An Ethical Study of Medical Professionals’ choice of Morality;

Deliberately do its Responsibility over a choice to Deteriorate

Individual’s Priority

Submitted by:
Jovita, Jesnefa P.

Submitted to:
Sir Daryl Y. Mendoza

Date Submitted:
June 1, 2021

GE-ETHICS
MWF 9:30-10-30AM
 I. Introduction

COVID-19 has had an impact on the lives and health of over one million individuals
worldwide. This overwhelms many nations' healthcare systems and, of course, has an impact
on healthcare personnel such as nurses who are battling on the front lines to save the lives of
everyone afflicted. Examining the impediments that healthcare professionals encounter
throughout their combat will aid in their assistance as well as the development of guidelines
and plans to increase their preparation. As a result, this integrative study will look at the
challenges that nurses faced in responding to the COVID-19 disaster. Although it may appear
that the frontliners are prepared for the task, they must also consider their personal safety in
these circumstances. A frontliner's underlying reluctance to help people might also have an
impact on their work ethic. They are regarded as great heroes all over the world, devoting
their time, effort, and, in some cases, their lives to help make this world virus free.

It is no secret that the COVID-19 virus does not decide its host, and notwithstanding
precautions made in hospitals, the virus does take control in certain cases. In one of the most
afflicted nations, India, many frontliners have acquired COVID and, tragically, perished in
hospitals that no longer take patients from all across the nation. While nurses, doctors, and
health professionals all take precautions, there is no predicting who will acquire the illness.
Even the government had difficulty taking over and managing the virus, as well as
determining how to combat it. There are several issues about how the global economy is
dealing with the covid-19 virus takeover, but this study will focus on the ethical duties of
healthcare personnel. Every day, an increasing number of healthcare workers put their lives in
danger in order to perform their obligations, complete their work, and return home from war.

In this study, we shall try to derive ethical resolutions from Virtue and Utilitarian
ethical theories. Its goal is to assess the current ethical challenge and offer insight into how
the following theories answer the question of whether healthcare personnel are needed to
work and risk their lives. Similar circumstances will be included in this investigation.

II. The Problem and Its Ethical Issues

During the pandemic, it is up to the frontliners, primarily healthcare professionals, to

battle the coronavirus whilst sacrificing their own lives. The growing phenomenon of the
covid-19 has presented a major medical ethics question: Do healthcare providers have moral
and legal duties to risk their lives to serve patients during a pandemic outbreak? This is a
crucial issue considering over 570,00 medical professionals in America have all been infected
and 2,500 have died as a result of this catastrophic outbreak.

To support this claim, we first must define healthcare personnel' ethical and legal
obligations during this epidemic. It is reasonable that when medical students matriculate, they
are required to swear several oaths molded after the World Medical Association's Declaration
of Geneva; nevertheless, neither of these oaths specify that healthcare practitioners must
sacrifice their lives in order to care for their patients.

When it comes to defining the responsibility of healthcare staff in the event of a

pandemic, there are competing viewpoints. (1) During catastrophic events, medical
professionals are forced to provide urgent medical care; nevertheless, if the hazard of
palliative insurance to individual patients is too high, these healthcare workers can abstain
from treating these covid-19 treatments in order to not negatively affect their capacity to
provide treatment in the future. (2) Medical practitioners are expected to fall ill under all
circumstances, and they risk losing their employment or possibly their licenses if they refuse
to negotiate in health care facilities during the epidemic. The American Nurses Association's
Code of Ethics for Nurses with Interpretive Statements (2015) provides guidance for nurses
in crisis situations, such as responding to pandemics. During pandemics, nurses must
determine how much high-quality care they can provide to others while also caring for
themselves and their loved ones. (Kadish & Loike, 2020). It was also noted that Provision 2
of the code specifies that the nurses' first obligation is to the patient. However, Section 5 of
the code emphasizes that the nurse owes the same obligation to herself as she does to the
others.

This pandemic entails competing duties to these medical experts and are expected to
work when given the call. They must, however, combine their professional commitments
with their responsibilities as someone outside the medical field and must also prioritize their
personal character aside from just being a medical professional such as being a husband,
wives, parent, or even children. The risk these healthcare frontliners face by battling their
personal health to fight this pandemic is alarming enough, however the risk of infecting their
loved ones and family members, specially those who are higher risk and more prone of
infection is ethically and morally unacceptable. However, there is an ethical consensus that
medical professionals must work because of all that has been invested in them and because of
their unique position which cannot simply be replaced by anyone. So, are healthcare staff
forced to work or may they withdraw due to personal vulnerabilities?

III. Virtue Ethics & Utilitarianism

By doing a competent ethical examination of the current circumstances. We must first

have a profound understanding of the two normative ethics that are being applied in this case.
The first is virtue ethics, which, unlike other normative ethical theories, is an ethical theory
created by Aristotle and is perhaps the oldest ethical theory back as far as ancient Greece.
Now to make the proper judgments, virtue ethics does not adhere to a set of rules. It instead
takes a "character approach." That seems to be, if someone focuses solely on being a decent
person, the proper deeds will naturally follow. Virtue ethics advocates that we consider our
character as a lifetime undertaking, one in which excellence or virtuous morality is not an act
but a habit in our personalities. Aristotle also affirmed two kinds of virtues: Intellectual
virtues and Moral virtues. Intellectual being the type of virtue to be learned through action
and experience and moral virtues was not an act but a skill and that it can only be learned
through experience and eventually transforming into a habit as mentioned before.

It adheres to the notion of adequate functioning in virtue ethics. Proper functioning

ensures that everything and everyone serves a purpose. If it does not serve its objective, it is
not working properly, according to the principle. Humans, too, require proper functioning.
Our purpose as animals is to develop and reproduce. Aristotle, on the other hand, argued that,
though humans are animals, we are also intellectual and social creatures. That is, we have the
ability to use logic and reason in order to get along with one another.
To obtain a better knowledge of Virtue Ethics, we must first grasp the two primary
ideas that Virtue Ethics provides. To begin with "the Golden Mean," Aristotle assumed that
virtue was the median between two extremes known as "vices." Even though the midpoint is
referred to as the "golden mean." However, this theory does not give a one-size-fits-all
solution to all problems. As previously stated, virtue ethics is concerned with "treating our
character," and that reaching the "Golden Mean '' in our decisions is based on our character.
In the book Nichomachean ethics, an important word is mentioned: "the decision lies with
perception" (Nichomachean Ethics, 1109 b 23, 1126 b 4; R&G, 42). This important word
shows that there are several aspects that might sway the decision made for the unique
circumstances. In addition, there are extrinsic influences that may influence the decision.
However, using the golden mean concept Virtue ethics will direct the decision-maker from
having an excess of virtue to having a deficiency of virtue, thus reaching the "golden mean."

The second principle is "Eudaimonia." The first principle teaches us "how to be

virtuous," while the second principle subsequently informs us "why we should be virtuous."
Eudaimonia is a Greek word that means "human flourishing or a well-lived existence."
Aristotle stated that we must be virtuous in order to live "a life of Eudaimonia." "A life of
Eudaimonia" is defined as a life of striving and the act of pushing oneself to the maximum
and obtaining satisfaction in one's own work. Furthermore, a life of Eudaimonia is simply a
life filled with pleasure as a result of hard-earned achievement through your own deeds. As a
result, there is a purpose and motivation to be righteous.

Utilitarianism is the second ethical philosophy. Utilitarianism is an ethical theory that

focuses on consequences to decide what is right and wrong. It's a variation of
consequentialism. Because Utilitarianism is consequentialist in nature, it attributes the
morality of an act to the consequences or outcome of the act being done. The consequence or
end on which Utilitarianism focuses is the determination of the morality of the act, as well as
its generation of utility. So, utilitarianism is a consequentialist theory of ethics that decides
the morality of an act if and only if it maximizes utility. The basic term "utilitarianism" holds
the key to comprehending it.

The first philosopher to establish a formal theory of utilitarianism was Jeremy

Bentham (1748-1842). In 1789, he wrote "An Introduction to the Principles of Morals and
Legislation." The classical understanding of Utilitarianism is Jeremy Bentham's theoretical
perspective. The fundamental principle of Utilitarianism is stated in the opening chapter of
his book: Nature has put mankind under the authority of two sovereign masters, pain and
pleasure. It is worth noting that 'nature' for Bentham and Utilitarian theorists is not the same
as 'nature' for natural law theorists such as Thomas Aquinas and Augustine. Natural laws
dealing with the metaphysics of essences or the predetermined essence in phenomena.
Utilitarianism refers to two aspects of human nature: pain and pleasure.

In Utilitarianism, the pleasurable and unpleasant effects of an event are determined

not just by the individual, but also by the experiences of the population affected by it. In
essence, the agent is only one of several factors to examine when determining the severity of
an action's consequences. According to Bentham, utility is defined as providing pleasure,
good, or happiness to the affected individual or precluding pain or misery to the affected
person. This means that if the party is the community, the happiness of that community is at
stake. Individuals, on the other hand, are concerned with their own happiness.

Jeremy Bentham devised hedonistic calculus, a method for determining the moral
merit of an act. He felt that an act was regarded good if the effect of the deed was greater
happiness for more people than damage (Woodward, 2017). The hedonistic calculus is made
up of seven different situations or circumstances. They are as follows: Intensity is the degree
of pain or pleasure induced by the act. Duration is the amount of time that the act causes pain
or pleasure. Certainty or Uncertainty, which refers to the probability of experiencing pain
and/or pleasure. Propinquity, also known as remoteness, relates to how quickly pain and/or
pleasure are caused. Fecundity relates to the application of comparable experiences on a
continuous basis (pain is followed by pain; and pleasure is followed by pleasure). Then,
purity is the result of a subsequent experience being disrupted (pain is followed by pleasure;
and pleasure is followed by pain). The last criterion is Extent, which refers to the number of
people affected by the act's suffering and/or pleasure. Then, purity is the result of a
subsequent experience being disrupted (pain is followed by pleasure; and pleasure is followed
by pain). The last criterion is Extent, which refers to the number of people affected by the
act's suffering and/or pleasure. The last criterion is Extent, which refers to the number of
people affected by the act's suffering and/or pleasure. These are the methods or criteria used
by Utilitarianism to calculate the levels of pleasure and suffering. The moral act is to
prioritize that action over other alternative actions that provide more happiness than pain, i.e.
utility. Once more, for utilitarianism, the activity is lawful or ethical if and only if it provides
the maximum amount of utility.

Utility, or the Greatest Happiness Principle, states that activities are good in
proportion to how they tend to promote pleasure, and bad in proportion to how they tend to
generate the opposite of happiness, according to John Stuart Mill, who was also a utilitarian
proponent. Happiness is defined as pleasure and the absence of suffering; sadness is defined
as pain and the deprivation of pleasure. After British idealists F. H. Bradley and T.H. Green
highlighted the matter. The problem with utilitarianism is that there is no adequate difference
between Higher and Lower Pleasures, which Jeremy Bentham kept silent about. Furthermore,
these superior capabilities are derived from the reasoning ability, which is unique to humans.
On the other hand, "lower faculties" are developed through sensual experience, which is
unique to animals. He argued that better-functioning humans demand a higher amount of
pleasure than lower-functioning humans. As a result, in order to be happy, humans demand
greater quality or pleasure.

Act Utilitarianism and Rule Utilitarianism should be included in this ethical analysis
since they are central to the Utilitarian ethical theory. Rule and Act Utilitarianism and
utilitarianism both agree that the ultimate purpose of analyzing action should be to produce
the greatest possible results, but they disagree on how to do so. Act utilitarians think that
when determining what to do, we should choose the action that will result in the highest net
utility (Nathanson, 2014). According to Act Utilitarianism, the theory of utility that produces
the highest net results should be adopted on a case-by-case basis. The optimal action out of
all potential actions is the one that gives the most utility (generates the most well-being). Rule
utilitarianism, on the other hand, differs from Act utilitarianism in that it takes a two-part
approach that emphasizes the importance of these moral standards. According to rule
utilitarians, a) particular actions are only morally permissible if they follow a moral rule that
is justifiable; additionally b) a moral rule is justifiable if including it in our moral code would
result in greater benefit than other feasible rules (or no rule at all) (Nathanson, 2014).
According to this viewpoint, we should assess the morality of particular actions in light of
universal moral standards. Furthermore, we should evaluate specific moral principles by
considering if their incorporation into our moral code will result in more well-being than
other feasible rules. The major contrast between act and rule utilitarianism is that act
utilitarians openly apply utilitarian theory to the evaluation of particular acts, whereas rule
utilitarians do not. whereas the rule utilitarians apply the utilitarian principle directly to the
examination of rules and then assess individual activities by determining whether they
comply with or defy particular restrictions, the more valuable of which is approved.

IV. Analyzing the Ethical Issue

In this section of the ethical analysis, we will use Utilitarianism and Virtue Ethics, our
selected theories or views in ethics, to determine which choices or behaviors are morally right
and morally wrong. Us to begin with the utilitarianism method to assess the ethical quandary
at hand; the ethical choice for healthcare staff is to work despite the risk to their life while
caring for patients. Because utilitarianism holds that the ethically correct conduct is the one
that provides the most good for the greatest number of people.

The hospitals are overcrowded with COVID-19 patients, and we cannot say that
health staff are not compelled to treat these infected people. As CNN Health reported,
hospitals in India are no longer accepting admissions and are diverting patients to other
medical clinics and hospitals where there is insufficient room and capacity. This is aligned
with the obligations that have been assigned to healthcare workers: Medical professionals are
expected and accountable for their care. One utilitarian rule of thumb is to save as many
people as possible. This rule might be applied to the current situation by assessing how many
lives would be lost if medical professionals abdicated their obligations and stopped treating
infected individuals. In Utilitarianism, the pleasurable and painful consequences of an
activity are determined not just by the individual, but also by the experiences of the
community affected by it. Utilitarianism is concerned with the consequences; it is apparent
that if health care providers abdicate their obligation, these patients' lives would suffer as a
result of not treating infected individuals. Furthermore, the agent is only one of several
factors to consider when determining the severity of an action's consequences. According to
Bentham, utility is defined as providing pleasure, good, or happiness to the affected person or
preventing pain or misery to the affected person. This means that if the party is the
community, the happiness of that community is at stake. Individuals, on the other hand, are
concerned with their own happiness.

Suvalescu et al., in their study "Bioethics; Utilitarianism and the Epidemic," dealt
with the ethical dilemma of the pandemic using "two-level utilitarianism," an argument by
Richard Hare, the father of contemporary utilitarianism. They think on two levels: critical and
intuitive. During the epidemic, intuitive thinking is largely employed since it is based on rules
of thumb and requires little hesitation. There are seven general guidelines that help us execute
our daily tasks:

1. Quantity: One of the utilitarian rules of thumb is to save as many people as

possible. The more front-line workers there are, the more people they can
rescue. But this isn't just any ordinary day; the front lines must also consider
twice before entering a battlefield; their lives are at stake the instant they enter.
The likelihood of the morality rate is one variable to examine.
2. Quality of Life: The term "Quality of Life" signifies that Utilitarianism takes
into account both the quality and the duration of life. The condition of not
treating the patients is deemed ethically wrong since, even if lines could be
established, for example, when the patient is judged a "lost cause," the
majority would still feel horrible, resulting in a failure to achieve greater good.
3. Life Expectancy: Utilitarianism addresses how long a certain advantage may
be enjoyed, which in this case may be both the patient's and the frontliner's
life. Although the quantity of lives is unimportant to Utilitarians, the harm
caused by avoiding doing the greater good is ethically wrong.
4. Acts and omissions equivalence, withdrawing and withholding:
Considering predictable deaths are deemed killing for Utilitarians, failing to
implement the rule of treating patients is equivalent to murdering the patient.
5. Accountability: For the frontliners, they are accountable for their actions as
well as their inaction. According to the study, failing to take that action to
prevent harm is equivalent to causing harm on purpose. Responsibility is not
just important to utilitarians; it also has an impact on the quality, duration, and
worth of life.
6. Social Worth: The word "social benefit" or "social value" refers to the fact
that the immediate and long-term repercussions of an activity are all tied to
decision making. As a result, the benefit of action to the patient is meaningful
to the frontliners as well.
 Moving forward, In the standpoint of Virtue ethics, it is comparable to the Utilitarian
stance in that healthcare staff must attend to the requirements of COVID patients. However,
from the standpoint of Virtue ethics, the best feasible answer for the scenario or problem is
based on the character of the healthcare provider.Besides that, according to Virtue ethics,
healthcare practitioners must first assess the circumstance. This would help the Virtuous
healthcare professional identify the "golden mean" in the circumstance. The virtue stressed in
the pandemic scenario is bravery.

Figure 1-1
Vice (deficiency) Golden Mean Vice (excess)

Timidity Bravery Hastiness

Refusing to assist despite the Continuing to assist with the Seeking to assist without the
presence of necessary necessary protective gear necessary protective gear
protective equipment

As previously stated in this dissertation, the golden mean is the presence but not the
excess of virtue. In this case, exactly the proper amount of bravery. As previously stated in
this dissertation, the golden mean is the presence but not the excess of virtue. In this case,
exactly the proper amount of bravery. "Actions in each scenario are now being carried out,
but indifferently from time to time owing to the variability." (R&G, 67; Nicomachean Ethics,
1103 b 1, 1104b 16) Figure 1-1 depicts and simplifies the activities to be completed by the
health care provider assuming he or she is a virtuous individual. With all of this said, the
answer to the question "is it ethical for health care personnel to cease assisting patients due to
personal danger" is no, according to virtue ethics, as long as the proper protective equipment
is there.

An identical report published in the Journal of the American College of Surgeons

linked it to a comparable scenario during the HIV/AIDS pandemic. The circumstance was
similar in that doctors may become infected with the sickness through the patients' diseased
blood. However, they used the same Virtue-based ethical theories and deemed it ethical from
the standpoint of Virtue ethics to treat infected patients, highlighting that as long as all
physicians and healthcare workers had access to the appropriate protective equipment.
According to virtue-based ethical theories, when all health personnel are wearing the
appropriate protective gear, it is their ethical obligation to offer treatment to COVID infected
patients or any patient, regardless of their diagnosis. B. Kramer and K. Kramer (Kramer,
2020).

Relating to the ethical dilemma of whether healthcare staff should work in the midst
of the epidemic or should they be able to leave owing to personal hazards, we should
personally choose the utilitarian stance. Furthermore, utilitarianism is more consistent and
appropriate for a worldwide epidemic since it focuses on acts that promote the greatest
benefit for the greatest number, as opposed to Virtue Ethics who would be incoherent since
everyone has their own personality and their behaviors would be heavily influenced by the
outcome of the "Golden Mean" of their specific situations. However, it is crucial to note that,
though the "Golden Mean" in Virtue ethics varies based on the scenario, a person who
follows Virtue ethics is more instinctive than any other individual who follows the majority
of the other ethical ideas Because virtue ethics permits one to do good by instinct and
experience. However, even if virtue ethics is capable of doing all of this, it has a drawback,
particularly when dealing with a huge number of individuals impacted by a circumstance
such as a pandemic. When practitioners of this moral theory are able to measure the
advantages and compare them to the weight of discontent or conflict that results from the
action, utilitarianism becomes an exceptionally effective and efficient ethical concept.

V. Similar Situations

A hypothetical case that we will use to simplify our arguments about the ethical issue
that we have chosen is if a fireman is required to dash into a burning house despite the risk to
his life in order to save the people inside. Should they work, like medical professionals, or
should they not?

Using the Utilitarianism method, the most utilitarian ethical action is to walk into the
fire to save the people inside if and only if he has the necessary protection equipment.
Furthermore, if the fireman is unable to leave the burning home alive but has successfully
saved all of the people inside, the highest usefulness for the largest number of people is
produced by allowing those spared citizens to contribute more to society's total utility.

Based on Act Utilitarianism, Act utilitarians think that anytime we decide what to do,
we should choose the action that would result in the highest net utility (Nathanson, 2014).
The firefighters' goal is to put out fires and save people's lives; this choice and action alone
results in the highest net utility; with that stated, this is the optimal action.

Through using the Virtue Ethics method, the ethical decision is for the fireman to
enter the burning home in order to save the people who are inside. Assuming the fireman is a
good person, he or she must be able to discover the "golden mean" in the scenario.
Furthermore, the virtue being emphasized in this case is bravery; the fireman must enter the
blazing house if and only if he has the necessary protection gear.

VI. Conclusion

The COVID-19 epidemic has genuinely created troubles and anguish for everyone,
and it is the responsibility of healthcare professionals to assist and care for their patients. But,
are medical professionals compelled to work at hospitals, putting their own lives at danger, or
may they refuse owing to personal risks? They resolve to adopt the utilitarian approach and
save as many lives as possible while also considering their own health. True, these experts
have consented to take on the hazards associated with their chosen line of work; yet, they
must balance their commitments as healthcare professionals with their duties outside the
field. They have decided to labor despite the fact that it puts their lives in danger if and only
if suitable protection measures and equipment are provided. Furthermore, if these healthcare
providers withdraw and refuse to care for their patients, it would only cause greater harm to
the greatest number of people, which is contrary to the rule of thumb of Utilitarianism.
Although virtue ethics is an efficient method of arriving at a moral answer. The fact that it is
inconsistent due to the fact that each individual has a unique personality is why it has not
received as much attention as Utilitarianism. Virtue ethics may be more instinctive, but its
moral behaviors are also dependent on experience, repetition, and how a person's character is
formed. To sum up, there are much too many variables influencing decision making in virtue
ethics, just as there are far too many distinct persons in the world.

Moreover, medical experts should labor in the middle of a pandemic despite risking
their own lives if and only if sufficient safety precautions and equipment are available, since
this would provide the most usefulness to the most number of people.
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