Decision Making in Value Issue
● Frontpage test
Objectives
● Define, identify, and analyze an
ethical dilemma in health care
● Demonstrate understanding of the
different ethical theories
● Apply the concepts of different
ethical theories in specific scenarios
Ethical Dilemma
● Similar to the two faces of a coin,
wherein importance needs to be
given to two equally desirable and
undesirable outcomes.
● Discusses an ethical issue to bring
out solutions and check the pros and
cons, where each alternative action is
justified according to the view of
ethical practice.
● A situation in which an individual is
compelled to choose between two
actions that will affect the welfare of
a sentient being, and both actions
are reasonably justified as being
good, neither action is readily
justified as being good, or the
goodness of the actions is
uncertain
● One action must be chosen, thereby
generating a quandary for the person
or group who is burdened with the
choice.
Quick Tests in Resolving an Ethical
Dilemma
● Legal Test
● Stench test
● Mom (parent) test
The Five Rs Approach to Ethical Nursing
Practice
● Read and learn about ethical
philosophies, approaches, and the
Code of Ethics for Nurses.
● Reflect mindfully on one’s
egocentric attachments—values,
intentions, motivations, and attitudes.
● Recognize ethical bifurcation
(decision) points, whether they are
obvious or obscure.
● Resolve to develop and practice
intellectual and moral virtues.
Knowing ethical codes, rules, duties,
and principles means little without
being combined with a nurse’s good
character.
● Respond to persons and situations
deliberately and habitually with
intellectual and moral virtues. Nurses
have a choice about their character
development and actions.
Two Major Viewpoints of Morality
● Consequentialist Ethics
- Teleological
- Concerned with consequences
- Egoism, Utilitarianism, Care Ethics
● Nonconsequentialist Ethics
 - Deontological
- Not based or concerned with
consequences
- Natural Law, Divine Command
Ethics, Kant’s Duty Ethics, Ross’s
Prima Facie Ethics
Consequentialist Ethics
● Ethical Egoism
A philosophical-normative, prescriptive
theory
- Individual Form
"Everyone ought to act in my
self-interest"
- Personal Form
"I ought to act in my own
self-interest, but make no claims
about what anyone else ought to do"
- Universal Form
"Everyone should always act in their
own self-interest"
Most commonly held version of
ethical egoism propounded by
Epicurus (341-270 BCE), Ayn
Rand, Jesse Kalin, and John
Hospers (1918-2011)
Utilitarianism
● Principal architects were Jeremy
Bentham (1748-1832) and John
Stuart Mill (1806-1873)
● Maintains that everyone should
perform that act or follow that moral
rule which will bring about the
greatest good (or happiness) for
everyone concerned
- Act Utilitarianism
Everyone should perform that act
which will bring about the greatest
good over bad for everyone
affected by the act
- Rule Utilitarianism
Everyone should follow the rule/s
that will bring about the greatest
number of good consequences for all
concerned
Act utilitarianism
One cannot establish rules in advance to
cover all situations and people because they
are all different.
Difficulties
- It is very hard to ascertain what
would be good consequences for
others.
- It is impractical to have to begin
anew with each situation, to decide
what would be moral in that
situation.
 - It is nearly impossible to educate the
young or the uninitiated to act
morally if they can be given no rules
or guides to follow.
Rule Utilitarianism
There are enough similar human motives,
actions, and situations to justify setting up
rules that will apply to human beings and
situations.
Difficulties
- It is difficult to determine what
would be good consequences for
others.
- It is difficult to see how rule
utilitarians can be sure that they can
create a rule that will truly and
always bring about the greatest good
for all concerned.
- It is difficult to avoid making so
many exceptions to rules that the
rules cannot really function
effectively.
General Challenge for Utilitarianism
"The end justifies the means."
Problems with Consequentialist Theories
● They demand that we discover and
determine all of the consequences of
our actions or rules.
● This is virtually impossible to
accomplish.
● Do consequences or ends constitute
all of morality?
Care Ethics
● "Feminist Ethics"
● Established by Carol Gilligan in her
book In a Different Voice
● Men and women think quite
differently when it comes to ethics.
- Men's moral attitudes have to
do with justice, rights,
competition, being
independent, and living by
rules.
- Women's moral attitudes
have to do with generosity,
harmony, reconciliation, and
working to maintain close
relationships.
● Kohlberg agrees but concludes that
women's ethical reasoning is inferior
to men's.
Heinz Dilemma
A woman was on her deathbed. There was
one drug that the doctors thought might save
her. It was a form of radium that a druggist
in the same town had recently discovered.
The drug was expensive to make, but the
druggist was charging ten times what the
drug cost him to produce. He paid $200 for
the radium and charged $2,000 for a small
dose of the drug. The sick woman's husband,
Heinz, went to everyone he knew to borrow
the money, but he could only get together
about $1,000 which is half of what it cost.
He told the druggist that his wife was dying
and asked him to sell it cheaper or let him
pay later. But the druggist said: “No, I
discovered the drug and I'm going to make
money from it.” So Heinz got desperate and
broke into the man's laboratory to steal the
drug for his wife. Should Heinz have broken
into the laboratory to steal the drug for his
wife? Why or why not?

Kohlberg vs. Gilligan

● Kohlberg
- The boy had a clear
understanding of the
situation.
- The girl's understanding of
the situation was weak.

● Gilligan
- The boy and girl were
answering different
questions.
- The girl thought in terms of
caring.
- Men and women should
consider both views of ethics.

The Trolley Problem

Philosopher Philippa Foot (1920-2010)

devised an ethical thought experiment
known as the trolley problem.

A runaway trolley is speeding toward a

group of five men working on the track.
They do not see the trolley coming and will
all be killed if no action is taken. You,
however, can throw a switch that will divert
the trolley to a sidetrack. This will save the
workmen, but there is a lone worker on the
sidetrack who will be killed if you throw the
switch.