NCMA218: ETHICAL PHILOSOPHERS
Discuss the personal and ethical background of
the following famous philosophers:
1. Immanuel Kant
2. John Bordley Rawl
3. St. Thomas Aquinas
4. William David Ross
LET’S START!
IMMANUEL KANT
(1724 – 1804)
 A German philosopher
 Opponent of UTILITARIANISM
KANT’S DEONTOLOGICAL MORAL THEORY
(FORMALISM)
 Our emotional preferences which
provides us with values, must be checked
against certain rational standards of a
PURELY formal kind;
 Supreme principle of morality referred to
as The Categorical Imperative (CI);
 Any choices we make must be such that we
would be willing for everyone else to make
the same choices (universality).
EXAMPLE:
If I choose to lie for my own benefit, would
I really be willing that others lie to me?
Since I prefer that they don’t lie to me,
therefore I should not lie to them
1. Act done in accord with duty and act done from
a sense of duty
2. Categorical Imperative
EXAMPLE:
Performing nursing functions out of the
desire to do so or out of fear of being
accused of negligence
KANTIAN ETHICS
 This method was advantageous because it
made NO appeal to any standard EXCEPT
the individual’s own CONSCIENCE;
 Nevertheless; it is open to serious
criticism – it is purely formal and has to
rely on emotivism to establish any
concrete values or practical rules;
 The weakness of Kant’s ethical belief must
be balanced with:
• FAIRNESS
• BENEFICENCE
KANTIAN 2 IMPORTANT QUESTIONS
1. Can I rationally will that everyone act as I
propose to act?
 When we are about to decide to do
something we must ask ourselves
with this question above
 If the answer is no, then we must
not perform the action.
2. Does my action respect the goals of human
beings rather than merely using them for
my own purposes?
 If the answer is no, then we must
not perform the action.
KANT ON MORAL WORTH
 A person's actions are right or wrong, a
person is morally worthy or lacks moral
worth (i.e., is morally base);
 A person's actions determine her moral
worth, but there is more to this than
merely seeing if the actions are right or
wrong.
KANT’S BASIC IDEA
 a person is good or bad depending on the
motivation of their actions and not on the
goodness of the consequences of those
actions;
 "Motivation" = the cause or reason you to
do the action (i.e., your reason for doing it).
 If the motivation is MORAL the act is also
MORAL
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UTILITARIANISM
 “The end justifies the means”
 is a pivotal form of moral philosophy for
health care delivery. Sometimes called
consequentialism
 is a type of teleological theory. Telos
comes from the ancient Greek language
and literally means end:
 is the moral theory that holds that an
action can be considered good or bad in
relation to its end result.
 is an important ethical philosophy that has
its basis in naturalism.
 According to the utilitarian school of
thought, the right action is that which has
the greatest utility or usefulness. No action
is, in itself, either good or bad. Utilitarian
hold that the only factors that make
actions good or bad are the outcomes, or
end results, that are derived from them.
Utilitarianism is widely used in the health care
system. It is the basis for many policy-level
decisions about the distribution of health care
services and can be integral to medical
emergency triage decisions.
Policy makers attempt to wisely appropriate
public funds. The debates about funding are often
in the news and include topics on a variety of
public programs, such as Medicare, Medicaid,
managed care, family planning, pediatric
services, mental health, and others.
As these programs focus on delivering cost-
effective health care to large numbers of people,
they serve very specific narrow populations
(denying resources to others) and provide or
deny very specific services—all based upon
utilitarian principles.
In emergency situations such as war or natural
disasters, utilitarianism may become the
default method of making these types of
decisions.
DEONTOLOGY
 Deontological theories of ethics are based
upon the rationalist view that the
rightness or wrongness of an act
depends upon the nature of the act,
rather than its consequences.
 The term deontology is taken from the
Greek word for duty. Occasionally,
deontology is called FORMALISM; some
writers refer to this type of ethical theory
as KANTIANISM. Kantianism is based
upon the writings of the German
philosopher Immanuel Kant, who shaped
many deontological formulations.
 Act only according to that maxim by which
you can at the same time will that it should
become a universal law.
 Act so that you treat humanity, whether in
your own person or that of another,
always as an end and never as a means
only.
Deontology also implies that ethics are derived
from fulfilling duties. One must act for the sake of
duty or obligation. Most professional codes of
ethics are based upon Kantian principles.
Nurses’ codes of ethics stress both the importance
of fulfilling duties that are inherently owed to
patients and the importance of preserving the
dignity and autonomy of each individual patient.
For example, section 1.2 of the ANA Code of Ethics
for Nurses (Appendix A) notes that, “The nurse
establishes relationships and delivers nursing
services with respect for patient needs and
values, and without prejudice.”
This statement presumes that the nurse has a
duty to respect and care for the patient in terms
of the patient’s own needs and values. It
demonstrates the principles of respect for person,
beneficence, and autonomy.
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These principles are so pervasive in the
profession that they often go unnoticed. When
you maintain confidentiality, when you advocate
for a patient, when you keep your promises, when
you tell the truth, and when you practice with
expert skill, you are utilizing deontic principles.
CONSEQUENTIALISM/TELEOLOGY
 Consequentialist moral theories evaluate
the morality of actions in terms of
progress toward a goal or end. The
consequences of the action are what
matter, not their intent.
 This is in contrast to previously noted
theories (e.g., deontology, virtue ethics,
and natural law) that consider intent.
 Consequentialism is sometimes called
teleology, using the Greek term telos,
which refers to “ends.” Thus, one finds
that the goal of consequentialism is often
stated as the greatest good for the
greatest number.
VIRTUE ETHICS IN NURSING
Virtue ethics, sometimes called character ethics,
represents the idea that individuals’ actions are
based upon a certain degree of innate moral
virtue.
First noted in the writings of Plato, Aristotle,
and early Christian thinkers, there has been a
contemporary resurgence of interest in virtue
ethics.
Western moralism emerged with the idea of the
cardinal virtues of wisdom, courage, temperance,
justice, generosity, faith, hope, and charity
(Kitwood, 1990).
Modern and contemporary writers also include
such virtues as honesty, compassion, caring,
responsibility, integrity, discernment,
trustworthiness, and prudence.
Though nearly absent in nursing ethics texts in
the past 20 years, virtue ethics is re-emerging as
an important framework for examining moral
behavior.
FOCAL VIRTUES
In the discussion of virtue as related to
biomedical ethics, Beauchamp and Childress
(2008) define character as:
 being made up of a set of stable traits
that affect a person’s judgment and
action. Like Aristotle, these authors
suggest that although people have
different character traits, all have the
capacity to learn or cultivate those that are
important to morality.
Beauchamp and Childress propose that there are
four focal virtues that are more pivotal than
others in characterizing a virtuous person:
1. Compassion
2. Discernment
3. Trustworthiness, and
4. Integrity.
VIRTUE ETHICS IN NURSING
How does the concept of virtue or character ethics
fit with nursing as a principled profession?
It is likely that principled behavior, while not the
sole domain of a good moral character, is more
likely to occur in the presence of one.
Certainly Florence Nightingale thought virtue
was an important trait of the good nurse.
Nightingale learned Greek as a child. She was
inspired by Plato and translated parts of Phaedo,
Crito, and Apology. Nightingale was intrigued by
Plato’s description of elite people with rare gifts
who command many kinds of knowledge.
The characteristics, or virtues, of these people
resonated with Nightingale and were reflected in
her writings throughout her life (Dossey, 2000).
She believed that one of the aims of philosophy
was to cultivate in gifted people their
potential intellectual and moral qualities.
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The Nightingale Pledge, composed by Lystra

Gretter in 1893 and traditionally recited by
graduating nurses, implies virtue of character as
nurses promise purity, faith, loyalty, devotion,
trustworthiness, and temperance.
It is reasonable to say that good character is the
cornerstone of good nursing, and that the nurse
with virtue will act according to principle. If
Aristotle was correct in his belief that virtue can
be practiced and learned, then we can learn,
through practice, those acts that, by their
doing, create a virtuous person.
CORE VALUES OF A PROFESSION NURSE
Nursing is a caring profession. Caring
encompasses empathy for and connection with
people.
Teaching and role-modeling caring is a nursing
curriculum challenge. Caring is best
demonstrated by a nurse's ability to embody the
five core values of professional nursing.
Core nursing values essential to baccalaureate
education include human dignity, integrity,
autonomy, altruism, and social justice. The
caring professional nurse integrates these values
in clinical practice. Strategies for integrating and
teaching core values are outlined and outcomes of
value-based nursing education are described.
Carefully integrated values education ensures
that the legacy of caring behavior embodied by
nurses is strengthened for the future

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JOHN BORDLEY RAWL SUMMARY:

 Born on February 21, 1921
1. Equal access to basic human rights and
 An American moral and political liberties of citizenship
philosopher 2. Fair equality of opportunity and equal
 His magnum opus, A Theory of Justice distribution of socio economic inequalities
(1971)
 According to English philosopher Jonathan RAWL’S NATURAL DUTIES
Wolff, John Rawls was the most  Justice,
important political philosopher of the  Avoiding harm to others,
20th century  Promise keeping,
 Social Contract as a solution to  Helping others in need.
Distributive Justice (the socially just
distribution of goods in a society); RAWL’S SUPPORT PRINCIPLES
 Resultant theory known as "Justice as  Respect for persons
Fairness”:  Non-maleficence
1. Society should be structured so  Fidelity
that the greatest possible amount  Beneficence
of liberty is given to its members,
2. Inequalities either social or
economic are only to be allowed
only if the worst will result under
an equal distribution;
3. Finally, if there is such a beneficial
inequality, this inequality should
not make it harder for those
without resources to occupy
positions of power, for instance
public office
JOHN RAWL’S ETHICS
 Design and evaluate social institutions and
practices on the basis of principles of
justice.
 Establish a social order based on the moral
standards of an equal form of justice.
 All persons receive an equal distribution of
certain political, social, and economic
goods and rights; however;
 Liberty principle, advocates that each
person should have an equal right to as
many basic liberties but not to infringe on
the liberty of others

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ST. THOMAS AQUINAS
 Born on 1225 at Sicily, Italy
 Proclaimed Doctor of the Catholic Church
 Joined the Dominican Order
 (Order of Preachers – OP)
 Thomas's ethics "FIRST PRINCIPLES OF
ACTION“
 Summa theologiae , he wrote:
 Virtue denotes a certain perfection
of a power;
 Now a thing's perfection is
considered chiefly in regard to its
end;
 But the end of power is act.
Wherefore power is said to be
perfect, according as it is
determinate to its act.
ST. THOMAS 4 CARDINAL VIRTUES
1. Prudence
2. Temperance
3. Justice
4. Fortitude
 The object of the theological virtues is GOD
Himself, Who is the last end of all, as
surpassing the knowledge of our reason;
 On the other hand, the object of the
intellectual and moral virtues is something
comprehensible to human reason.
Wherefore the theological virtues are
specifically distinct from the moral and
intellectual virtues.
4 KINDS OF LAW BY ST. THOMAS AQUINAS
I. Eternal Law: laws of the universe --- "the
whole community of the universe" is
governed by God which "is not subject to
time but is eternal"
II. Divine Law: the revealed word of God
(revelation) --- we need to be guided to our
supernatural destiny, our reason being
inadequate to reveal it to us
III. Natural Law: eternal law as it applies to us,
which we know by reason: "The natural
law is promulgated by the very fact that
God instilled it into men's minds so as to be
known by them naturally"
IV. Human Law: created by us for the purpose
of carrying out natural law
GOAL OF HUMAN LIFE
(ST. THOMAS AQUINAS)
 The goal of human existence as union and
eternal fellowship with God;
 This goal is achieved through the beatific
vision, in which a person experiences
perfect, unending happiness by seeing the
essence of God;
 The goal of union with God has
implications for the individual's life on
earth.
 Thomas stated that an individual's will
must be ordered toward right things, such
as charity, peace, and holiness.
 Those who truly seek to understand and
see God will necessarily love what God
loves. Such love requires morality and
bears fruit in everyday human choices.
AQUINAS ETHICS
 “Do good, avoid evil”
 The inherent capacity of every individual ,
lettered or unlettered to distinguish the
good from the bad through reason and
reflection (syndresis)
 Double effect principles situation in which
a good and evil effect will result
 Principle of totality
3 DETERMINANTS OF MORAL ACTION
1. Object
 The will intends
2. Circumstances
 May mitigate or aggravate
3. End of the agent
 Purpose
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WILLIAM DAVID ROSS 5. Harm-Prevention

 Born on April 15, 1877 at Thurso, Scotland  duty of a person to prevent harm to
 He is a Scottish philosopher others from causes other than him-
 Education: University of Edinburgh or herself.
 The moral order...is just as much 6. Beneficence
part of the fundamental nature of  to do good to others: to foster their
the universe (and...of any possible health, security, wisdom, moral
universe in which there are moral goodness, or happiness.
agents at all) as is the spatial or 7. Self-Improvement
numerical structure expressed in  to act so as to promote one’s own
the axioms of geometry or good
arithmetic; 8. Justice
 "MORAL INTUITIONIST" theory  act in such a way that one
distributes benefits and burdens
THE PRIMA FACIE DUTIES OR MORAL fairly; the duty of justice includes,
GUIDELINES to prevent an unjust distribution of
 According to W. D. Ross (1877-1971), benefits or burdens.
there are several prima facie duties that 9. Respect for freedom
we can use to determine what, concretely,  avoid coercion of others and,
we ought to do. insofar as we are able:
 A prima facie duty is a duty that is binding  provide conditions of
(obligatory) empowerment especially to
 "Unless stronger moral considerations those who radically lack
outweigh, one ought to keep a promise them;
made."  it does not enslave or
kidnap others or force them
THE PRIMA FACIE DUTIES INCLUDE
to participate in the
1. Fidelity activities of our particular
 duties to keep one’s promises and religious group;
contracts and not to engage in
 or it support efforts to
deception; not to tell lies;
ensure basic health and
2. Reparation
educational opportunity for
 a duty to make up for the injuries
those unable to secure them
one has done to others; "resting on
for themselves.
a previous wrongful act"
10. Care
3. Gratitude
 a duty reflecting concrete
 a duty to be grateful for good deeds
relationships such as occur within
done to oneself and if possible to
families or between close friends;
return such favor
we should exercise special care for
4. Non-injury (also known as non-
[persons] with whom we are
maleficence)
concretely related, attending to
 is the duty not to harm others
their own needs, values, etc. and
physically or psychologically: to
responding positively to these
avoid harming their health,
needs, etc., especially of those most
security, intelligence, character, or
vulnerable in society.
happiness.

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11. Non-parasitism
 the principle of not being a "free
rider;
 we should do our part to
abide by the rules of an
institution in which we
willingly participate and
from which we willingly
accept benefits;
 concrete duty not to steal
the property of others.
WHEN IN DOUBT REMEMBER:
1. Non-injury overrides other prima facie
duties.
2. Fidelity overrides Beneficence

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