim shouldn’t change bcsHelp others” maxim shouldn’t change bcs
of feelings or circumstancesof feelings or circumstances
 Origin……..feelings ………. ReasonsOrigin……..feelings ………. Reasons
 Foundation predictable human natureFoundation predictable human nature
 universal or theological truthuniversal or theological truth

19. DeontologyDeontology
 Deontology: Greek word DutyDeontology: Greek word Duty
 Formalism/ Kantianism (Immanuel Kant)Formalism/ Kantianism (Immanuel Kant)
 Nature of the act rather thanNature of the act rather than
consequencesconsequences
 Shook religious and political systemShook religious and political system
 Ethical rules are universal,Ethical rules are universal,
 Awareness of moral rule is productAwareness of moral rule is product
reason, not experiencereason, not experience
 absolute and apply to all peoplesabsolute and apply to all peoples
 Knowledge could be obtained by a maximKnowledge could be obtained by a maxim

20.  A person is a rational human being withA person is a rational human being with
freedom, moral worth, and ideally a goodfreedom, moral worth, and ideally a good
willwill meaning a person should act from ameaning a person should act from a
sense of duty.sense of duty.
 Humans have freedom to make moralHumans have freedom to make moral
judgmentsjudgments
 Human should drive certain rules to guideHuman should drive certain rules to guide
 Peoples ought to follow a universalPeoples ought to follow a universal
framework of moral maxim or rules toframework of moral maxim or rules to
guide right actionsguide right actions

21. Categorical ImperativeCategorical Imperative
 Categorical: Moral rules that do not admitCategorical: Moral rules that do not admit
exceptionsexceptions
 Imperative: Command that is derived from principleImperative: Command that is derived from principle
 ““ Act only according to that maxim byAct only according to that maxim by
which you can at the same time will that itwhich you can at the same time will that it
should become a universal law”should become a universal law” (Trans. 1959(Trans. 1959
 A categorical has always a meaningA categorical has always a meaning
 Morally right actions are universal lawMorally right actions are universal law
 Treat person as end not only as meanTreat person as end not only as mean
 Equal and rationalEqual and rational

22.  Regard of others desires, allow themRegard of others desires, allow them
choicechoice
 Liberty, equality, fraternity in politicallyLiberty, equality, fraternity in politically
organized societyorganized society
 Treat all people as ends, not as means toTreat all people as ends, not as means to
an endan end
 Codes of Ethics: importance of fulfillingCodes of Ethics: importance of fulfilling
duties that are ownedduties that are owned
 Dignity and autonomyDignity and autonomy
 Dilemma: Conflicting values, rigid,Dilemma: Conflicting values, rigid,
exception less,exception less,

23. Practical ImperativesPractical Imperatives
 Act so that you treat humanity, whether inAct so that you treat humanity, whether in
your own person, or that of another,your own person, or that of another,
always an end and never a means to analways an end and never a means to an
end only. (trans. 1959)end only. (trans. 1959)
 Domination of one person over another isDomination of one person over another is
morally wrong.morally wrong.
 No allowance for dominated person’sNo allowance for dominated person’s
power of decision makingpower of decision making
 Realms of ends– politically organizedRealms of ends– politically organized
societysociety

24.  A systematic union of rational beingsA systematic union of rational beings
through common objective lawthrough common objective law
 Equal and autonomous membersEqual and autonomous members
 Promote regards for others wishes,Promote regards for others wishes,
desiresdesires
 Allow them freedom of decision makingAllow them freedom of decision making
 Ethics of democracyEthics of democracy
 It requires liberty, equality, fraternityIt requires liberty, equality, fraternity
 Moral worth based on reverence of lawMoral worth based on reverence of law

25. ApplicationApplication
 Most codes of ethics are basedMost codes of ethics are based
 Importance of fulfilling your duties andImportance of fulfilling your duties and
obligations, inherently owedobligations, inherently owed
 Preserving the dignity and autonomyPreserving the dignity and autonomy
 ““ The Nurse establishes relationship andThe Nurse establishes relationship and
delivers nursing services with respect fordelivers nursing services with respect for
patients’ needs and values withoutpatients’ needs and values without
prejudicesprejudices
 Should not go unnoticedShould not go unnoticed
 But is exception less, rigid and conflictingBut is exception less, rigid and conflicting

26. Hypothetical ImperativesHypothetical Imperatives
 Duties or rules that people ought toDuties or rules that people ought to
observe if certain ends are to be achieved.observe if certain ends are to be achieved.
 ““If- then”If- then”
 ConditionalConditional
 ““If I want to pass exam, then I should beIf I want to pass exam, then I should be
diligent in my studies”diligent in my studies”
 Moral actions must be unconditionalMoral actions must be unconditional
 Laws are absolute and universalLaws are absolute and universal
 If I perform this action, would IIf I perform this action, would I willwill that itthat it
becomes a universal law.becomes a universal law.

27. Virtue EthicsVirtue Ethics
 Virtue: excellence of intellect or characterVirtue: excellence of intellect or character
 Character: certain innate moral virtueCharacter: certain innate moral virtue
 What sort of person must I be to achieveWhat sort of person must I be to achieve
my life purposesmy life purposes
 What makes one a good or excellentWhat makes one a good or excellent
personperson
 Rather than “what is right or good to beRather than “what is right or good to be
based on my duty or to achieve goodbased on my duty or to achieve good
consequencesconsequences

28.  Virtues are intellectual or character traitsVirtues are intellectual or character traits
or habits that are developed throughoutor habits that are developed throughout
one’s lifeone’s life
 Personal effort, training, and practicePersonal effort, training, and practice
 Cardinal Virtues: Wisdom, courage, hopeCardinal Virtues: Wisdom, courage, hope
justice, faith, love, charity, temperance,justice, faith, love, charity, temperance,
 Honesty, compassion, caring,Honesty, compassion, caring,
responsibility, integrity, discernment,responsibility, integrity, discernment,
trustworthiness, prudencetrustworthiness, prudence
 Nursing: an important framework forNursing: an important framework for
examining moral behaviorexamining moral behavior

29.  ““ What morally we ought to do?”What morally we ought to do?”
 It is not moral requirement?It is not moral requirement?
 Moral virtue is a character trait that isMoral virtue is a character trait that is
morally valuedmorally valued
 A person with moral virtue has bothA person with moral virtue has both
consistent moral action and morallyconsistent moral action and morally
appropriate desireappropriate desire
 Practice of virtuous behaviorPractice of virtuous behavior
 Rather than virtuous acts being the endRather than virtuous acts being the end
result of good characterresult of good character

30.  Virtues are tendencies to act, feel, andVirtues are tendencies to act, feel, and
judge that are developed from naturejudge that are developed from nature
capacity by proper training and exercisecapacity by proper training and exercise
 Practice creates habit of acting in aPractice creates habit of acting in a
virtuous wayvirtuous way
 Virtue can be learned and improvedVirtue can be learned and improved
 Excellence of character depends onExcellence of character depends on
motivation, deliberation, clear judgment,motivation, deliberation, clear judgment,
self control and practiceself control and practice
 Fruit of intelligent pursuitFruit of intelligent pursuit
 Possession of the simple person, not thePossession of the simple person, not the
gift of innocent intent (Aristotle)gift of innocent intent (Aristotle)

31.  Virtuous acts must be chosen for their ownVirtuous acts must be chosen for their own
sakesake
 Virtuous character is created repeatedlyVirtuous character is created repeatedly
acting in a virtuous manneracting in a virtuous manner
 Virtuous acts must be chosen for their ownVirtuous acts must be chosen for their own
sakesake
 Choice must proceed from a firm andChoice must proceed from a firm and
unchangeable characterunchangeable character
 Virtue is disposition to choose the meanVirtue is disposition to choose the mean
 Human wellbeing is the highest aim ofHuman wellbeing is the highest aim of
moralitymorality

32.  Golden mean of virtuous behaviorGolden mean of virtuous behavior
 Golden Virtue: Practicing moderationGolden Virtue: Practicing moderation
 Avoiding both excess and deficiencyAvoiding both excess and deficiency
 No list of moral principlesNo list of moral principles
 Basic Moral question is not “What should oneBasic Moral question is not “What should one
do?” but “What should one be?”do?” but “What should one be?”
 Virtue lies not only engaging in virtuous acts, butVirtue lies not only engaging in virtuous acts, but
also inalso in Will ( Phillipa Foot)Will ( Phillipa Foot)
 WillWill is defined as “which is wished for as well asis defined as “which is wished for as well as
what is sought.”what is sought.”
 Positive will is sometimes the necessaryPositive will is sometimes the necessary
ingredient in successingredient in success

33.  Sometimes one man succeeds whereSometimes one man succeeds where
another fails not because there is someanother fails not because there is some
specific difference in their previousspecific difference in their previous
conduct but rather because his heart liesconduct but rather because his heart lies
in different place; and disposition of heartin different place; and disposition of heart
is part of virtue. A man’s virtue is judgedis part of virtue. A man’s virtue is judged
by his inner most desires as well as by hisby his inner most desires as well as by his
intentions. This fits with idea that a virtueintentions. This fits with idea that a virtue
such as generosity lies as much assuch as generosity lies as much as
someone’s attitudes as in his actions.someone’s attitudes as in his actions.
( Phillipa foot, 1997)( Phillipa foot, 1997)

34. According to footAccording to foot
 Virtue is not a skill or an artVirtue is not a skill or an art
 Can’t be merely a practiced or perfectedCan’t be merely a practiced or perfected
actact
 It must engage in willIt must engage in will
 An act can’t be considered virtuous, if theAn act can’t be considered virtuous, if the
intention is not goodintention is not good
 Virtue is one of hope (every one hasVirtue is one of hope (every one has
capacity to learn virtuous acts butcapacity to learn virtuous acts but
 Road to virtuous character is less easilyRoad to virtuous character is less easily
traveledtraveled

35. Nursing VirtuesNursing Virtues
 Character: As being made up of a set ofCharacter: As being made up of a set of
stable traits that affect a person’sstable traits that affect a person’s
judgment and actionjudgment and action
 All persons have different character traits,All persons have different character traits,
and all have capacity to learn and cultivateand all have capacity to learn and cultivate
those that are important to moralitythose that are important to morality
 Compassion: ability to imagine oneself inCompassion: ability to imagine oneself in
the situation of another, or a trait ofthe situation of another, or a trait of
combining an attitude of active regard forcombining an attitude of active regard for
another’s welfare, imaginative awarenessanother’s welfare, imaginative awareness
and emotional responseand emotional response

36.  Deep sympathy and discomfort at theDeep sympathy and discomfort at the
other person’s suffering.other person’s suffering.
 Compassionate and caring presenceCompassionate and caring presence
outweigh need for technical careoutweigh need for technical care
 But it does not impede ability to makeBut it does not impede ability to make
objective decisionsobjective decisions
 Discernment: wisdom, sensitive insights,Discernment: wisdom, sensitive insights,
acute judgment, understanding,acute judgment, understanding,
appropriate action in given situationsappropriate action in given situations
 It results in decisive actionsIt results in decisive actions
 Requires sensitivity and attentionRequires sensitivity and attention

37.  Strives to recognize and understandStrives to recognize and understand
important nuances in human behaviorimportant nuances in human behavior
 Comfort and reassurance rather thanComfort and reassurance rather than
privacyprivacy
 Trustworthiness: confident belief in theTrustworthiness: confident belief in the
moral character of another person,moral character of another person,
 another person will act with the rightanother person will act with the right
motives in accord with moral norms,motives in accord with moral norms,
 consistency, predictability,consistency, predictability,
 Accounted for in the reputation we haveAccounted for in the reputation we have
among coworkersamong coworkers

38.  Helps in developing relationshipsHelps in developing relationships
 Integrity: soundness, reliability,Integrity: soundness, reliability,
wholeness, and a coherent integrationwholeness, and a coherent integration
 Continue over time, reasonable stable,Continue over time, reasonable stable,
justified in action and judgment,justified in action and judgment,
 A person of integrity has a consistency ofA person of integrity has a consistency of
conventions, actions, emotions, and isconventions, actions, emotions, and is
trustworthytrustworthy
 Deficiency may include hypocrisy,Deficiency may include hypocrisy,
insincerity, and bad faithinsincerity, and bad faith

39. Virtue ethics in NursingVirtue ethics in Nursing
 One of aim of philosophy is to cultivate inOne of aim of philosophy is to cultivate in
gifted people their potential intellectualgifted people their potential intellectual
and moral qualitiesand moral qualities
 The nightingale pledge: Promise purity,The nightingale pledge: Promise purity,
faith, love, loyalty, devotion, temperancefaith, love, loyalty, devotion, temperance
trustworthiness,trustworthiness,
 Good character is cornerstone of goodGood character is cornerstone of good
nursingnursing
 Nurse will act according to principleNurse will act according to principle

40. Natural Law EthicsNatural Law Ethics
 Saint Thomas Aquinas (1225-1274)Saint Thomas Aquinas (1225-1274)
 Disseminated by Roman catholic churchDisseminated by Roman catholic church
 Also influenced by AristotleAlso influenced by Aristotle
 Rightness of an action is self evident fromRightness of an action is self evident from
the law of naturethe law of nature
 most cases Orchestrated by lawgiver Godmost cases Orchestrated by lawgiver God
 Morality is determined not by customs,Morality is determined not by customs,
and human preferences but isand human preferences but is
commanded by law of reasoncommanded by law of reason
 Implanted in nature and human intellectualImplanted in nature and human intellectual

41.  Natural law ethicists believed that behaviorNatural law ethicists believed that behavior
that is contrary to their views of the laws ofthat is contrary to their views of the laws of
nature is immoralnature is immoral
 Examples are artificial means of birth control,Examples are artificial means of birth control,
and homosexual relationshipsand homosexual relationships

42. Moral/ ethical ProblemsMoral/ ethical Problems
 Moral Uncertainty: sense that a moralMoral Uncertainty: sense that a moral
problem, but are not sure of morallyproblem, but are not sure of morally
correct action, unable to define moralcorrect action, unable to define moral
problem what moral theory/ principleproblem what moral theory/ principle
apply, sense something is not right,apply, sense something is not right,
uncomfortable with the situationuncomfortable with the situation
 Can’t figure out the problemCan’t figure out the problem
 Nature and cause of inadequacyNature and cause of inadequacy

43. Moral/Ethical DilemmaMoral/Ethical Dilemma
 A dilemma exists when a difficult problemA dilemma exists when a difficult problem
seem to have no satisfactory solution orseem to have no satisfactory solution or
when all solutions to a problem appearwhen all solutions to a problem appear
equally favorable (Davis 97)equally favorable (Davis 97)
 Conflicting moral claimsConflicting moral claims
 Conflict = evidenceConflict = evidence
 Terminally ill patient, preserve life, prolongTerminally ill patient, preserve life, prolong
sufferingsuffering

44.  Agent, one or more moral norms existsAgent, one or more moral norms exists
 Critical care bed allocation?Critical care bed allocation?
 Perceive or conceptualize: obligation, principle,Perceive or conceptualize: obligation, principle,
duties, rights, loyaltiesduties, rights, loyalties
 Moral Distress:- face situations seem to haveMoral Distress:- face situations seem to have
clear solutions, yet unable to follow their moralclear solutions, yet unable to follow their moral
belief due to restraintsbelief due to restraints
 No conflicting moral claimsNo conflicting moral claims
 Impossible to peruse course of actionImpossible to peruse course of action
 Powerless, hierarchy, culture of silencePowerless, hierarchy, culture of silence
 Personal risky = hospitals endPersonal risky = hospitals end

45. Moral OutrageMoral Outrage
 Someone else performs an act the nurseSomeone else performs an act the nurse
believes to be immoralbelieves to be immoral
 Do not participate directlyDo not participate directly
 No feelings of responsibility butNo feelings of responsibility but
powerlessnesspowerlessness
 Whistle blowingWhistle blowing may be response to moralmay be response to moral
outrageoutrage

46. REFERENCES:REFERENCES:
 Burkhardt, M.A; Nathaniel, A.K. Ethics &Burkhardt, M.A; Nathaniel, A.K. Ethics &
Issues: in Contemporary Nursing. (2Issues: in Contemporary Nursing. (2ndnd
ed) .ed) .
Delmar Thomson Learning Ch:2 (20-38),Delmar Thomson Learning Ch:2 (20-38),
Ch:6 (92-96)Ch:6 (92-96)