Notes. Hard Principles PDF

PHI 213 LECTURE I NOTES
PHI 213 LECTURE NOTES
LECTURE I: INTRODUCTION TO PHILOSOPHY, BIOMEDICAL ETHICS,

NIHILISM, RELATIVISM, OBJECTIVISM, ETHICAL THEORIES,
BIOMEDICAL PRINCIPLES, AND FUNDAMENTAL PRINCIPLES IN
BIOETHICS
I. GENERAL INTRODUCTION TO PHILOSOPHY
A. What is Philosophy?
1. "Philosophy" comes from the Greek "φíλη" (love, friend) + "σοφóς" (of
wisdom).
2. Different branches or disciplines within philosophy:
a. Epistemology - Theory of knowledge
b. Metaphysics - Theory of existence
c. Ethics - Theory of best way to live, or happiness
d. Logic - reasoning, validity, soundness
e. Social/Political Philosophy - Theory of justice or how best to run a state
http://www.mc.maricopa.edu/~davpy35701/text/213_1.html 28/08/2019, 12A24 AM

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f. Aesthetics - Theory of beauty
g. "Philosophy of": Language, Religion, Psychology, Mind, Science, Biology,

Mathematics.
h. Philosophy by region or group - E.g., Western Philosophy, Eastern

Philosophy, Feminist Philosophy
3. Ethical Disciplines:
a. Descriptive Ethics: Psychological or sociological explanations, with the

goal of attaining empirical knowledge of morality of accepted moral views.
The views could be current or past moral views. E.g., Why did we as a culture
accept slavery, as a practice? Why does this person have these views of
abortion?
b. Normative Ethics: Attempt to determine what is morally right and what is

morally wrong with regard to human action. Normative ethics determine
what should be the case, whether or not it currently is the case. E.g., Applied
normative ethics questions: Are abortions in the case of the imminent death
of the mother morally permissible? Is actively administering a lethal
injection to a patient who is in pain morally permissible?
c. Metaethics: Concerned with tasks such as analyzing the nature of moral

judgments and specifying appropriate methods for the justification of
particular moral judgments and theoretical systems. E.g., What makes a right
action right? Which theory is the better moral theory: Utilitarianism or
Kantianism? Are consequences or intentions more useful in determining the
rightness of actions?

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II. BIOMEDICAL ETHICS IN PARTICULAR:
A. Biomedical ethics is applied normative ethics, focused on health care,

medical science, and medical technology.
1. Bioethical questions: Should doctors or nurses ever lie to their patients?

Should human embryos ever be used in medical research? Should people in
persistent vegetative states be removed from life support? Is abortion ever
morally permissible? Is a woman justified in having an abortion if prenatal
testing reveals that her fetus has a developmental defect? Is (therapeutic
and/or reproductive) cloning morally permissible? Do we have a right to
health care?
B. Morality is a normative or evaluative enterprise, concerning moral norms

or standards that help us decide the rightness of actions, judge the goodness
of persons or character, and prescribe the form of moral conduct. (Non-moral
norms such as legal, aesthetic, grammatical, etiquette-related, and legal
norms differ from moral norms.) Features of moral norms:
1. Normative Dominance: These norms take precedence over other norms.
2. Universality: These norms are supposed to apply to all doctors, nurses,

and patients in relevantly similar situations, not just to this doctor
in this situation.
3. Impartiality: Everyone should be considered equal; everyone's interests

should count the same.
4. Reasonableness: We look for good and consistent reasons for doing what
we think should be done, as opposed to knee-jerk reactions or emotional
responses (though emotions can be part of the reasoning process).

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C. Morality v. Ethics: We're going to ignore the distinction the book makes on
pp. 3c2-4c1 about the difference between morality and ethics.
III. NIHILISM, SKEPTICISM, RELATIVISM AND OBJECTIVISM: (SEE

DR. Y’S CHART ONLINE WITH THIS ELEMENTS ON IT – UNDER
“OPTIONAL MATERIAL”)
IV. RELATIVISM [FYI TO STUDENTS: THIS IS NOT IN THE BOOK; SEE

DR. Y’S NOTES ONLINE WITH “RELATIVISM” IN IT – UNDER
“OPTIONAL MATERIAL”)]
A. Ethical Relativism: The view that what is ethically right is relative either
to the individual (Individual Relativism or Subjectivism) or to one’s culture
(Cultural Relativism or Conventionalism). That is, to an Individual
Relativist, every person is the sole determiner of what is right and wrong; to a
Cultural Relativist, each culture is the sole determiner of what is right and
wrong. Note: Both of these views cannot be true at the same time.
1. Two Objections to Individual Relativism:
a. It refutes itself. If whatever each individual believes is correct about

morality is right, then if one person thinks that there is an objective truth
about ethics, he or she is right (and everyone else would have to be wrong)!
b. There can be no argument about what is right and wrong, no matter

how sure you are that someone does (or has done something) wrong. Hitler
is right, Stalin is right, and every action any one has ever done, as long as the

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person thought it was ethically right, is right. E.g., as a teacher, I could fail you
if you earn all A's on the coursework, and you would have to admit that I was
correct, fair, etc. to do so, if Individual Relativism is the correct ethical theory.
2. Five Objections to Cultural Relativism:
i. Explanation v. justification: Though helpful as an explanation of other

cultures, it does not justify them. This view may help us to understand why
cultures have accepted cannibalism, slavery, sexism, racism, genital
mutilation, having no human rights, etc., but it doesn’t give a good argument
as to why these actions are ever moral.
ii. "We're all (ethically) right!?": There can be no argument about what is
right and wrong between cultures, no matter how sure your culture is that
some other culture has done something wrong. E.g., marijuana smoking.
iii. There will be "Immoral Rebels": If you do not follow the culture’s beliefs,
you are immoral. It is unclear how one can go about changing the culture’s
belief or practice, if one finds oneself thinking that the culture is wrong.
Anyone who thinks abortion should be illegal is wrong, and if they perform
any action on that belief, they are immoral.
iv. What proportion counts? Is it 51%? 66.6%? 75%? 90%? Who takes the polls
and how often? How do we even know what our culture thinks about LOTS
of questions: cloning, genetic engineering, etc.?
v. Whose culture is relevant? What culture do I count as my own? What if

my Dad is from one culture and my Mom is from another, and they both
conflict with American culture? Which one is right? (Other subcultures?)
B. Legality and Morality: Questions:

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1. Is what is legal always moral?
2. Is what is illegal always immoral?
Answer(s): Almost certainly not. Why?
Legal Illegal
(Arguably) Donating to charity Helping slaves escape to freedom
Moral
Arguably) Nazi science experiments on Jews Killing people for fun
Immoral
C. Religion and Morality: Questions:
1. Is what is religious (according to a given religion) always moral?
2. Is what is irreligious (according to a given religion) always immoral?
Answer(s): Arguably not. Why?
· Religious but (arguably) immoral examples: The Crusades, Inquisitions,

(intent to) sacrifice a son, 9/11 attacks.
· Irreligious but (arguably) moral examples: Giving a blood transfusion to

a minor child of a Jehovah’s Witness adherent, wearing mixed fabric clothes,
giving a percentage of your income to charity instead of a religious sect.
D. Conclusion of this section:
1. Nihilism, Individual & Cultural Relativism are implausible ethical views;

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2. What is (il)legal is (im)moral, so only looking to the law to determine
morality is (arguably) implausible; and:
3. What is (ir)religious is not necessarily (im)moral, so only looking to (one)

religion is (arguably) implausible.
V. KANTIAN DEONTOLOGY (IMMANUEL KANT'S ETHICAL THEORY)
A. KANT'S LIFE: Lived from 1724-1804. (More bio in class.)
B. THE CATEGORICAL IMPERATIVE: There are two formulations

(for our purposes - there are actually six in his whole book, Grounding for the
Metaphysics of Morals):
1. First Formulation: "Act only on that maxim through which you can at the
same time will that it should become a universal law." Maxim = a description
of action in imperative form. E.g., "Help this person in dire need" or "Lie to
avoid hurting one's feelings."
2. Second Formulation: "Act in such a way that you always treat humanity,
whether in your own person or in the person of any other, never simply as a
means, but always at the same time as an end." Some explanation of the
second formulation:
a. People (rational beings) are ends in themselves; non-rational beings

(non-human animals) and anything else (chairs, dirt) are things. There are
three reasons why we are ends in themselves: (1) People have practical reason
(= ability to define context, know the means to your end). (2) People
have Autonomy (auto-nomos) - we create laws for ourselves - we determine

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our ends through practical reason. Autonomy is roughly equivalent to free
will. (3) We human beings have intrinsic value, not mere instrumental
value. That is, we always have intrinsic value, we may have instrumental
value as well.
b. What actions are morally impermissible? Treating people simply as a

means, or treating a person solely as an instrument to obtain something for
yourself. EXs: Slavery, rape, human trafficking, industrialists (e.g.,
sweatshops), lies to further yourself, and suicide. These actions are morally
impermissible.
c. What actions are morally permissible? Treating people only as ends in

themselves (e.g., not littering in the Grand Canyon, out of respect for
others) and/or treating people both as means and as ends (e.g., my teaching
you - I earn money from you; and you learning from me - you receive
knowledge; but we treat each other with respect). These actions are morally
permissible.
d. Respect for Rational Beings: Every person, by virtue of his/her humanity

(i.e., rational nature) has an inherent dignity. From this, we need to respect
ourselves and others too. If we all did that, we'd have what Kant calls a
Kingdom of Ends.
3. Comparison of Categorical Imperative v. Golden Rule: Suppose

the Golden Rule = Do unto others as you would have them do unto you.The
Golden Rule is more permissible/lenient than Kant's categorical imperative
because the Golden Rule relativizes its principle to passions, inclinations, etc.
In other words, Kant's theory goes above and beyond the Golden Rule, so you
should not think of them as being equivalent (though his view is certainly
related to it).

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C. PERFECT DUTIES V. IMPERFECT DUTIES:
1. Perfect Duties: Duties that require that we do or abstain from certain acts,
and have no legitimate exceptions. Notable perfect duties: Not to kill an
innocent person, lie, break promises, and/or committing suicide. No matter how
beneficial the consequences, the action is strictly impermissible. [NOTES: (1)
You can't play these duties off of one another - you can't promise to lie,
promise to commit suicide, or say you'll commit suicide and then say you
can't lie, so you need to carry it out! All of these would be contrary to reason,
just as using your will to destroy your will is self-contradictory. (2) It's not
breaking a promise to not have any way of fulfilling a promise: For instance, I
promise my son to play football this weekend, but I break my leg between
now and then. I am physically unable to fulfill the promise, so I'm not
morally wrong to not play football. The only way in which it WOULD be
immoral for me to not play football with the broken leg, is if I intentionally
broke my leg in order to not fulfill the promise! Why is this Kantian? Because
one of his famous phrases is "Ought implies can" - you can't morally require
something of someone that he or she cannot mentally, physically,
or logically do. For instance, I can't say that a two year old should read more
Kant, or that my Mom should become a square circle, or that my Dad should
fly to the moon under his own power.]
2. Imperfect Duties: Duties that have exceptions (e.g., to help others where one
can, assure our own happiness, develop one's talents, and/or improve
oneself). [NOTE: As with playing perfect duties off of one another, one also
cannot play imperfect duties off of perfect duties: EX: I cannot say I need to
lie (or break a promise, or commit suicide) in order to benefit someone else,
assure my happiness, improve myself, and/or express my talent!]
D. More on Kant's Ethical Theory:

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1. What is good in itself, for Kant? The only thing that is good in itself is a
good will. Will = faculty in one's mind for choosing a course of action.
2. How does a good will choose? A good will chooses an act for good
reason(s) and duty.
3. The good will, motives, and intentions. Having a good will is roughly
equivalent to having good intentions. Your behavior and other externalities
are worthless without a good will.
4. Reason v. emotion, pleasure, or inclination. We should, according to

Kant, value and base our actions on reason, not emotion, pleasure, or
inclination. [EX: Homeless shelter cases.]
5. Getting pleasure from doing an action before, during or after that is

fine, but pleasure cannot be the main part of your motivation for doing the
action. Paradigmatic Kantian situation: If you get no pleasure, you have no
desire to help others, but you help others anyway from a sense of duty, you've
acted morally, according to Kant.
6. Consequences, schmonsequences! Kant thinks consequences are

irrelevant to determining what is moral or not ("A good will is not good
because of what it effects or accomplishes ... it is good through its willing
alone - that is, good in itself").
7. Acting with a sense of (or from) duty v. acting in accordance (or in

conformity) with duty: Acting with a sense of duty (GOOD) = choosing an
action only or primarily because it is one's duty. EX: Saving a child in a canal
because he's drowning and it's your duty to help others. Acting in accordance
with duty (BAD) = acting in a way that is consistent with your duty, but for
self-interested reasons. EX: Saving a child drowning in a canal because you're

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running for the Senate.
E. APPLYING KANT’S THEORY TO BIOMEDICAL ISSUES: According to

Kant’s theory, physicians cannot lie to patients – may not issue placebos,
researchers must have voluntary, informed consent. And: physician-assisted
euthanasia is morally impermissible according to Kant’s theory, since it is a
form of suicide.
F. Evaluation of Kant's view:
In favor:
1. Rational, consistent, and impartial.
2. Respects the intrinsic worth of a human being.
3. A moral framework for rights.
4. Non-relativistic rights and duties.
5. Autonomy and ability to choose your moral projects.
6. Alternative: Consequences?
Against:
1. Hard case: The Nazi Case. The terminally ill suicide case.
2. Two objections from David Hume:
a. Reason does not discover moral rules.
b. Reason does not motivate moral action.

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3. Akrasia (weakness of will or moral conviction).
4. Is the good will always good without qualification? Can't I be a do-

gooder who always tries to do my duty but creates misery instead?
5. What about non-human animals and/or non-rational animals?
VI. ACT UTILITARIANISM
A. ACT UTILITARIANISM = a person ought to act so as to produce the

greatest balance of good over evil, everyone considered.
1. Utility = The net balance of good over evil (everyone considered) that is
likely to be produced.
2. Jeremy Bentham v. John Stuart Mill: Bentham thinks that pleasure has
intrinsic value, pain has intrinsic disvalue, and that there is no difference in
the quality of pleasures (e.g., pleasure from sex = pleasure from philosophy or
curing someone). Mill thinks that happiness has intrinsic value, unhappiness
has intrinsic disvalue, and that there is a qualitative difference between
pleasures (e.g., studying philosophy, art, or other intellectual pleasures are
noble pleasures; having sex, eating, partying are base pleasures).
3. Steps to use Act Utilitarianism:
a. Delineate alternative paths of action.
b. Attempt to foresee consequences for everyone (individual or group)

involved, for each action

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c. Evaluate consequences, weighing good and bad, and then
d. Discover what act produces the greatest utility (or the least unfavorable
balance); that action should be done.
EXAMPLE OF ACT UTILITARIANISM:
Teaching vs not teaching
The Ethical Question: Should we (i.e., George and I) hack into Danny’s
computer, just to see if we can do it (i.e., but not harm Danny’s computer)?
YES Me George Danny Total Grand

Total
Amount +8 0 0 +8
of
Pleasure
Amount 0 -6 0 -6
of Pain
YES:
+2
NO
Amount 0 +2 0 +2
of
Pleasure

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Amount -4 0 0 -4
of Pain
NO: -2

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Result: More pleasure results from doing the action; therefore, we should do
the action.
4. It is not true that certain acts are just intrinsically wrong, or wrong in their
nature, so Act Utilitarianism is a situational ethics. Lying, killing, etc., may be
right, depending on the situation.
5. One must not allow one’s interests to weigh more heavily than the
interests of others in the calculation.
6. Questions: How do I weigh anxiety v. inconvenience? How can I predict

what will happen? How can I spend so much time calculating pleasure?
Answers: There’s no escape from a consideration of probabilities in rational
decision-making, predict and weigh as best you can, considering the time you
have available for deliberation.
7. Applying Act Utilitarianism to Bio-Ethics:
a. A severely impaired newborn has contracted pneumonia won’t survive

more than 2 weeks. Should you treat it with antibiotics, or let it die (withhold
treatment)? Act Utilitarianism assessment: The infant has nothing to gain,
something to lose in living longer; the parents will not stop suffering no
matter what, hospital resources would be better used elsewhere.
b. A biomedical researcher researching a new drug, knows it has prolonged

nausea as a side effect – if prospective volunteers know about the side effect,
she won’t get volunteers to sign up, but if they don’t know about it, there will
be volunteers. Act Utilitarianism assessment: Don’t deceive the prospective

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subjects, because you would ruin the integrity of experimentation ethics.
c. There is room for one kidney dialysis patient, but two candidates need it.
One is a woman, married, civic-minded, and has 4 children; the other is a
man, unmarried drifter, and an alcoholic. Act Utilitarianism assessment: One
should clearly choose the woman, because she is more socially useful and
creating more happiness.
8. Assessment of Act Utilitarianism:
A. In favor of Mill’s ethical theory:
1. Intuitive in general: It links happiness with morality, instead of possibly

pitting happiness against morality (such as Kant’s view). We think it makes
sense with common beliefs about morality. For instance, in general, it backs
up murder's being wrong, lying, rights. So Utilitarianism gives us a system to
our intuitions.
2. It is common sense that pain is bad, pleasure is good: Everything being

equal, though people have many different and conflicting moral beliefs,
people agree that pain is bad, and pleasure is good.
3. Act U'm is impartial, fair, & promotes social harmony: Utilitarianism

requires us to balance our interests with those of others.
4. Practical, clear-cut procedure: Act utilitarianism doesn’t rely on vague

intuitions or abstract principles. It allows psychologists and sociologists to
determine what makes people happy and which policies promote the social
good [Warning: Do not use this as your main reason why you like this theory -
flipping a coin as Two Face in "The Dark Knight" is a simple ethical decision
procedure, but that by itself does not make it a good theory].

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5. Flexible and sensitive to circumstances: Act utilitarianism tries to
maximize happiness for each set of people in their situation. Different actions
will be right or wrong depending on the people involved and their happiness
or lack thereof with each option.
B. Against Mill’s ethical theory:
1. Negative Responsibility [STRONG]: According to Utilitarianism, you are

morally responsible for:
a. The things you did not do but could have done to maximize happiness;
and
b. The things that you could have prevented others from doing that
decrease overall happiness; as
well as for:
c. What you actually do to maximize/increase

happiness.
EX: if you go out and play tennis, you could be doing something (almost
certainly) to increase the overall happiness of the world instead. Therefore,
Utilitarianism is an excessively demanding theory: You need/may need to give
up a lot, if not everything, in order to do the moral thing.
2. Lack of autonomy/integrity of the moral agent [STRONG]: Utilitarianism

takes moral responsibility out of the realm of personal autonomy. The agent
must choose the one act that will maximize happiness, as opposed to his/her
own moral projects that rank second or below that, which technically would
be immoral to do, even if they create a lot of happiness. If you like the idea of
choosing your own moral projects, act utilitarianism is not for you.
Ex: overall happiness before your happiness.
Dont study. Your 8 hrs in the classroom are better spent cleaning the city.
Wag ka mag girlfriend/bf: time is better spent donating money.
Dont save money. Donate it all.

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3. Can people not be wrong about what is pleasurable? [STRONG] Does
everyone always accurately decide for him or herself what is
pleasurable? Can I mistake what in fact will really bring me pleasure and
what will not? Would we think this is a good theory with which to handle or
raise children? EX: should we ask them what they would like to eat or drink
and maximize their pleasure, especially if they outnumber us and are much
more excited about having something than we parents or adults are about
their having it? Mill cannot ignore what “ignorant” people are wanting or
(think they will) find pleasurable.
4. Hard Cases: Act Utilitarianism may require us to commit morally

reprehensible acts, according to other ethical theories [WEAK or
STRONG - see each example]:
a. Prisoners of War [WEAK]: You, as one of many prisoners, are told, "If you
don't give me the name of a prisoner to shoot in 5 minutes, then I will shoot
10 myself." What should you do? Utilitarianism requires you to choose the
prisoner who is the least useful or happiness-producing. [Note: This is weak,
only because a staunch utilitarian will not flinch at this objection, but just
nod his/her head. To other theories, such as Kant's, choosing someone to kill
is not permissible, because the person holding you captive should not kill any
prisoners, and perhaps should not even have them as prisoners. Moreover,
the prisoners have no reason to believe that the captor will keep his/her word
(e.g., the captor might kill 10 anyway, or just make this same offer every hour
until everyone is dead anyway), so why play the game? It's not as if everyone
will get to leave once one person is killed, right? The fact that the captor has a
bad will to use the prisoners only as a means does not allow you to do the
same.]
b. Torture a terrorist’s child? [WEAK]: You have access to the child of a

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ruthless terrorist who has a nuclear weapon aimed at your city. If you torture
the child, you can get the terrorist to stop the bombing action. Should you
torture the child? Utilitarianism might require you to torture the child to
ensure the safety of the whole city. [Note: Again, Kant would say that we
should not torture people in this way or ever, because we'd be using the child
only as a means to an end, and you could not and could never know that
torturing anyone ever will give you the outcome you desire. The fact that the
terrorist has a bad will to use everyone in the city only as a means does not
allow you to do the same.]
c. Rotten Professor example [STRONG]: Suppose there's a really ornery,

mean professor who has no living relatives (or if he does, they all don't like
him!) and who happens to be very healthy! Suppose you're his doctor who
knows that there are 5 people looking for organs, and the professor is a good
match for all of them. The question is, if no one would know about it, should
you kill the professor to donate the organs for transplants? There would be
happiness created by every “donee” and his/her family and friends, plus the
students of the rotten professor! Therefore, act utilitarianism says you should
murder the rotten professor. [Now imagine thinking of homeless people as
organ donors ...]
5. Utility Monsters? [STRONG]: Robert Nozick proposed that there could be

creatures ("Utility Monsters") that experienced more pleasure than the
average human, so if we assume that they experienced 100 times the pleasure
of a human when eating a cookie, e.g., then we would have to do what
pleased the utility monster, eventually doing everything we do in order to
please the monster.
VII. RULE UTILITARIANISM

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A. RULE UTILITARIANISM = A person ought to act in accordance with the
rule that if generally followed, would produce the greatest balance of good
over evil, everyone considered.
B. Rule Utilitarianism may endorse common sense rules of

morality (which were just “rules of thumb” for Act Utilitarianism), such as do
not kill, steal, lie, and do keep promises.
C. Also, Rule Utilitarianism may endorse rights (but may not – see examples
below).
EXAMPLE OF RULE UTILITARIANISM:
The Ethical Question (Simple Example): I have made a promise to meet a

friend who is on his deathbed; should I keep my promise?
Step 1: Think about the kind or type of action that the action is.
Step 2: Ponder different rules, considering whether they maximize happiness

in general or not.
Step 3: Do that action based on a rule that maximizes happiness in general (not
necessarily for this action right now).
This action involves promise keeping, and the rule of keeping promises in

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general maximizes happiness.
Result: Since the rule of keeping promises IN GENERAL maximizes

happiness (whether or not it does do that today in this action), I should keep
my promise.
The Ethical Question (Complex Example): I have made a promise to meet a

friend who is on his deathbed; on my way to meet him, I find a woman who is
wounded (but curable) and needs my help (no one else is around). Should I
keep my promise?
These actions involve either promise keeping or helping others, and both
keeping promises and helping others maximize happiness in general. Thus,
we are faced with a dilemma (see below).
Result: EITHER: One can argue that, since helping the woman is an
immediate matter of life and death, and the rule of helping others maximizes
happiness IN GENERAL, I should help the woman. OR: One could argue
that the rule of keeping promises maximizes happiness, and keep his or her
promise. Problem: If we pick the action that maximizes happiness IN THIS
CASE, we would use Act Utilitarianism as our ethical theory and make Rule
Utilitarianism pointless. But if we can just pick either rule and be a rule
utilitarian, then Rule Utilitarianism is arbitrary -- it allows you to do whatever

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action you wish, as long as you can come up with a rule that seems to
maximize happiness in general. So Rule Utilitarianism in this case would not
provide effective guidance.
Note about: Vaughn on Rule Utilitarianism, "says that the right action is one
that conforms to a rule that, if followed consistently, would create for
everyone involved the most beneficial balance of good over bad" (36c2; my
underlining). "For everyone involved" does NOT imply that you ask how
happy individuals in an individual action would be if you followed the rule,
because that would be using Act Utilitarianism, where you should ask how
(un)happy each individual is, and calculate which action creates the most
happiness. “For everyone involved" means, for everyone involved in this
KIND of situation, that action would create the most happiness (i.e., "most
beneficial balance of good over bad").
D. Applying Rule Utilitarianism to Bio-Ethics:
1. Is it ever right as a physician to lie to a patient? Rule U’m assessment: No,

since it would erode the trust between patient/physician.
2. Is voluntary (active) euthanasia OK? Rule U’m assessment: the patient

would stop pain/die with dignity, but it might increase anxiety of older
people, worried they might be killed for their money.
3. Should a doctor violate patient/physician confidentiality if patient

threatens to kill? Rule U’m assessment: You’d save lives possibly v. get good
treatment for the patient, if they don’t want to talk to you anymore.

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E. Assessment of Rule Utilitarianism:
In favor:
1. Rule utilitarianism is less demanding of individuals than Act Utilitarianism.
2. Rule utilitarianism is fine with close relationships, since these tend to

maximize happiness.
3. Rule utilitarianism is flexible to circumstances, if the rules conflict [Note:

this quickly turns into an objection – see below.]
4. Intuitive in general (to max happiness in general).
5. Impartial, fair, & promotes social harmony (to think about what max’es
happiness in general).
Against:
1. Negative Responsibility [STRONG]: According to Utilitarianism, you're

morally responsible for:
a. The things you didn't do but could have done to maximize happiness; and
b. The things that you could have prevented others from doing that decrease
overall happiness; as well as for:
c. What you actually do to maximize/increase happiness.
EX: You need to think of every rule that you could be following right now,
that would max happiness in general, and follow that right now.

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2. Can people not be wrong about what is pleasurable in
general [STRONG]? This is a problem for Rule Utilitarians because we could
be wrong about what causes pleasure in general as well.
3. Conflict of Rules? [STRONG] What if rules conflict in a moral situation (as

in the complex example above)? EX: Since both helping someone in need
and keeping promises maximizes happiness, what should I do?
• OBJ1: If we should maximize the happiness of these people affected by this

action, then the rule utilitarian has changed his/her ethical theory to Act
Utilitarianism.
• OBJ2: If we should pick either rule and follow it, then the theory is
arbitrary and/or does not provide effective guidance, because you get to just
choose whatever you feel like doing, as long as you can cite a rule that
maximizes happiness in general, that is relevant in this situation.
VIII. PRINCIPLES OF BIOMEDICAL ETHICS:
A. There are four principles (ignoring “Utility” in the book – see #4 below):
1. Principle of Autonomy: Requires that health professionals not interfere

with the effective exercise of a competent patient’s ability to make their own
health care decisions.
2. Principle of Beneficence: Requires that health-care professionals act in

ways that promote patient welfare.
3. Principle of Justice: Requires that social benefits (e.g., health-care

services) and social burdens (e.g., taxes) be distributed in accordance with the
demands of justice.

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4. Principle of Non-Maleficence: [NOTE: NOT in book – The concept of
“Utility” biases the whole discussion of ethical theories in terms of
Utilitarianism! And “non-maleficence” reminds us of what many hold as a
major principle of bioethics: “First, do no harm.”] Requires that health-care
professionals not act in a way that entails harm or injury patients.
IX. FUNDAMENTAL PRINCIPLES:
A. Autonomy: Right of self-determination or self-governance = the right of

autonomous decision makers to determine for themselves what will be done
to their bodies. E.g., some physicians are actually blamed, even if they are
trying to save a patient, for interfering with a patient’s autonomy. Actions (e.g.,
acts, choices) and agents can be autonomous, and autonomy is a matter of
degree, not a yes/no quality.
1. An action is autonomous when the action is:
a. Intentional. EX: signing a form that you don’t understand fully.
b. Based on sufficient understanding. EX: a volunteer in a study who

doesn’t understand what the study really entails. Due to this condition,
children are usually considered non-autonomous.
c. Sufficiently free of external constraints. EX: a medical student goes to a

concert the night before an anatomy exam. She is there intentionally and can
leave anytime, understands the implications of being there, and so it’s free
from external constraints. External constraints can be physical barriers or
different forms of coercion; e.g. prisoners, deliberate use of force or threat to
do so. “Occurent coercion” = Use of physical force. “Dispositional” coercion:

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Threat of harm.
d. Sufficiently free of internal constraints. EX: having had two drinks at a

bar, Salvator has the choice of having another drink or going home to study:
Autonomous or not? Intentional, understands (?), no external constraint, but
internal? EX: Suppose Salvator is an alcoholic. Then Salvator is internally
constrained and is not acting autonomously. Suppose he is schizophrenic,
hearing voices telling him to imbibe more! He would not be acting
autonomously.
2. Undermining one’s autonomy = limiting one’s liberty. To act

autonomously, the agent must deliberate effectively: a careful, clearheaded
assessment of one’s options in terms of one’s values and priorities.
3. Whence comes autonomy, ethically speaking?
a. From Kant’s and Ross’s deontological views: Kant says we must respect
persons as ends in themselves with their own projects. Autonomy is related to
free will for Kant, and therefore is essential to morality.
b. Utilitarianism: Liberty of action and thought is essential to developing

both the intellectual and character traits necessary for truly human
happiness. Autonomy has utility value.
B. Liberty Limiting Principles (There are six that are frequently

mentioned): These principles can be used to defend limiting individual
autonomy with respect to actions or practices. One might use more than one
of these six principles simultaneously to argue for limiting someone’s
autonomy.
1. The Harm Principle: A person’s liberty is justifiably restricted to prevent

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that person from harming others. The Harm Principle is the most widely
accepted liberty limiting principle (e.g., bystander preventing a terrorist from
killing or injuring others).
2. The Offense Principle: A person’s liberty is justifiably restricted to

prevent that person from offending others. Offense Principle: Offensive
behavior is behavior that causes shame, embarrassment, or discomfort to
onlookers. Bioethics example: Person committing offense being involuntarily
committed to a psychiatric ward though not harming anyone including
themselves. What is offensive?
3. The Principle of Legal Moralism: A person’s liberty is justifiably

restricted to prevent that person from acting immorally. Legal Moralism is
used to “enforce morals.” EX: Legislating against homosexual acts, gambling,
or prostitution on the grounds that such activities are thought to be morally
unacceptable? Legal Moralism is a tyranny of the majority, according to Mill,
for instance.
4. The Social Welfare Principle: A person’s liberty is justifiably restricted to

benefit others. Social Welfare Principle: EX: funding Medicare in the U.S.
The taxpayer’s liberty is restricted for the sake of society.
5. The Principle of Paternalism: A person’s liberty is justifiably restricted to

prevent that person from harming him or herself. Paternalism = the
interference with a person’s liberty of action justified by reasons referring
exclusively to the welfare, good, happiness, needs, interests, or values of
the person being coerced.
a. Biomedical paternalistic examples: EX1: Physician lies to a patient who

says that he’d rather die than have Alzheimer’s disease, once it is diagnosed.
EX2: Suppose surgery is in the best interest of the patient; physician worried

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that patient would choose alternative that wouldn’t benefit patient as much as
surgery. Leave out details of other alternatives? Reactions from Kant and Mill:
i. Kant: According to Kant’s theory, paternalism is morally unacceptable.

Omitting information to patients is not treating them as ends in themselves.
ii. Mill: Mill finds paternalism morally unacceptable as well: Mill assigns a
high social utility to liberty or individual autonomy –
minimizing paternalism maximizes human happiness.
b. The Exception to Anti-Paternalism? EX1: Children and whenever the

“person’s ability to act autonomously is significantly constrained by
intellectual deficits (e.g., lack of reasoning ability or ignorance of relevant
facts) and cannot be easily augmented (e.g., by providing needed
information).” EX2: People under influence of drugs who believe that they
can fly; severely mentally disabled individuals going by themselves in a busy
city, etc. The desire to commit suicide under temporary disorientation due to
drugs, alcohol, reversible depression – paternalism seems justifiable in these
cases. However, what about the decision to end one’s life if carefully
considered in conjunction with a view about what it is to have a meaningful
life? It begs the question (Begging the question occurs when the arguer
assumes what the arguer wants to prove. EX: You have to wash the dishes
tonight because you have to wash the dishes tonight) to say that any thought
of suicide is irrational. It is at least theoretically possible that someone could
rationally desire to commit suicide. Given these examples and considerations,
it seems that paternalistic interventions seem to be warranted when:
i. Intervention is responsive to the welfare of an individual whose autonomy

is significantly diminished; or
ii. When temporary constraint is necessary to prevent a person from acting

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in a self-harming and presumably non-autonomous manner until it can be
determined whether the person is acting autonomously.
c. Weak v. Strong Paternalism: Invoking paternalism only in these two cases

is called weak paternalism and is consistent with Mill’s view. Strong
paternalism is accepting paternalism in any other cases than the two above.
X. CONCLUSION FOR FIRST LECTURE:
A. We have:
1. Reviewed principles of biomedical ethics.
2. Examined different ethical theories: Nihilism, Moral Skepticism,

Individual and Cultural Relativism, Kantian Deontology, Act Utilitarianism,
and Rule Utilitarianism.
3. Examined autonomy and liberty limiting principles.

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PHI 213 LECTURE I NOTES

PHI 213 LECTURE NOTES

LECTURE I: INTRODUCTION TO PHILOSOPHY, BIOMEDICAL ETHICS,

I. GENERAL INTRODUCTION TO PHILOSOPHY

2. Diﬀerent branches or disciplines within philosophy:

a. Epistemology - Theory of knowledge

b. Metaphysics - Theory of existence

c. Ethics - Theory of best way to live, or happiness

d. Logic - reasoning, validity, soundness

e. Social/Political Philosophy - Theory of justice or how best to run a state

http://www.mc.maricopa.edu/~davpy35701/text/213_1.html 28/08/2019, 12A24 AM

g. "Philosophy of": Language, Religion, Psychology, Mind, Science, Biology,

h. Philosophy by region or group - E.g., Western Philosophy, Eastern

a. Descriptive Ethics: Psychological or sociological explanations, with the

b. Normative Ethics: Attempt to determine what is morally right and what is

c. Metaethics: Concerned with tasks such as analyzing the nature of moral

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A. Biomedical ethics is applied normative ethics, focused on health care,

1. Bioethical questions: Should doctors or nurses ever lie to their patients?

B. Morality is a normative or evaluative enterprise, concerning moral norms

1. Normative Dominance: These norms take precedence over other norms.

2. Universality: These norms are supposed to apply to all doctors, nurses,

3. Impartiality: Everyone should be considered equal; everyone's interests

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III. NIHILISM, SKEPTICISM, RELATIVISM AND OBJECTIVISM: (SEE

IV. RELATIVISM [FYI TO STUDENTS: THIS IS NOT IN THE BOOK; SEE

1. Two Objections to Individual Relativism:

a. It refutes itself. If whatever each individual believes is correct about

b. There can be no argument about what is right and wrong, no matter

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2. Five Objections to Cultural Relativism:

i. Explanation v. justification: Though helpful as an explanation of other

v. Whose culture is relevant? What culture do I count as my own? What if

B. Legality and Morality: Questions:

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2. Is what is illegal always immoral?

Answer(s): Almost certainly not. Why?

C. Religion and Morality: Questions:

1. Is what is religious (according to a given religion) always moral?

2. Is what is irreligious (according to a given religion) always immoral?

Answer(s): Arguably not. Why?

· Religious but (arguably) immoral examples: The Crusades, Inquisitions,

· Irreligious but (arguably) moral examples: Giving a blood transfusion to

D. Conclusion of this section:

1. Nihilism, Individual & Cultural Relativism are implausible ethical views;

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3. What is (ir)religious is not necessarily (im)moral, so only looking to (one)

V. KANTIAN DEONTOLOGY (IMMANUEL KANT'S ETHICAL THEORY)

A. KANT'S LIFE: Lived from 1724-1804. (More bio in class.)

B. THE CATEGORICAL IMPERATIVE: There are two formulations

a. People (rational beings) are ends in themselves; non-rational beings

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b. What actions are morally impermissible? Treating people simply as a

c. What actions are morally permissible? Treating people only as ends in

d. Respect for Rational Beings: Every person, by virtue of his/her humanity

3. Comparison of Categorical Imperative v. Golden Rule: Suppose

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D. More on Kant's Ethical Theory:

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4. Reason v. emotion, pleasure, or inclination. We should, according to

5. Getting pleasure from doing an action before, during or after that is

6. Consequences, schmonsequences! Kant thinks consequences are

7. Acting with a sense of (or from) duty v. acting in accordance (or in